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PRODUCT FOCUS INSTRUMENT STORAGE & TRANSPORT
CE ARTICLE MANAGING TIME
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CORPORATE PROFILE
SPOTLIGHT PROFILE REBECCA VOTINO
LIFE IN AND OUT OF THE OR
OCTOBER 2020
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SURGICAL CONFERENCE
SCRAPBOOK PAGE 58
NOW MORE THAN EVER‌ Choose the Most Effective Cleaning Solutions
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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.
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OR TODAY | October 2020
contents features
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HOW ORs & ASCs ARE REOPENING Hospital operating rooms and surgery centers are faced with the difficult task of resuming procedures amid the COVID-19 pandemic. In this article, experts share their insights as well as checklists and advice issued by organizations.
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As the global surgical market continues to expand it boosts the surgical instrument storage and transport market.
Healthmark Industries continues to provide health care facilities with innovative solutions for infection control.
Cardio or strength training is absolutely essential when it comes to a healthy heart.
SURGICAL MARKET GROWTH CONTINUES
CORPORATE PROFILE: HEALTHMARK
CARDIO FOR A STRONG HEART
OR Today (Vol. 20, Issue #10) October 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. Š 2020
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SPOTLIGHT ON
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John Wallace
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RECIPE OF THE MONTH Easy Chicken Enchiladas with Black Beans
DIGITAL SERVICES Cindy Galindo Kennedy Krieg Erin Register Kristen Register
INDUSTRY INSIGHTS 8 News & Notes 16 2020 OR Today Live Recap 18 IAHCSMM: SPD-OR Partnership Agreement Sets Stage for Better Relationship, Patient Outcomes 20 ASCA: It’s Safe to Resume Non-Emergency Outpatient Surgery 23 CCI: Nursing Education is Changing 24 OR Today Webinars ‘Consistently Brings Relevant and Critical Information’
CIRCULATION Lisa Lisle Jennifer Godwin
ACCOUNTING Diane Costea
EDITORIAL BOARD Hank Balch, President & Founder,
IN THE OR 26 M arket Analysis: Surgical Market Growth Continues 27 Product Focus: Instrument Storage & Transport 30 CE Article: Managing Your Time: Work Smarter, Not Harder 36 Corporate Profile: Healthmark
Sharon A. McNamara, Perioperative Consultant, OR Dx + Rx Solutions for Surgical Safety Julie Mower, Nurse Manager, Education
OUT OF THE OR 44 Spotlight On: Rebecca Votino, BSN, RN, ONC 46 Fitness 48 Health 51 EQ Factor 52 Nutrition 54 Recipe 56 Pinboard 58 OR Today Live Scrapbook
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Choose air-free patient warming and avoid the risk of aerosolizing pathogens Warm your patients safely in ORs, ERs and ICUs, and avoid the risk of aerosolizing airborne pathogens. Active patient warming is a critical therapy when hypothermia is a concern. As a result of the COVID-19 pandemic, ORs, ERs and ICUs are choosing to warm patients without mobilizing pathogens. Research has shown that forced-air warming can spread airborne contaminants.1-13 HotDog blankets and mattresses are encased in an anti-microbial shell and are easily cleaned between uses. HotDog blankets and mattresses are designed for reuse, so there are no resupply issues. The HotDog system warms patients above and below simultaneously for more effective warming without blowing air.
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INDUSTRY INSIGHTS
news & notes
UV-C Disinfecting Robots Confirmed as Safe for Use Against Coronavirus on N95 Respirators UltraViolet Devices Inc. (UVDI) announced its UVDI-360 Room Sanitizer is the first 254nm UV-C disinfecting robot to be recognized by 3M as a coronavirus decontamination method that will not damage its respirators. 3M’s June Technical Bulletin “Decontamination Methods for 3M Filtering Facepiece Respirators such as N95 Respirators” now includes the UVDI360 Room Sanitizer as safe for up to 10 N95 use cycles. To be included on 3M’s “Decontamination Methods” bulletin, a product must meet several criteria: inactivate the virus that causes COVID-19, not impact or damage the respirator’s filtration or fit, and be safe for the person wearing the respirator. The bulletin’s recommendations are in line with the Centers for Disease Control and Prevention (CDC) guidance on Decontamination and Reuse of Filtering Facepiece Respirators. Given the COVID-19 pandemic, global supply constraints for effective, hospital-grade personal protective equipment such as N95 respirators have led CDC and industry leaders such as 3M to provide guidance for safe reuse and decontamination of respirators for use in health care facilities globally. •
Dräger Supplies Ventilators to COVID-19 Hot Spots Because mechanical ventilation is critical in the care of COVID-19 patients, Dräger leveraged its Intensive Care On-line Network (ICON) emergency program to supply 20 mechanical ventilators to metro New York City and other hard hit area hospitals during the city’s COVID-19 peak crisis and continues to deliver ventilators to emerging pandemic hot spots in support of health care providers and their patients. The ICON Critical Care Resource Center offers all Dräger ventilation customers access to online continuing education and a real-time support system staffed 24/7 by clinicians. This enables Dräger to provide an elite level of clinical education and support that reaches new heights in customer satisfaction. “Through the ICON program we have a mechanical ventilation resource immediately available to distressed facilities at the forefront of the COVID-19 crisis,” said president and CEO for Dräger in North America, Lothar Thielen. “We were there to help hospitals located in the initial pandemic hot spots, are currently working with hospitals in areas where infections are surging, and, at the same time, are preparing resources to address potential future outbreaks in the months ahead.” •
7D Surgical Achieves CE Mark Certification 7D Surgical announced that it has achieved CE Mark certification for its Machine-vision Image Guided Surgery (MvIGS) system for spine surgery. This achievement clears the way for 7D Surgical to commence commercialization efforts of its spinal platform across the European market and additional global regions. The 7D Surgical MvIGS System is the only approved image guidance system that utilizes a novel and proprietary camera-based technology, coupled with machine-vision algorithms to eliminate the long-standing frustrations with legacy surgical navigational platforms. The speed, accuracy and efficiency of the MvIGS System, combined with
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a fundamentally streamlined surgical workflow provides significant economic value and harnesses the true potential of image guidance – all while enabling a safe, radiation-free surgical environment. “We are extremely excited to achieve our CE Mark. With successful launches already underway in the United States, Canada, Australia, New Zealand and the Caribbean, we are eager to begin expanding the MvIGS technology into the European spine market,” said Beau Standish, chief executive officer of 7D Surgical. “We are very proud of our team for accomplishing this important milestone and we are continuing our growth and expansion into international markets.” •
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INDUSTRY INSIGHTS
news & notes
FDA Clears Sterile, Single-Use Duodenoscope The Ambu aScope Duodeno has received 510(k) clearance from the U.S. Food and Drug Administration (FDA). “At Ambu, we are determined to advance patient safety through innovative design of single-use devices, and we are excited to improve safety for the 2 million patients each year who require an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) procedure,” said Juan Jose Gonzalez, CEO of Ambu A/S, which is based in Copenhagen, Denmark. “It’s no longer necessary to balance the necessity of the procedure against the risk of infection from a reusable endoscope. Now, both doctor and patient can focus on diagnosis and treatment by using a sterile, single-use duodenoscope.” Reusable duodenoscopes have been under increasing critique from the FDA in recent years because there have been cases of device-related infections and patient fatalities. In August 2019, the FDA recommended duodeno-
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scope manufacturers and health care facilities transition to duodenoscopes that are partially or completely single-use. “The aScope Duodeno is sterile, single-use and seamlessly integrates into existing hospital systems and offers an intuitive, lightweight design with similar functionality to reusable duodenoscopes,” said Jens Kemp, vice president of marketing at Ambu Inc. “Over the past six months, we have expanded our sales organization and built a dedicated commercial infrastructure for gastroenterology. After today’s FDA clearance, we will now approach our customers to arrange product demonstrations, set up evaluations and promote what Ambu has to offer within the field of GI.” Ambu’s duodenoscope solution consists of a singleuse endoscope (Ambu aScope Duodeno) and a reusable processor unit (Ambu aBox Duodeno). The FDA clearance covers both devices. •
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INDUSTRY INSIGHTS
news & notes
Ethicon Technology Granted Breakthrough Device Designation Ethicon, part of the Johnson & Johnson Medical Devices Company, announced the U.S. Food and Drug Administration (FDA) has granted Breakthrough Device Designation for transbronchial microwave ablation technology using roboticassisted bronchoscopy, which is currently under development. The Breakthrough Devices Program is a voluntary program for certain medical devices that provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions. The goal of the Breakthrough Devices Program is to provide patients and health care providers with timely access to these medical devices by speeding up their development, assessment and review, while preserving the statutory standards for premarket approval, 510(k) clearance and De Novo marketing authorization, consistent with the agency’s mission to protect and promote public health. “Our acquisitions of NeuWave Medical and Auris Health have enabled us to bring two bestin-class platforms together as we work to develop this breakthrough technology,” said Vladimir Makatsaria, company group chairman of Ethicon, Johnson & Johnson. “We look forward to working collaboratively with the FDA to help prioritize development and access for patients.” •
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Healthmark Offers New EndoPro-Cam Healthmark has announced the addition of the EndoPro-Cam to its ProSys Optical Inspection product line. Designed for evaluating the condition of rigid endoscopes, the EndoPro-Cam is a portable endoscopic video system providing 1080p high resolution HD imagining that assists health care workers with inspection of their facilities’ rigid scope to check if their device is damaged. Manufactured for visual inspection of rigid scopes after cleaning and prior to further processing, the lightweight ergonomic EndoPro-Cam allows for image capture, recording and adapts to any C-Mount coupler. Featuring a 4.3 inch LCD monitor, the EndoProCam is equipped with a Micro SD card slot, Micro USB port and Mini HDMI port. The EndoPro-Cam includes a rechargeable Li-ion battery power bank, Micro SD card for storage and a Mini HDMI cable for secondary monitor usage. Additionally, the EndoPro-Cam comes with a camera stand that has a test pattern card affixed to it, which allows the user to view the card through their rigid scope to observe a standard test pattern to determine the resolution and color bars to check for dark spots. •
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Fujifilm Launches ELUXEO Surgical System FUJIFILM Medical Systems U.S.A. Inc. has announced its innovative ELUXEO Surgical System, a first-of-itskind equipment tower comprised of products from the company’s endoscopy and minimally invasive surgery portfolios. The system leverages the company’s endoscopic image processing technology to deliver surgeons unparalleled visualization while performing both flexible and rigid endoscopy from a single tower. The ELUXEO Surgical System was engineered to assist clinicians during a wide range of procedures and is particularly effective for procedures that require both flexible and rigid endoscopes including pre- and post-operative EGD, colonoscopy, bariatric procedures, thoracic and interventional pulmonology surgeries, among others. “Today’s busy surgeons and clinical OR personnel demand tools that enhance productivity and workflow while improving the chances for more successful clinical outcomes,” says Taisuke Fujita, general manager of FUJIFILM Medical Systems U.S.A. Inc.-Endoscopy. “Fujifilm’s ELUXEO Surgical System is a powerful solution that provides unparalleled visualization and lets surgeons move seamlessly from using one scope to another with ease and confidence.” Fujifilm’s ELUXEO Surgical System recently received 510(k) clearance from the FDA and is available for sale in the U.S. •
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INDUSTRY INSIGHTS
news & notes
Getinge Offers Surgery Backlog Solution COVID-19 could potentially lead to 30 million cancelled or postponed surgeries worldwide in 2020. Clearing the backlog will be a worldwide priority that is estimated to take a full year – even if hospitals increase their daily number of surgeries performed by 20%. In the effort to support, Getinge launched Torin OptimalQ, an efficient planning tool for prioritizing the surgical wait list caused by COVID-19. “We all feel the effect of COVID-19; our health care professionals most of all,” says Matthias Rath, director product management and business development OR solutions at Getinge. “To help health care providers restart their surgical activity, we looked at how we can utilize our miles of data and knowledge on surgery planning. We now offer a solution that is scalable, easy to deploy and that offers quick results for staff and patients.” Torin OptimalQ is a cloud-based software solution that merges customer waiting list data with Getinge knowledge base information on average procedure duration and best planning practices. Matched with patient scorings and hospital capacities, Torin OptimalQ calculates the best way to prioritize the surgery schedule per OR, week or service. The solution is offered as stand-alone for existing Torin OR Management customers or in a Software as a Service (SaaS) environment with consulting expertise to support hospitals in fine-tuning their processes around the surgical pathway. Torin OptimalQ can be upgraded to the full Torin OR Management solution at a later point in time, helping hospitals realize even more significant improvements with accurate surgery schedules, realtime progress updates, performance analytics and complete surgery documentation. •
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Hillrom Announces 2 New Respiratory Therapy Devices Hillrom has launched two new respiratory therapy devices: the Volara System, which provides hospital-grade oscillation and lung expansion (OLE) therapy, and the Synclara Cough System. “As part of our vision of advancing connected care, we want to make it easy for patients to leave the hospital with the technologies they need to get better faster,” said John Groetelaars, president and CEO of Hillrom. “Our new Volara System is proven to reduce hospital length of stay and time on a ventilator by delivering effective OLE therapy, and the Synclara Cough System, which delivers mechanical insufflation and exsufflation, helps keep upper airways clear. We’re delighted to introduce these practical, accessible innovations to patients and their caregivers.” The Volara System delivers OLE therapy, combining Continuous Positive Expiratory Pressure (CPEP), Continuous High-Frequency Oscillation (CHFO) and a nebulizer in one portable, lightweight device. Respiratory therapies delivered by the Volara System are suitable for a number of acute and chronic conditions, including post-operative pulmonary complications, that are treated both in acute care settings and at home. The Volara System is versatile, enabling patients to continue receiving OLE treatments with the precise settings they used in the hospital, at home. Volara can be used with a mouthpiece, face mask, tracheostomy or in-line on a ventilator. The Synclara Cough System is a non-invasive therapy that simulates a cough to remove secretions in patients with compromised peak cough flow. The Synclara Cough System uses mechanical insufflation-exsufflation technology to clear secretions from the upper airways, representing the most complete solution available to assist patients with vital secretion evacuation. Synclara has been designed with the programmability and sensing technology to deliver a more individualized treatment, the portability and ease-of-use to improve the patient experience, and specialized patient training, therapy optimization and support. “For patients with compromised lung function, cough simulation can be a lifesaving therapy,” said Groetelaars. “With Synclara, we’ve developed a cough system that senses how a patient is breathing and automatically adjusts the cough cycle to match the patient’s breathing rhythm, making it possible for caregivers to tailor therapies for specific patient needs.” The Volara System and Synclara Cough System are available in the United States. •
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INDUSTRY INSIGHTS
news & notes
Encompass Group LLC Announces New Incontinence Pad Encompass Group LLC has launched the next-generation of its market-leading incontinence pad designed to help protect the skin of hospital patients and senior living residents. The Comfort Care underpad greatly improves upon the clinical performance of its predecessor with 20% better moisture wicking and absorbency and only one-third the amount of moisture retention on the surface next to the skin as before. Moisture next to the skin is one of the key components on skin breakdown, which can cause pressure ulcers, and the Comfort Care pad’s enhanced synthetic surface is drier to the touch than ever before after a patient void. This ability to remove moisture from the surface away from the skin is retained after even multiple patient voids. “Patient bed linens, including the bedding and the patient gown, are one of the few items that are in contact with a patient’s skin 24 hours a day while they are admitted in the hospital,” said Jamie Orlando, Encompass vice president for healthcare textiles. “We feel the need to make sure that patient room textile products should help functionally protect the patient’s skin from the key components of skin breakdown – pressure, moisture and shear – and not only be attractive to look at.” “There really hasn’t been much innovation in underpads in a long time – our previous generation had been developed well over 10 years ago – and we felt the need to make
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performance improvements for the benefit of the patient while retaining the construction and durability attributes it was known for,” he continued. “We are doing our part to help reduce PIs with not only the new Comfort Care pad, but a full suite of high-performing bed linens and patient apparel we call the Comfort Bed System.” The three layers (top surface, middle soaker and bottom barrier) of the Comfort Care pad are laminated together instead of stitched to reduce the amount of potential pressure points under the patient’s body. Pressure-mapping studies show that the smooth and thin profile of the Comfort Care pad does not add any additional pressure to the body when used as directed. This allows high-end pressure reduction mattresses to do their job to relieve as much pressure as possible on the bony prominences which are at most risk for PIs such as the sacrum, hips and buttocks. The Comfort Care pad then works on the microclimate next to the patient’s skin to reduce moisture while affording a relatively high breathability to move air as well. The Comfort Care pad improves on its predecessor’s air permeability measure as well. The Comfort Care pad is available now in both standard 34” x 36” size and 34” x 45” bariatric size. • For more information, visit www.encompassgroup.com.
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INDUSTRY INSIGHTS
news & notes
Nihon Kohden Launches Video Laryngoscope in U.S. Nihon Kohden announced that it is now offering the NK AWS-S200 video laryngoscope as part of its critical care portfolio. Designed for the safe and secure intubation of patients in even the most difficult situations, the NK AWS-S200 may reduce the exposure to aerosolized particles, which can help protect clinicians while intubating patients suffering from COVID-19 or other respiratory infections. The lightweight NK AWS-S200 video laryngoscope includes a high-definition color LCD screen and on-screen crosshairs to guide clinicians of all skill levels through an intubation. Studies have demonstrated that the NK AWS-S200 video laryngoscope offers superior laryngeal view and a significantly shorter median time to intubate patients who present with difficult airways. With the NK
AWS-S200, clinicians can intubate even difficult airways in 22.9 seconds, well below the 30-second threshold recommended for intubations and up to 33 seconds faster than other devices. “Whether dealing with COVID-19 or another critical illness, it is imperative that health care providers have tools that can help them quickly and easily establish an airway,” said Genoveffa Devers, DNP, MSHA, RN, CPHQ, vice president of clinical and strategic alliances at Nihon Kohden. “The NK AWS-S200 video laryngoscope is designed to accomplish this while also keeping clinicians safe because they don’t have to lean in to visualize the vocal cords and larynx. It is the embodiment of Nihon Kohden’s commitment to bring exceptional and simple solutions to health care providers, and NK-HealthProtect, which is designed to protect the health of those whom we serve.” •
UV-Concepts Launches UV-C Enclosure UV-Concepts Inc. has announced worldwide availability of the UV-C Enclosure (UVE), the first and only automated no-touch UV-C enclosure designed to improve upon the existing standard of manual cleaning and disinfection of large portable medical equipment (PME). The UVE is one component of a threepronged ecosystem solution that includes digital tags and a cloudbased process management system to enable improved tracking and monitoring of PME disinfection in the health care setting. Research shows high-touch surfaces on PME, such as wheelchairs, intravenous poles, computer workstations, and infusion pumps, are a potential vector for transmission of bacteria and viruses, including MRSA, C.Diff, and SARS-CoV-2. UV-Concepts developed a novel platform using short-wavelength ultraviolet light (UV-C, 254nm) in an enclosed structure to optimize the inactivation of disease-causing microorganisms. Ultraviolet germicidal irradiation (UVGI) has been shown to be an effective method of disinfection in health care over the past decade. “The concern for the cleaning and disinfection of high-touch surfaces in the health care environment has grown exponentially due to COVID-19,” said Jeremy Starkweather, president and co-founder, UV-Concepts Inc. “The UVE completely surrounds an item with high intensity germicidal UV-C light resulting in the fastest and most powerful UV-C disinfection solution available to health care providers. We’re very pleased to make the UVE
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available for health care institutions globally to help protect patients, health care workers, and visitors from harmful bacteria and viruses.” Prior to the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) estimated about 700,000 patients are diagnosed with a healthcare-associated infection (HAI) each year in the United States, and of those, 70,000 die during their acute care hospitalization. While progress has been made to reduce, and in some cases eliminate HAIs, the market is constantly seeking new and improved disinfection solutions. “With use of the UVE, we have been able to process over 5,200 N95 masks, which allows us to get five uses per N95 mask. It has been a lifesaver when no new N95 masks were available,” said John P. Ostdiek, director of transportation, Aramark at Saint Joseph Hospital of SCL Health in Denver, Colorado. “We also run all portable medical equipment that can fit in the enclosure for treatment and have physicians request to use the unit for their own equipment. This is the right piece of equipment at the right time to help health care personnel have one more tool to stop the spread of infectious diseases in a hospital setting.” •
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INDUSTRY INSIGHTS
news & notes
oneSOURCE Announces Free Access to Continuing Education Earlier this year, oneSOURCE announced a partnership with Pfiedler Education, a subsidiary of AORN Inc., to offer free access to a webinar course from sterile processing expert Rose Seavey. This course will focus on effective tools to help pass accreditation surveys and allow health care professionals to receive 2.0 continuing education credits in multiple areas including HLD, sterilization, and implants and tissue management. “Authoritative entities, like the Joint Commission and AAMI, have increasingly updated their requirements for
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maintaining accreditation for health care professionals to ensure patient safety. These compliance mandates can often be met by pursuing continuing education credits in a number of disciplines, including infection prevention and sterile processing,” said Heather Thomas, CMO an executive vice president sales and marketing. “With over 40 years in this field, Rose is well appointed to lead this course and we couldn’t be more excited to have her involved in this capacity.” By partnering with Pfiedler Education, the CE course will allow health
care professionals to access free instructional programming to help uphold the guidelines instituted by the governing bodies. The course will be available for two years to oneSOURCE clients and other medical professionals on the oneSOURCE and Pfiedler Education websites. The CE course is an adaptation of Seavey’s presentation on completing the accreditation survey. To receive credit, the participants will have to pass a quiz upon completion. For more information, visit onesourcedocs.com/knowledge-center.
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INDUSTRY INSIGHTS
news & notes
OR Today Live Conference Delivers Safe Networking, Education By John Wallace erioperative nurses and SPD professionals from across the country gathered at OR Today Live in Denver in August to discover new opportunities, broaden their knowledge and exchange ideas. OR Today Live provided a safe and clean environment amid the COVID-19 pandemic for individuals to network and earn valuable CE credits..
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Amy Hobbs, USOC Medical executive director of sales and customer service, said the opportunity to interact with customers and potential customers in a safe environment was among her reasons for attending OR Today Live. “I was ready to get out of the house and be face-to-face with customers again,” Hobbs said. Vangie Dennis, executive director for perioperative services at Well-
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Star Atlanta Medical Center and WellStar Atlanta Medical Center South, mentioned networking and top-notch educational sessions when asked about the conference. “For me, OR Today Live has always been an excellent connection for meeting with our peers and the educational offerings are always great,” Dennis said. “So, why during this pandemic would I choose to come? I think it is re-connectivity.” “I prefer the live connection,” she added. “I’ve done a lot of webinars. So, I am going to put my mask on. I’m going to wash my hands and I’m not going to touch my face. Being a first responder in a Level I trauma center in Atlanta, and I’m going to be honest with you and I’m not cavalier, this is the least of my worries of being in a small venue. And, I am so glad that I did come.” Karen Elliott, a clinical nurse specialist, who is active in the Den-
ver chapter of AORN praised the conference. “This is my first time being at an OR Today Live conference,” she said. “I am very glad we are doing a live event with all that we are dealing with with COVID. I think it is very beneficial to network, to speak with others and really to express what we are doing here for the community and for the nurses.” Tracey Young, nursing professional development periop education at West Penn Hospital, said she found out about the OR Today Live conference through the OR Today webinar series. “I’ve been watching the webinars for about six months, I use them for my CEs and also I am in periop education. So, I also pass them on to my staff,” Young explained. She said her first ever OR Today Live conference was a great experience. WWW.ORTODAY.COM
INDUSTRY INSIGHTS
SURGICAL CONFERENCE
news & notes “ I’ve never been to a conference that has as much to offer as they do with the price point.” -Jill Teubel
On-Demand education available at ortodaylive.com
Jill Teubel, RN, MSN, clinical surgery educator at OSF Saint Francis Medical Center is another attendee who enjoyed previous OR Today Live conferences and was excited to experience the 2020 version in Denver. “From the first time we went to OR Today Live we felt like it was something different than any of the other conferences,” she explained. “It’s definitely much more intimate. I feel like we gotten to know people and network with people and every year we can come back and touch base with them which has been really awesome in practice and what they are doing.” “You can’t beat the price point of it,” she added. “I’ve never been to a conference that has as much to offer as they do with the price point. So, between the both of those I just feel it was a no brainer that this is something we want to attend every year because we learn lots of things. You have great speakers who are bringing up different topics. And that, in a nutshell, is why we always come.” MD Publishing Vice President Kristin Leavoy said it was an honor to once again host the OR Today Live conference and bring peers together for a successful event. “The 2020 OR Today Live conference may have looked different from past years with masks and social distancing procedures in place, but the feeling of camaraderie was stronger than ever,” Leavoy said. “As an event organizer hearing from attendees that they felt safe and comfortable at the conference provided reassurance that we made the right decision to proceed with an in-person meeting this year.” WWW.ORTODAY.COM
She added that the event would not be possible without the great nurses and companies who support the OR community. “I would personally like to thank the attendees and vendors who participated in this event. You placed your faith in us that we would host this event in a safe and clean environment and we truly appreciate your support,” she said.
See the ORTL scrapbook on Page 58!
For information on a FREE subscription to OR Today magazine and/or the electronic newsletter visit ORToday.com/subscribe.
OCTOBER 2020 | OR TODAY |
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IAHCSMM
SPD-OR Partnership Agreement Sets Stage for Better Relationship, Patient Outcomes By Julie E. Williamson erhaps nowhere else in a health care organization are two departments more closely intertwined as sterile processing (SP) and the operating room (OR). Despite obvious differences in their core responsibilities, the two teams cannot function without the other, and they share the same primary goal: promoting patient safety and positive outcomes through the delivery of highquality, effective service.
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Although SP professionals rarely meet the patients on the receiving end of their instrumentation, safe surgical procedures simply cannot take place without their delivery of clean, well-functioning and sterile devices. At the same time, SP professionals cannot do their job safely and effectively, or efficiently provide for the OR, if the surgical team doesn’t do its part to manage instrumentation properly at the point of use and ensure that surgery scheduling stays in line with the facility’s resource capabilities (e.g., taking into consideration existing instrument/set inventories, reprocessing equipment availability, staffing levels, etc.). Without taking into
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consideration all factors that impact the availability of safe, functional devices – and without working together to mitigate instrument-related challenges – service quality can suffer, interdepartmental relationships and trust can erode and negative patient outcomes can occur. “It’s absolutely critical that sterile processing and operating room professionals commit to a strong partnership, recognize each other’s challenges and work together to overcome them to ensure that patient safety remains the top priority,” said Natalie Lind, CRCST, CHL, FCS, IAHCSMM’s education director.
Put it in writing Creating effective partnerships between the two disciplines requires each to have a better understanding of the other’s responsibilities and requirements – neither of which may be fully understood without defining them and then developing protocols and procedures to help establish expectations and offer guidance for standards-based best practices. An effective, ongoing partnership hinges on this mutual understanding and both sides’ commitment to meeting individual and shared goals, and ensuring processes
are adopted and implemented by all who are involved. Collaboratively developing a written partnership agreement can clearly identify responsibilities and expectations, all while helping ensure that instrumentation is turned around as efficiently, effectively and safely as possible. What follows is an example of an SP and OR responsibility agreement for turnaround instruments. Note: This agreement serves as a general template that should apply to most facilities; however, it can be easily customized to meet facilities’/ departments’ own unique needs and responsibilities (the facility’s policy for loaned instruments/sets should be included on this agreement, for example). To ensure the agreement becomes standardized and accepted across all shifts, all SP and OR employees should sign it, and each department should revisit the document periodically to ensure all employees are still adhering to it.
Sterile Processing Responsibilities 1. Sterile processing personnel will clean and sterilize turnaround instruments utilizing the written instructions provided by the manufacturers WWW.ORTODAY.COM
we’re on instagram! of these reusable devices, in accordance with ANSI/AAMI ST79, Section 2.2.2. 2. Items requiring immediate turnover (e.g., back-to-back surgical cases) must be processed using established cleaning/disinfecting and sterilizing protocols. Note: Multiple trays may extend the process time required for cleaning/disinfection. Whenever possible. OR staff will reduce the need for immediate turnover by considering processing requirements when surgical schedules are developed. 3. Sterile processing professionals and OR team leaders will communicate throughout the day to resolve instrument preparation issues for the next day’s surgical cases. 4. Sterile processing staff are responsible for using appropriate telephone etiquette skills that are consistent with established customer service policies.
Operating Room Responsibilities 1. Upon completion of each surgical case, OR staff will remove gross debris and place used instruments in transport containers. The used instruments will then be sprayed with an enzymatic spray (or kept moist by draping a towel wet with sterile water over them) before being transported to the SP department’s (SPD’s) decontamination area. Unused instruments will be placed in their original tray and returned with the used instruments for processing. 2. OR staff must telephone the SPD for all requests for set/ WWW.ORTODAY.COM
instrument turnover (call extension xx). 3. OR personnel will notify SP staff about all schedule changes as soon as possible. 4. OR staff are responsible for using appropriate telephone etiquette skills that are consistent with established customer service policies.
SP and OR Team Leader Responsibilities
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Team leaders from the OR and SPD will review turnaround instrument logs annually. The instruments and instrument trays with the highest turnaround requests will be identified and recommendations will be made to increase quantities of these items.
Summary of Understanding SP and OR personnel will work cooperatively at all times. This collaboration will protect the patient and support the hospital’s mission, vision and values.
Conclusion Successful surgical outcomes rely heavily of effective partnerships between SP and the OR. A written partnership agreement can help clearly outline each department’s responsibilities and expectations, which can promote safer, more consistently delivered practices across all shifts.
Julie E. Williamson, BA, is the IAHCSMM communications director and editor.
Reference 1. I nternational Association of Healthcare Central Service Materiel Management. Central Service Leadership Manual, Chapter 16, p. 292. 2010. Chicago, Ill.
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INDUSTRY INSIGHTS CCI ASCA
It’s Safe to Resume NonEmergency Outpatient Surgery By Bill Prentice y the time you read this message, coronavirusrelated guidance of many kinds will have been in place in communities across the country for more than half the year. For patients who could not get routine or non-emergency health care under some of that guidance and others who chose to delay getting care because of concerns about the coronavirus, the time has come to reconsider those decisions.
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Looking back at the temporary restrictions placed on elective surgery in all settings after the U.S. declared COVID-19 a public health emergency in March, it is easy to see why a partial lockdown made sense at the time. In March, personal protective equipment (PPE) was in short supply and needed to be reserved for the health care professionals providing frontline care to COVID-19 patients and to patients facing emergency situations. Since then, however, PPE supplies have become more plentiful, and we have learned a lot about how the virus is transmitted and what health care providers can do to deliver care while protecting their patients from the coronavirus. Today, we have information from a multitude of sources that suggests continuing to delay non-emergency
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health care carries greater risks than stepping inside a properly prepared health care facility. We also have information from sources like Johns Hopkins University in Baltimore, Maryland, and Rush University Medical Center in Chicago, Illinois, that suggests that the pent-up demand for outpatient surgical care that already exists since the temporary suspensions last spring will cause backlogs of surgical cases for some time to come. It is important to remember that when we use the term elective surgery, we are not referring to surgery that is not necessary. What we are talking about is procedures that do not have to be performed immediately to save a life and can, therefore, be scheduled in advance. Delaying elective surgery can have serious consequences such as worsening conditions, heightened anxiety levels, greater pain, longer recovery times, an increase in opioid use, decreased work capability, greater expense in treating more advanced disease states and, in some instances, death. In an article published in The New England Journal of Medicine this June, one interventional cardiologist even suggested that the toll of delayed care on non-COVID-19 patients will be much greater than COVID-19 deaths. Recently, while recording a new
episode of ASCA’s Advancing Surgical Care Podcast (you can listen to that episode at https://www. buzzsprout.com/1065259), I had the opportunity to talk with Dr. Tom Deas, a highly regarded gastroenterologist who is board-certified in gastroenterology and internal medicine. Deas practiced medicine for 20 years in the U.S. Air Force before retiring as lieutenant colonel and launching a distinguished private sector career that included a term as president of the American Society for Gastrointestinal Endoscopy. During our discussion, Deas talked about how the initial bans on non-emergency surgery, including routine screening colonoscopies and patients’ decisions to delay that kind of care at that time made sense. One reason he cited was the shortage of PPE. Another was the belief, early on, that any delays were likely to last one or two months at most. Now, Deas said, the situation is different. Today, after delaying non-emergency care like colonoscopies for more than six months, the possibility that a cancer diagnosis will be seriously delayed or missed entirely in a patient who is reluctant to visit a health care facility for a screening procedure continues to grow. Also, as endoscopy and other procedures resume, the productivity and turnover rates are slower due to the precautions WWW.ORTODAY.COM
being taken to protect patients and health care workers from COVID-19. For patients who are in pain or confronting worsening medical conditions, the increased time a facility needs to provide each patient’s care can quickly translate into longer wait times for procedures that may have already been delayed well beyond the date they should have been performed. During our conversation, Deas also pointed out that thanks to teams of experts who worked together to recommend additional protocols that could be put in place to protect patients from the coronavirus in endoscopy centers, he would argue that perhaps these facilities are some of the safest places on earth when it comes to avoiding COVID-19. He also suggested endoscopy centers could easily be far safer than the post office or a local restaurant and said he would be perfectly comfortable getting an endoscopy in a facility that has these protocols in place. I would add that for patients who are in need of outpatient surgical care but reluctant to visit a hospital, ambulatory surgery centers that are not located on a hospital campus provide an excellent alternative. As I write this message, the end of COVID-19 is not yet in sight, but while it is one thing to forego a haircut for a couple of weeks or postpone an indoor meet-up with friends, health care cannot always wait. That is an important message that all health care providers should be sharing with their patients, friends and family members.
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INDUSTRY INSIGHTS
CCI news & notes
Nursing Education is Changing By James X. Stobinski recently read a short online article by Jon Marcus (2020) which was posted on the Wired magazine website. His article on microcredentials is one example of how education may be changing because of the pandemic. I would like to introduce some other examples to expand on this theme of change in education.
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A relatively recent development in the space shared by education and credentialing is that microcredentials are garnering more attention and acceptance. “Microcredentials are a digital form of certification indicating demonstrated competency/mastery in a specific skill or set of skills.” (NEA, 2019) Marcus makes the point that microcredentials are now being stacked together allowing the learner to earn an associate or baccalaureate degree. Students incrementally increase their expertise, enjoy quick achievements and reap the benefits of increasing their skill set. The pace of change in nursing, especially the technology intensive operating room setting, requires lifelong learning. This fact is coupled with an increasing emphasis to increase the education level in the profession. At CCI, we believe that microcredentials are one part of the solution for these learning needs. We also know that the broad field of education is changing markedly. While some of these changes were already happening, the pandemic has spurred on the pace of change and brought about new opportunities. The trend to baccalaureate-level WWW.ORTODAY.COM
education in nursing continues unabated even during the pandemic. The American Association of Colleges of Nursing (AACN) tells us that there were 777 RN to BSN programs in 2018 with 139,587 students enrolled and 66,530 graduates annually. Most of these programs are partially or entirely online. These graduates combined with the BSN educated students passing the NCLEX will add nearly 150,000 BSN nurses to our profession. The culmination of all these offerings is a change in the makeup of the American nursing workforce with an increasing ratio of nurses holding baccalaureate and graduate-level degrees. We also know that some very experienced nurses have chosen to retire during the pandemic. This has exacerbated staffing shortages and increased the need for education and training courses for nurses entering the profession. The need for systematic, organized talent development over the span of a career is now accentuated. The quality of our educational courses for bringing nurses into the profession is being tested in real time as facilities must meet staffing needs as surgery schedules are resumed. We believe that there is an opportunity to assess these types of courses, determine best practices and refine our programs. There is also an opportunity to enhance our competency assessment methods in these courses beyond knowledge-based tests. As a profession, nursing has long used professional and membership meetings as a means for ongoing professional development. Those meetings provided the familiar CE credits needed for licensure
and certification. It is safe to assume that both education and travel funding will be in tight supply for the near future. However, many of these in-person meetings have been canceled or converted to a virtual format. Nurses will need other, cost-efficient options if attendance at these meetings are curtailed. One last consideration is that new skill sets are needed in American health care. For nursing, financial management skills for leaders have become essential. At CCI, we continue to shape our programs to support nurses as they advance their education. We are also engaged in developing new educational offerings in our learning management system to facilitate the lifelong learning of our certificants. We believe that innovations such as microcredentials and certificate programs offer perioperative nurses’ diversity and flexibility, a much-needed asset in these unsettled times.
Reference American Association of Colleges of Nursing (AACN) (2019). Associate Degree in Nursing Programs and AACN’s Support for Articulation. Accessed August 3, 2020 at: https://www. aacnnursing.org/News-Information/Fact-Sheets/ ADN-Facts Marcus, J. (2020). More Students Are ‘Stacking’ Credentials en Route to a Degree. Accessed August 3, 2020 at: https://www.wired.com/story/ students-stacking-credentials-route-degree/ National Education Association (2019). Microcredential guidance. Accessed August 3, 2020 at: http://www.nea.org/home/microcredentials.html
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INDUSTRY INSIGHTS
news & notes webinars
WEBINAR SERIES
OR Today Webinars ‘Consistently Brings Relevant and Critical Information’ he recent OR Today webinar “United We Stand Divided We Fall: Collaboration is the Solution You’ve Been Searching For!” presented by Michelle Lemmons, RN, BSN, PHN, was eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing. It was sponsored by Key Surgical.
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Lemmons, clinical educator-OR at Key Surgical, discussed how we often get excited about a new idea that we believe could have a significant, positive effect on our department only to have the idea fall flat, or never get off the ground because of interactions with another department? In the hospital, operating room and sterile processing departments have immediate impacts on the other’s workflow, success and failure. This presentation was able to shed new light on the value of
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collaboration and the role leaders, staff and management play in the successful implementation of new and improved processes. More than 150 individuals registered for the live presentation of the webinar. A recording of the session is now available for on-demand viewing. In a post-webinar survey, attendees were asked to provide feedback regarding the webinar series. “Michelle was very engaging! She clearly is very knowledgeable about the topic of collaboration. I will always remember that collaboration also means ‘co-labor’ as she shared from her husband. The topic is very timely. I will be able to use some of this information for a project that I am planning with other clinical areas in conjunction with SPS,” shared C. Wylie, RN-RME coordinator/supervisor/educator. “I have been dealing with a lot of change in leadership. The seminar helped me remember that there is
no ‘right’ or ‘wrong’ way to lead,” RME Coordinator D. Maestas said. “OR Today consistently brings relevant and critical information for the health care industry in an easy-to-consume format,” said B. Brown, a vice president of sales and marketing. For more information, visit ORToday. com/webinars.
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IN THE OR
market analysis
Surgical Market Growth Continues Staff report he global and North America surgical market continues to show growth with market researchers predicting continued expansion in coming years. This growth will, no doubt, boost the surgical instrument storage and transport market.
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The global general surgery devices market size is expected to reach $26.5 billion by 2026 registering a compound annual growth rate (CAGR) of 8.5%, according to a new report by Grand View Research Inc. An increasing number of surgical procedures being performed coupled with technological advancements is anticipated to drive the market. Moreover, rising awareness and patient affordability for plastic or reconstructive surgeries is expected to propel the number of procedures conducted during the forecast period. Global health initiatives for the advanced surgical procedure is expected to boost the market. In January 2017, Ethiopia Federal Ministry of Health
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(FMOH) launched the Health Sector Transformation Plan (HSTP) and Safe Surgery (SaLTS) program that prioritizes safe surgery and makes anesthesia care and emergency surgical services accessible and affordable. Technological advancements are also contributing to the market growth. Several key companies are investing in research and development for the development of innovative products. For instance, development of medical robots to assist surgeons is a key advancement in the field. Medical robots offer several advantages, such as a 3D view of the operating field, reduced blood loss and transfusions, lower risk of infection, faster recovery time, minimal scarring and high precision. Furthermore, a growing aging population and cases of road accidents and increased health care expenditure in emerging economies are likely to boost the market during the forecast period. According to the World Health Organization (WHO), the world’s population aged 60 years and older is expected to
reach 2 billion by 2050 from 900 million in 2015. Members of the geriatric population are more susceptible to a number of diseases, which is likely to increase the need for effective treatments, thereby driving the global general surgery devices market. According to an analysis of Reports and Data, the global surgical Instruments market was valued at $11.75 billion in 2018 and is expected to reach $21.52 billion by year 2026, at a CAGR of 7.9%. The expected rise in the growth is subjected to various applications for which the surgery procedure is required. “This industry has a huge potential for progress. But there are some factors which may hinder its development. The cost involved with the equipment is high which leads to high cost for surgery procedures, also the demand for alternatives to the surgery procedures are also increasing day by day in the industry which is another major hindrance factor to the development of this industry,� according to Reports and Data. WWW.ORTODAY.COM
IN THE OR
product focus
Case Medical
SteriTite Sterilization Containers and Case Carts Protect and organize your surgical instruments with high quality, durable SteriTite Sterilization Containers and Case Carts. SteriTite containers are universally compatible with steam and lowtemperature sterilization modalities so you can standardize your container inventory. Adding customized inserts and multi-level trays make efficient use of space and protect instruments, reducing instrument repair and replacement costs. SteriTite Case Carts are engineered for maximum internal space and designed to fit DIN-sized containers with ID plaques facing front for easy identification. Stainless steel construction, including bumpers and casters, make these case carts durable and easy to clean. •
CIVCO
TEE Transport Tray CIVCO offers a full range of products that protect, clean, transport, disinfect and store transesophageal (TEE) and endovaginal/endorectal ultrasound probes, to help facilities maintain compliance with The Joint Commission and Centers for Disease Control and Prevention standards. Simplify the workflow with the TEE Transport Tray and ultrasound probe storage cabinet. The transport tray features a reversible lid for easy clean/dirty indication. It protects expensive, delicate TEE probes from damage while safeguarding the disinfected probe shaft from the handle, cord and connector. The storage cabinet provides a safe and clean environment by hanging probes vertically and keeping connectors and probes separate with a continuous flow of filtered air. •
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IN THE OR
product focus
Healthmark SST-2136
Sized for complete surgical sets, the Helathmark SST-2136 is ideal for retrieval of OR and OB instruments. Also, it is the right size for high-volume emergency rooms. It is available in three material configurations. The maximum temperature for all Steristrainers is 285°F. • For more information, visit www.hmark.com
Total Scope Inc. Motorized Endocart
The Motorized Endocart is preferred by hospital endoscopy departments because it makes for easy travel. Whether the cart is needed to do an ERCP in radiology or to make a trip to the OR, all of the supplies will remain organized when moving between locations. Each motorized endoscopy cart goes through a 27-point inspection to ensure the highest quality. All of the Total Scope Endocart products are made in the USA and can be customized to fit individual needs. • For more information, visit www.totalscopeinc.com.
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IN THE OR
product focus
Key Surgical Endo-Liner
Transporting an endoscope, whether it’s a clean scope being transferred to a procedure or a dirty scope after a procedure, requires an extra level of care. The Key Surgical Endo-Liner should be used with your endoscope trays to line, cover and identify scopes as clean or contaminated to protect patients, users and third parties from microbial contamination during transport. Provided sterile, the Endo-Liner includes two protective color-coded covers (red/ biohazard and green/clean), one opaque tray liner and one clear plastic tray bag with self-adhesive. Elastic banding makes Endo-Liner compatible with most tray systems. It complies with OSHA requirements and vacuum-sealed packaging helps with shelf space. • For more information, visit www.keysurgical.com
InstruSafe
Instrument Protection Trays InstruSafe Instrument Protection trays are designed in collaboration with Intuitive Surgical the maker of the da Vinci robot. InstruSafe trays are FDA cleared for a variety of popular sterilization modalities for both wrap and rigid containers. InstruSafe Trays for da Vinci Xi are designed and constructed exclusively to protect and maximize the useful life of da Vinci instruments. The Xi endoscope tray is one of the company’s most popular solutions because it can accommodate all generations of Xi endoscopes and fits most low-temperature sterilization chambers. Each tray also provides the same organization and protection customers know and love, ensuring optimal performance and patient safety. •
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CE712
IN THE OR
continuing education
Managing Your Time: Work Smarter, Not Harder By Sheila J. Leis, MS, RN-BC “Effective time management is critical to completing tasks and achieving desired outcomes has been found to improve job satisfaction.”1 Yet how often have you said to yourself, “I managed my time well and got a lot done today?” For many nurses, it’s just the opposite. We are constantly stressed about managing our time better and feel too overwhelmed to come up with solutions. Nursing is a complex, dynamic, time-consuming job. If you do not learn to prioritize and manage your time, you are at risk of missing critical aspects of patient care. You will soon begin to feel the effects of burnout because you will notice a consistent lack in your ability to meet patient needs. Time management is an essential skill of 21st century nurses.2 It is the key to improving outcomes and keeping patients safe. This course helps nurses determine ways to be more productive, more efficient, and less stressed — in other words, to work smarter not harder.
Defining Time Management So exactly what is time management? Time management is the ability to analyze how you spend your working hours and then following through by making a plan to set priorities and organize your work for maximum efficiency.2 There are four “P’s” to consider when analyzing time management:2
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� Productivity and Efficiency. How much do you get done and how long does it take you? Do you end up staying later than you expect most days? � Performance. How well do you know your strengths and weaknesses? Are you great at talking with patients but always seem behind on physical care? Are you great at technical skills but not so great at emotional support? � Perception. How satisfied are you, your coworkers, and your patients with what you accomplish? � Patient Outcomes. Are your patients safe, comfortable, and free from avoidable complications? Do they know the needed information to prevent illness and be healthy and independent?
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 35 to learn how to earn CE credit for this module.
Goal and Objectives The goal of this continuing education course is to help nurses explore ways to improve their ability to manage time and be more productive in the clinical setting. After studying the information presented here, you will be able to: •
Determine at least three barriers in achieving efficient time management.
•
Apply the “five rights” and “four steps of delegation” to save time and keep patients safe.
•
Identify at least three strategies you will use to improve your time management skills.
Time Management Barriers A good place to start when working to improve time management skills is to gain insight into what’s slowing you down. What things get in your way? Think about the following common barriers to effectively managing your time: � Procrastination. The action of putting off tasks because you do not like to do them or because they tend to be time-consuming. Perhaps procrastination is part of your personality. Do you often find yourself rushing to do things at the last minute, or do you take a more proactive approach? � Taking on more work than manageable. Some people have trouble delegating tasks because they feel like they need to be in control or they find it difficult asking for help
due to low confidence in the ability of their colleagues. � Wanting things to be perfect. Are you a perfectionist? Can you let things go when they are done satisfactorily, or do you want them to be perfect? Recognizing when “good is good enough” can save an immense amount of time. When you weigh what you have to do with how much time you have to do it, you have to be realistic. You cannot spend too much time on any one task because you run out of time for other tasks. WWW.ORTODAY.COM
IN THE OR
continuing education One nurse gains peace over her “perfectionism” by living by the motto, “Do your best, and leave the rest.” If you are a perfectionist, this motto can help reduce your stress. � Underestimating how much time you need to get things done. This is a common issue that is usually solved by experience. This is one of the reasons care continuity is important, especially with complex patients. If you are a manager, work to keep the same caregivers matched with certain patients to overcome this issue. It is also good to give estimated time frames for finishing certain tasks in procedure manuals and care plans. � Interruptions, distractions, and losing focus. These are common barriers to time management that are now a national concern because they are viewed as system problems that threaten patient safety.3 Distractions and interruptions consist of anything that disrupts people from tasks by diverting their attention.3, 4 Sources for interruptions and distractions include noise, other people, or electronic devices. Noises may include alarms, ringing phones, and other clinicians. Electronic distractions include smartphones, text messages, emails, or other communication technologies. One study observed 98 nurses while they prepared and administered 4,271 medications to 720 patients in an Australian hospital.5 This study showed that each interruption resulted in a 12.7% increased risk of a medication error and that the error rate tripled when a nurse was interrupted six times. There are new initiatives in clinical practice aimed at reducing interruptions and distractions that include establishing no interruption zones (NIZ), adopting do-not-disturb policies, providing staff education, determining the best time for necessary interruptions, creating checklists, and managing mobile devices.3 While it might take time before policies are put in place to reduce interruptions and distractions, there are WWW.ORTODAY.COM
some things nurses can do immediately. Nurses should avoid interrupting coworkers especially during crucial times such as charting or giving medications. When you are interrupted during an important task, learn to say, “I’ll be with you in a moment” or “I can’t stop what I’m doing right now.” If you must stop what you are doing, write down exactly what you were working on and make coming back to it your next top priority. Consider having a unit meeting that addresses ways to help nurses stay focused on important tasks without distractions. � Poor organization and planning. If you arrive at work just in time to throw your bag in your locker and head for report, your day will likely consist of delays and backtracking. Nurses arriving 10 to 20 minutes early to check on their assignment will see a big difference in improving time management and reducing stress. Arriving early also allows nurses time to assess, organize, and plan. � Not recognizing time wasters. Leaders must encourage their staff to identify time wasters. For example, if you are sitting around waiting to get medications or linens or to transport people, you are losing valuable time. Time is also wasted on poorly organized units. For example, if nurses are taking more time than needed because of poor unit design or having to document the same things in more than one place, that is wasting time. � Challenges of learning. Learning today is a necessary, but time-consuming process that can cause nurses to lose focus on the real work of caring for patients. It can be challenging and frustrating, but it will ultimately improve productivity and patient care. When examining how you manage your time, ask if there are new skills, technology, or organization methods that can help you be more productive. When you are in “learning mode,” be patient and realize you cannot rush what you are trying to
do. If you are the “techy type,” share your knowledge and ideas with those around you. If you are a leader, make sure staff get support during important learning periods (in the end, this saves time) � Stress, hunger, and fatigue. Working long hours in a stressful environment without breaks or sustenance reduces brain power, concentration, and physical abilities. This is a common issue for nurses. I once spoke on a panel that included the U.S. Assistant Surgeon General and two professionals from Vanderbilt University. We had a 30-minute question-andanswer period. At least 20 minutes were devoted to answering questions from the audience like, “You say that breaks are important, but what do we do when we aren’t allowed to take breaks?” As nurses, we must acknowledge the importance of selfcare as caregivers. Just as nurses apply Maslow’s Hierarchy of Needs to patient care, Maslow’s theory points to the importance of nurses paying attention to their own basic survival needs (food, water, rest).6
Maslow's Hierarchy of Needs
Setting Priorities Setting priorities – a skill that comes with knowledge and on-the-job experience – is vital to time management. If nurses do not discriminate between what must be done now and what can wait, they may endanger their patients because all tasks will be considered equally important. Lots of minor things may get done while major issues go unaddressed. The 80/20 Rule, developed by Italian OCTOBER 2020 | OR TODAY |
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continuing education economist Vilfredo Pareto in 1906, is a great guide for setting priorities.7 Known as Pareto’s Principle, there are many applications of this rule. For example, people wear 20% of the clothes in their closet 80% of the time (think about this the next time you shop or arrange your closet). In nursing, the 80/20 rule can be applied in two ways: 1. On any given day, nurses have a full list of things they need to do for their patients. To prioritize, they need to identify the top 20% of tasks that MUST get done first – here is where nurses need to spend most of their time. 2. Twenty percent of nurses’ patients will generate 80% of the work that needs to be done. Therefore, prioritize your work on the 20% of patients that require the most care.
Nurses should stop for a moment to think about how the above applies to their daily work. Setting goals and making a to-do list are key steps in setting priorities. It can be challenging to sort through the details of all your tasks without visual cues that help you see the big picture. Once the to-do list is complete, you can analyze the tasks and decide where they fit into the bigger picture using the following scale.2 � First-order priority. Must do – important and urgent (e.g., addressing safety risks; assessing unstable patients). � Second-order priority. Must do – important but not urgent (e.g., routine vital signs). � Third-order priority. Nice to do – not as important and not urgent (e.g., chatting with a patient about his vacation). After organizing your list according to the preceding priorities, ask, “Are there things on this list that I could or should be delegating to someone else? If so, who is the best person to do the task?” Keep the tasks that you, and only you, can do; delegate the tasks that someone else can do (see next section
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on delegating safely and effectively). Stephen Covey, author of the classic self-help book, “7 Habits of Highly Effective People: Powerful Lessons in Personal Change,” gives an excellent model for setting priorities.8 His model, referred to as Covey’s Four Quadrants for time management, involves drawing a grid with the following four quadrants: � Quadrant 1. Urgent important activities (e.g., safety risks). � Quadrant 2. Things that are important, but do not have to be done immediately (e.g., patient discharge teaching). � Quadrant 3. Time-pressured issues. These are not really important, but someone wants it now (e.g., a patient who wants you to help him order a pizza). � Quadrant 4. Things that really do not need doing because they do not have much value (e.g., responding to every text message someone sends). If you search “Covey’s Quadrants Images” online, you will find good examples of how these quadrants are used in various contexts.
Delegating Safely and Effectively Almost every management article or seminar addresses the importance of delegation. Delegating tasks that do not require detailed attention gives nurses more time to focus on important priorities that only they are qualified to do. Yet, delegation is a highly complex skill that requires trained clinical judgment that considers both patient status and worker knowledge/ qualifications.2 Safe and effective delegation requires an understanding of the concepts of authority, responsibility, and accountability.9 What tasks are you authorized to delegate and to whom can you delegate? Who is responsible and accountable for the results? Knowing what your state’s Nurse Practice Act authorizes you to delegate – or prohibits you from delegating – is of utmost importance in keeping your patients
safe and protecting you from negligence lawsuits. If you are unsure about what you may or may not delegate, check the Nurse Practice Act’s policies and procedures or double check with your manager or unit educator. One of the most helpful documents addressing how to delegate is the American Nurses Association and the National Council of State Boards of Nursing’s Joint Statement on Delegation (https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA. pdf). Pointing out that there is more work to do than there are nurses to do it and that many nurses are stretched to the limit, this document addresses Five Rights of Delegation and Four Steps to the Delegation Process. Keeping in mind that delegation is defined as “authorizing someone to perform a selected task in a selected situation while retaining accountability for results,” here is a summary of what these rights and steps involve:
Five Rights of Delegation9 � The right task � Under the right circumstances � To the right person � With the right directions and communication � Under the right teaching, supervision, and evaluation
Four Steps of the Delegation Process9 1. Assess and plan. Consider the patient, the task, and worker competencies to make a plan for what tasks you will assign to whom. 2. Communicate. Give clear, concise, and complete directions about what to do, how to do it, what needs reporting, and when to touch base with you (verify that the worker understands directions). 3. Surveillance and supervision. Monitor the patient and worker performance as frequently as needed based on the above. 4. Evaluation and feedback. Evaluate the effectiveness of the delegaWWW.ORTODAY.COM
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continuing education tion by assessing patient response yourself. Decide whether you need to make changes in the patient’s plan of care or how the worker is completing the task. Evaluate the worker’s performance and give teaching and feedback as needed. (This helps the worker improve skills, ultimately freeing you for other important work.)
Factors Key to Successful Delegation10 � Assessment of best interest of the patient � Good communication � Positive relationships and attitudes � Clear job descriptions and policies � Level of nursing assistant’s competence and knowledge � Supervision and outcome evaluation While all of the preceding is important, remember the following rule: Nurses should always assess their patients themselves to determine the results of tasks they delegate. For example, if you delegated the task of getting someone out of bed twice a day, ask the patient directly how many times he got out of bed, how he felt about the experience, and if there is anything he would like to do differently. When you assess your patients directly, not only do you know the results, but your workers are likely to do a better job because they know they will be assessed. This helps ensure your patients are safe and, ultimately, saves you time because you quickly know when things are not going well. You do less backpedaling because you are dealing with facts rather than assuming that all is going well. From a time-management perspective, you will be able to stay focused on priorities and identify care issues and omissions early.
Nine Common Care Omissions11-13 1. 2. 3. 4. 5. 6.
Ambulation Turning Delayed or missed feedings Patient teaching Discharge planning Emotional support
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7. Hygiene, including oral care 8. Intake and output documentation 9. Attending interdisciplinary conference Research has identified inadequate labor resources as the primary reason for missed care, including unexpected increases in unit acuity, insufficient unit staffing, and/or insufficient numbers of assistive personnel (nursing assistants, unit secretaries).12, 13
Best Practices Organizations can also implement best practices to save time. For example, Ruth Hansten, PhD, RN, FACHE, principal of Hansten Healthcare, has helped more than 175 hospitals to improve outcomes through focused, effective teamwork. She developed a bundle of 10 best practices to improve outcomes and save time.14, 15 There are two practices that are especially important: better planning and enhanced team communication that focuses on patient/family expectations/results. Hansten points out that when nurses set up a plan with assistive personnel for communication – including initial communication to set expectations, timelines for getting things done, parameters for what should be reported, and planning for specific checkpoints throughout the shift – they report saving up to an hour a shift. This “found” time comes from ensuring there is no duplication of work or time wasted searching for colleagues or data by giving direction early in the shift and ascertaining what tasks will be done within a reasonable time. Hansten stresses the importance of shift report at the point of care with a focus on patient/family preferred goals and priorities. This helps patients feel engaged in the process as the whole team navigates toward individualized desired outcomes. Nonessential and redundant care is avoided while all efforts focus on the patient’s goals. The entire team streamlines their work and initiates a process that means less omitted care; fewer healthcare-acquired conditions, such as
pressure ulcers or falls; and reduced readmissions from unplanned transitions. Nurses report saving at least a half hour per day thanks to an efficient point-ofcare handoff process. Hansten’s findings are supported by several articles on bedside shift reports and critical processes in patient care that promote patient safety and reduce medical errors.16
Time-Management Tips Here are some time-management tips you can use in your daily nursing practice: � Start well. Arrive early so you can review your assignment, check whom you are working with, and get organized. If it seems that you are not able to arrive early, consider your prework routine. Are there improvements you could make in time management at home? Would simple strategies like setting your alarm clock 15 minutes ahead, not answering phone calls, or avoiding technology before work help? � Identify major goals for the day and make a to-do list. Revisit your list frequently during the day, deciding what has been done and what still needs to be done. Focus on “must-do” tasks before “nice-to-do” tasks. You may use paper to-do lists or a recommended time-management app to make sure you do not miss the things that are not addressed in electronic health records (EHR). � Make charting high priority. Complete patient records as soon as you can. This is especially important in acute care settings. Charting often triggers you to recognize something important that needs to be done. With some EHRs, when you enter in certain data, the system cues you to consider patient status changes or other things that must be done. Charting creates records that promote safe patient care. These records may serve in your defense if you are accused of negligence. Your records are likely to reflect a lack of care if OCTOBER 2020 | OR TODAY |
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continuing education you chart in a rush at the end of the shift. You may be an excellent nurse, but if your charting does not show that, you and your patients may be in jeopardy. � Build relationships with staff at all levels. The saying “credentials on a wall do not make you a decent human being” applies. Teamwork is all about relationships and empowering your coworkers. When your team experiences miscommunications, these relationships will help you fix them without pointing fingers and wasting time. You will be able to find solutions by staying focused on common goals: you all want to give good care. � Engage patients and families. Ask them, “What’s the most important thing you want to get done today?” Let patients know what they are allowed to do for themselves (many will be unsure). Teach them what they need to know to be independent. Let them know when you will be off the unit and who will be covering their care. � Set limits. It is easy to keep adding to your to-do list. If your list keeps growing, you may not have time to focus on your own priorities and patients. Do not be afraid to say, “I can’t right now. Can you get someone else?” � Create routines such as doing huddles at specific times during the day. Huddles should be less than 10 minutes and can be held at the beginning of the shift or whenever significant changes in work flow arise. Getting the team in a huddle to discuss what is happening and making adjustments to improve work flow can help patients and staff. A recent study concluded that huddles improved efficiency and quality of information shared and increased levels of accountability, empowerment, and sense of community, which together create a culture of collaboration and collegiality among staff members.17
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� Reduce clutter and organize the environment. A cluttered environment distracts the mind from the most important things. Designate places for specific things (e.g., frequently needed equipment) and tasks (e.g., charting, education). � When under pressure, ask, “What’s the most important thing I have to do right now?” Stay focused on the most important task in the present moment. � Cluster activities before entering a room. Think ahead and anticipate needs (e.g., a need for pain medication). � If you feel overwhelmed or “out of your league,” ask for help. For example, you may need to call the pharmacy to answer your questions or notify the rapid response team if you are concerned about a patient. Delays in getting help contribute to poor patient outcomes. � Reserve time in your daily schedule for unexpected events. Work ahead because a new admission or patient crises may put you behind. � Stay on task and see things through. You will get better results, be more focused, and get a sense of accomplishment. Multitasking is risky, especially if you have a lot of interruptions. You may end up doing a little bit of a lot of things but not complete any one major undertaking. � Build time in your personal life for rest, fun, and renewal. Steven Covey calls this “sharpening the saw.”8 He tells a story about a man who is trying to cut down a large tree. He keeps sawing at the huge trunk until the blade becomes dull, and it is almost impossible to continue. Seeing his struggle, a passer-by asks him why he does not stop and sharpen the saw. The man responds, “I don’t have time.” The man then continues sawing ineffectively with tired muscles and a dull blade. This story also applies to the way of thinking that you do not have time to change
to something new. If the tools you are using – for example, a computer system – is old and ineffective, making the time to update may be a high priority. � If you are struggling with time management, ask your preceptor, manager, or trusted coworkers to share their time management tips with you. There are many different work styles, and we can all learn from one another. There will always be more than enough requests, demands, and distractions that nurses will face. Time management will continue to be a core skill and challenge of 21st century nurses. As circumstances change, nurses will need to develop new approaches. Developing these skills helps nurses manage their work more efficiently. It does not mean cutting corners or reducing quality. It means using the resources to get the best results for their patients and healthcare team. Nurses who gain control over how they use their time boost performance, gain a sense of satisfaction, reduce stress, and keep patients safe. EDITOR’S NOTE: Rosalinda AlfaroLeFevre, MSN, RN, ANEF, previous author of this CE activity but has not had an opportunity to influence this version. Relias LLC guarantees this educational activity is free from bias. 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 at an 800+ bed magnet hospital.
References 1. Sahito Z, Vaisanen P. Effect of time management on the job satisfaction and motivation of teacher educators: a narrative analysis. International Journal of Higher Education. 2017;6(2):213224. doi: 10.5430/ijhe.v6n2p213 2. Alfaro-LeFevre R. Critical Thinking, Clinical WWW.ORTODAY.COM
CE712
How to Earn Continuing Education Credit Reasoning and Clinical Judgment: A
https://www.ncsbn.org/Delega-
Practical Approach. 6th ed. Philadel-
tion_joint_statement_NCSBN-ANA.
phia, PA: Elsevier-Saunders; 2016.
pdf. Published 2005. Accessed July 9, 2019.
1. Read the Continuing Education article. 2. Go online to ce.nurse.com to take the test for $12. If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at https://www.nurse.com/ sign-up for $49.95 per year.
3. Sørensen EE, Brahe L. Interruptions in clinical nursing practice. J
10. Taylor K. Principles of delegation
Clin Nurs. 2014;23(9-10):1274-1282.
and accountability. Practice Nurse.
doi:10.1111/jocn.12329.
2015;45(7):40-43.
4. ISMP Medication Safety Alert!
11. Klein CJ. Delegation, Documenta-
Side tracks on the safety express.
tion, and Knowledge of Evidence-
Interruptions lead to errors and
Based Practice for Oral Hygiene.
unfinished … wait, what was I doing?
MEDSURG Nursing. 2017;26(4):242-
Institute for Safe Medication Prac-
247.
tices Web site. http://www.ismp.org/ newsletters/acutecare/showarticle.
12. Saqer TJ, AbuAlRub RF. Missed
aspx?id=37. Published November
nursing care and its relationship
2012. Accessed July 9, 2019.
with confidence in delegation among hospital nurses. J Clin Nurs.
5. Westbrook JI, Woods A, Rob MI,
2018;27(13/14):2887-2895. doi:
Dunsmuir WT, Day RO. Association
10.1111/jocn.14380
of interruptions with an increased risk and severity of medication
13. Bragadottir H, Kalisch B. Com-
administration errors. Arch Intern
parison of reports of missed nursing
Med. 2010;170(8):683-690. 10.1001/
care: Registered Nurses vs. practical
archinternmed.2010.65.
nurses in hospitals. Scand J Caring Sci. 2018; 1-10, doi: 10.1111/scs.12570
6. Phillips C. How to maximize employee health and productiv-
14. Hansten R. A bundle of best bed-
ity: Maslow s “hierarchy of needs”
side practices: field evidence. Health
shows how individual needs
Care Manage. 2009;28(2):111-116. doi:
affect the work environment.
10.1097/HCM.0b013e3181a2cb0b.
New Hampshire Business Review. 2018;40(5):20.
15. Hansten R. 10 best practices for nursing at the bedside [webinar].
7. Reh FJ. Pareto’s principle: the
http://rrohc.com/OverviewRRO-
80-20 rule. About.com Web site.
HCWebinar_Slides_2_28_2013.
http://management.about.com/
pdf. Recorded February 28, 2013.
cs/generalmanagement/a/Pa-
Accessed July 9, 2019.
reto081202.htm. Accessed July 9, 2019.
16. Gregory S, Tan D, Tilrico M, Edwardson N, Gamm L. Bed-
8. Covey S. The 7 habits of highly
side shift reports: what does
effective people: Powerful lessons
the evidence say? J Nurs Adm.
in personal change (25th ed.). New
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York, NY: Simon & Schuster, 2013.
NNA.0000000000000115.
9. American Nurses Association
17. Goldenhar L, Brady P, Sutcliffe
and the National Council of State
K, Muething S. Huddling for high reli-
Boards of Nursing. Joint statement
ability and situation awareness. BJM
on delegation. National Council of
Quality Safety. 2013;22(11):899-906.
State Boards of Nursing Web site.
doi: 10.1136/bmjqs-2012-001467.
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Deadline Courses must be completed by 9/5/2022 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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CORPORATE PROFILE
healthmark
Healthmark
Going the
EXTRA
MILE
T
his year has been challenging for the health care industry, businesses and the way we go about our everyday lives. COVID-19 has made us all go the extra mile to think about patients, employees and everyone’s safety overall. Over the years, Healthmark has focused on providing innovative solutions for infection control to health care facilities. Healthmark Industries was established in 1969 in Grosse Pointe, Michigan by Ralph A. Basile and his wife, Suzanne. After a successful career in medical sales, Ralph decided to start his own company. In the early days, Healthmark was operated out of the family home, for their first generation products. After a few years of success and growing business, Healthmark moved to its first “real” office on the corner of Mack Avenue and Harvard Road in Grosse Pointe Park. Continued success led to the need for a larger facility, and in 1979 Healthmark moved to a building on 9 Mile between Mack and Jefferson in St. Clair Shores. From the beginning, Healthmark operated as a family business. Sons Ralph, Mark and Steve were among
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Healthmark’s first employees, stamping literature with the company information on a pay-for-piece basis. As time went on, each of the sons, at different times and with different prior experiences, joined the family business and helped it grow. Healthmark’s founder and patriarch, Ralph A. Basile, passed away in 2001 after a battle with cancer. Through the efforts of his wife, three sons, grandchildren and many loyal employees, the company has continued to grow. Over the years Healthmark has expanded its product line to fit the needs of health care facilities. COVID-19 continues to be a critical issue in health care across the country. Communication is more important than ever. Healthmark developed custom signs and label-
ing product lines for hospitals and health care facilities to use in the fight against COVID-19. “One of the ongoing challenges in the health care industry is to effectively stay safe as the amount of surgeries increase during these times,” says Ralph Basile, vice president. Healthmark has always offered products designed to help hospitals and health care facilities provide safe environments. One of the most innovative products for the operating room that Healthmark offers is the Insulation Tester. Designed for electrically 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. 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 in order to prevent inadvertent tissue burns, which may occur during electrosurgical instrument procedures. Manufactured with a rechargeable battery, the Insulation WWW.ORTODAY.COM
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Healthmark Tester maintains applied test voltage with constant current source, features full test current at low voltages, limited output current for operational safety, easy to read LED Indicators, as well as LED display of alarm and battery charge. The Insulation Tester comes with the following reusable and interchangeable accessories: ground wire with alligator clip, ring electrode, tri-hole electrode, brush electrode, saddle and case. The Bi-Polar Fixture accessory that works in conjunction
with the saddle, ground wire and brush electrode can be purchased separately. Additionally, an optional Wire Tester accessory used with an HV Red Lead Wire is available for testing wires by locating and identifying defects such as pinholes or cracks in the conductive core. StyleYourPPE.com is a site created by Healthmark where health care professionals can purchase PPE and other attire for individual use. Face masks, Cool Aids and other PPE attire are available as well as socks
that are creatively designed to add a little fun to a serious dress code. Healthmark continuously strives to create educational opportunities for health care professionals to earn CEUs. This past year, Healthmark added free bi-weekly webinars hosted by its clinical educators and other professionals around the industry. Additionally it has added a new “Ask the Educator� podcast, hosted by Kevin Anderson. Both can be registered directly on the website at http://hmark.com/education.php.
Healthmark's MM513-100 Insulation Tester.
Over the years, Healthmark has focused on providing innovative solutions for infection control to health care facilities. WWW.ORTODAY.COM
OCTOBER 2020 | OR TODAY |
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CORPORATE PROFILE
Healthmark
In addition to the new webinars and podcasts being offered, Healthmark launched its newest online game on Crazy4Clean.com late last year, “The Instrument BodyGuard.” It is another unique free service that Healthmark offers. Crazy4Clean.com is a website that consists of educational games designed to teach health care professionals about proper reprocessing of instruments/equipment while earning free CEUs.
“Games are a great way to learn. They simulate experiences that teach you new skills while you’re entertained,” said Basile. “This will be the fifteenth game we have launched on Crazy4Clean.com and we are very excited for everyone to play it online.” At the end of each game, players receive a free CEU by completing a quiz based on what they’ve learned. If you are looking for indus-
try news, helpful hints and other information, Healthmark produces a weekly newsletter that is distributed to thousands of readers. Each Healthmarket Digest features a story written by a member of the Healthmark team as well as a weekly coupon. For more information about Healthmark Industries, visit www.hmark.com or call 800-521-6224.
(Left) Custom Covid signs and floor signs made at Healthmark. (Below) Healthmark's newest facemask.
38 | OR TODAY |
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SAFELY RETRIEVE REUSABLE SHARPS WITH AN SST SYSTEM A simple & effective way to protect personnel, patients and the environment from contaminated sharps The SST System provides for safe handling and transporta�on of soiled reusable instruments in compliance with OSHA Guidelines. SST’s are three-part container systems: Solid base tray, SteriStrainer drain basket and cover. Placed near the procedure site, the tray system is used to collect the instruments. Covered, it is then safely transported to the decontamina�on site. There the cover is removed, and the Steri-Strainer is li�ed out of the solu�on and the decontamina�on process safely begins.
Cover biohazard symbols on your SST Systems with our green 4”x 4” Removable Clean Label
Manufactured to convey key informa�on to healthcare professionals, the clean label is intended to conceal and cover the biohazard symbol on SST systems when transpor�ng clean medical instruments. The 4x4 inch design includes a removable adhesive backing. Prior to use, ensure the applica�on surface area is dry and simply apply the label with firm thumb pressure.
TRANSPORTATION IDENTIFICATION TAG 2 in 1 Removable Label For Effective Communication Designed for compliance with OSHA standard CFR 1910.1030, this 3.125” x 5.125” label includes one perforated tab, a green top tab with “CLEAN” a fluorescent orange/red bo�om tab with “DIRTY”, and the removable OSHA approved “Biohazard Label” adhesive backing. Available with or without the checklist shown.
HMARK.COM | 800.521.6224
By Don Sadler
40 | OR TODAY |
OCTOBER 2020
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COVER STORY
A
s COVID-19 restrictions have loosened in most parts of the country, elective and nonessential surgeries have been allowed to resume at many hospitals and ambulatory surgery centers (ASCs). While this is obviously good news for patients and health care facilities, the reopening process has been fraught with challenges. “Shutting down was the easy part,” says Renae Battié, MN, RN, CNOR, vice president of nursing for the Association of periOperative Registered Nurses (AORN). “The restart has been much harder.”
ASCs Are Pivoting At the onset of the pandemic, as state regulators determined to suspend elective surgeries, many ASCs had to either limit the number and type of cases performed in their facilities or close their doors temporarily, notes The Joint Commission. “Considerations were made to reduce unnecessary exposure to ASC patients and staff since patient and staff safety is The Joint Commission’s number one priority,” says Pearl S. Darling, MBA, the executive director of Ambulatory Care Services for The Joint Commission. To preserve access to care and serve the ASC community, as well as mitigate losses, many ASCs were able to pivot, Darling says. “Some have partnered with their local health agencies and health systems to address emergency cases that can be performed safely,” she says. “Some ASCs have been able to resume elective surgeries while putting precautionary steps in place,” adds Jamie Ridout, RN, MSN, MBA, NEABC, CNOR, CASC, the administrator at Capital City Surgery Center in Raleigh, North Carolina. This includes his facility, which Ridout says is running “at full operation.” According to Ambulatory Surgery Center Association (ASCA) Board President Michael Patterson, RN, ASCs in every state are now free to perform emergency and elective surgeries. “ASCs are experiencing WWW.ORTODAY.COM
significant pent-up demand, which is a reminder that elective surgery is not the same thing as unnecessary surgery,” he says. The federal government has enacted a series of waivers making it easier for ASCs to provide outpatient surgery to patients who are unable to get the care they need in hospitals inundated with COVID-19 patients, Patterson notes. “Many states have followed suit,” he says, “either adopting the federal rules or specifying policies of their own.” Keith Griffis, the executive director of marketing for Surgical Endoscopy and Systems Integration for Olympus Corporation of the Americas, believes that ASCs – which have been hard hit by the pandemic and are looking for ways to make up lost revenue – are in a good position to pick up the case volumes that have been restricted within hospitals. “Some patients may be hesitant to visit hospitals where the focus for months has been on fighting the pandemic,” he says. “They may be more likely to want to see a doctor at an ASC.” The agility of ASCs could serve them well during this time, Griffis adds. “They have the ability to screen and limit COVID exposure in a dedicated facility,” he says. “ASCs can also offer scheduling flexibility and a purpose-driven procedure mix.” Darling concurs: “ASCs are nimble and responsive, meeting patient needs in ways that other health care settings aren’t able to in these times.”
Reopening Guidance for ASCs A number of organizations have issued guidance regarding the criteria ASCs should follow in fully reopening their OCTOBER 2020 | OR TODAY |
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facilities and ramping back up to prepandemic levels. ASCA has published a collection of these guidelines in its COVID-19 Resource Center, which is available online atascassociation.org/ covid-19. “For the most part, ASCs can resume cases while ensuring a few considerations are in order,” says Darling. These include the following: � Sustained reduction in the rate of new COVID-19 cases in the relevant geographic area for at least 14 days before resumption of elective surgical procedures. � Allowance to resume by local municipal, county and state health authorities. � Collaboration with local health providers for coordination of care if needed. � Assurance that the appropriate numbers of trained and competent staff are on hand. � Updated staff with knowledge of current trends and issues regarding COVID-19. “Most of the statements issued to help ASCs and others resume nonemergent care contain recommendations rather than mandates,” says Patterson. “But in some states, ASCs are now required to conduct COVID-19 tests on their patients before they can have surgery.” Patterson stresses that ASCs are putting patient safety first by enforcing strict infection prevention practices already in place and adopt-
ing new testing, personal protective equipment (PPE) and social distancing protocols designed to prevent the spread of COVID-19. These measures appear to be working as evidenced by a recent study conducted by the ASC Quality Collaboration. The study found that out of more than 84,000 patients who underwent surgery at 709 ASCs between March 15 and April 30 of this year, only 16 were found to be COVID-19 positive within 14 days of their surgery. “None of these cases could be linked to the care the patients received in the ASC,” says Patterson.
AORN Roadmap and American College of Surgeons Checklist AORN has published a comprehensive “Roadmap for Resuming Elective Surgery After the COVID-19 Pandemic.” A joint statement accompanying the release of the roadmap stressed that before resuming elective procedures, hospitals should wait until there has been a sustained reduction in the rate of new COVID-19 cases in the area for at least 14 days. In addition, hospitals should ensure that they have adequate numbers of trained staff and supplies, including PPE, beds, ICU and ventilators to treat non-elective patients without resorting to a crisis-level standard of care. The roadmap includes eight key principles and considerations to guide
hospital OR personnel in the resumption of elective surgeries. Highlights include the following: � Implement a policy for testing staff and patients for COVID-19 that accounts for accuracy and availability of testing and a response when a staff member or patient tests positive. � Form a committee that includes surgery, anesthesiology and nursing leadership to develop a surgery prioritization policy. This policy should factor in previously canceled and postponed cases and allot block time for priority cases like cancer and living donor organ transplants. � Adopt COVID-19-informed policies for the five phases of surgical care, ranging from preoperative to post-discharge care planning. � Collect and assess COVID-19-related data that will be used to frequently re-evaluate and reassess policies and procedures. � Create and implement a social distancing policy for staff, patients and visitors in non-restricted areas in anticipation of a second wave of COVID-19 activity. “The roadmap has been especially helpful as hospitals review their backlog of cases to prioritize which surgeries should be performed first,” says Battié. “Hospitals I’ve talked to recently are back up to between 75 and 100 percent of their pre-COVID-19 volume.”
ARTICLE CONTRIBUTORS
ANN GEIER
RENAE BATTIÉ
MICHAEL PATTERSON
MS, RN, CNOR, CASC
MN, RN, CNOR
RN
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COVER STORY
The full roadmap is available at aorn.org/guidelines/aorn-support/ roadmap-for-resuming-elective-surgery-after-covid-19. Additionally, the American College of Surgeons has published a 10-point checklist offering a set of principles to guide local facilities as they plan for resumption of elective surgical care. The checklist includes: 1. Know your community’s COVID-19 numbers, including prevalence, incidence rates and isolation mandates. 2. Know your COVID-19 diagnostic testing availability and develop operational testing policies for patients and health care workers. 3. Be aware of local PPE availability and develop policies for health care workers. 4. Know your facility’s capacity in terms of beds, ICUs and ventilators, including expansion capacity (e.g., weekends). 5. Make sure that a steady supply of products and supplies will be available from traditional or new vendors. 6. Address workforce staffing issues – for example, through contingency planning and multidisciplinary staffing coverage for routine and expanded hours. 7. Assign a governance committee to clarify, interpret and iterate policies; make real-time decisions; and initiate and communicate messaging. 8. Devise a patient communication plan to answer the myriad questions surgery patients may have during the ramp-up period. 9. Create a surgery prioritization and protocol plan. 10. Ensure safe, high-quality and highvalue care of surgical patients across the Five Phases of Care continuum: preoperative, immediate preoperative, intraoperative, postoperative and post discharge.
Reopening Challenges Ann Geier, MS, RN, CNOR, CASC, chief nursing officer with Surgical Information Systems, moderated a panel discussion at this year’s virtual AORN WWW.ORTODAY.COM
“ The rules and regulations ASCs are facing can be overwhelming and they change constantly. It’s a good idea to assign one staff member to keep up with them – otherwise, you can get behind the eight-ball quickly.” – Ann Geier, MS, RN, CNOR, CASC conference in which the panelists discussed some of the experiences and challenges they’ve faced in reopening their ASCs. She says one of the main challenges discussed by panelists was patient testing. “Who should be tested and when?” says Geier. “And what if test results are delayed – should you cancel cases? If so, you’re going to have some very upset patients.” Staff should also be tested and their temperature should be checked regularly. “Ask staff the standard questions and keep a record of everything in case you need to prove it to a surveyor,” says Geier. Ideally, an infection preventionist should coordinate all of this and keep everything organized in one notebook. “Make note of all the regulations that have affected your center and the actions you took to comply with them,” says Geier. Patterson concurs with the testing challenges faced by ASCs. “Testing supplies can be difficult to come by and the time needed to get test results appears to be increasing as more tests are being done,” he says. “ASCA is continuing to work with federal officials and others to reach solutions to this concern.” Staffing is another big challenge. “At first, some staff whose family members were still at home were reluctant to return to work due to concerns about increasing their risk of exposure to COVID-19,” says Patterson. “Now, some staff still facing additional demands at home do not want to return fully to their former schedules.” According to Geier, the problem of laid off or furloughed employees who are receiving generous unemployment
benefits not wanting to return to work is very real. “So is the problem of childcare for staff with young children at home and nobody to watch them if their school and daycare facilities have been closed,” she says. In addition, some staff are reaching burnout as their regular eight-hour days are being stretched to 10 or 12 hours or longer. “They’re tired and grumpy and they didn’t sign up for this,” says Geier. “They need a break but there’s no help on the horizon.” “The rules and regulations ASCs are facing can be overwhelming and they change constantly,” Geier adds. “It’s a good idea to assign one staff member to keep up with them – otherwise, you can get behind the eight-ball quickly.”
Diligence is Key Ridout believes that the key to meeting the challenges of reopening lies in “diligence and adherence to the processes you’ve put in place.” “We all want to keep our staff, patients and visitors as safe as they can be,” he says. Meanwhile, Darling stresses the importance of assigning leadership oversight and accountability in the areas of staff and patient safety and infection prevention. “Team leaders can take the reins in ensuring that communication channels are open while continuing to stay abreast of current regulations and infection rates within their community,” she says. “They should also continuously educate their staff on the latest updates in safety and infection control practices.” OCTOBER 2020 | OR TODAY |
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SPOTLIGHT ON:
RebEccA VotinO, BSN, RN, ONC
Director of Perioperative Services at Magruder Hospital in Port Clinton, Ohio By Matt Skoufalos
s
ituated at the mouth of the Portage River on Lake Erie, Port Clinton, Ohio is a community defined by “the lake life,” said Rebecca Votino. Its population fluctuates seasonally, boosted by fivefold in the summer months, when vacationers flood the county seat to visit the Walleye Capital of the World. Serving them year-round is Magruder Hospital, where Rebecca Votino, its new director of perioperative services, supervises 30 direct employees who perform some 3,000 cases a year on average. The position at Magruder reflects a significant change from her prior appointment at Bon Secours Mercy Health, where Votino oversaw perioperative services and pre-admission testing for a 12-bed operating room, performing 7,500 cases annually with 80 direct employees. “My experience is in other larger, busier, OR arenas, but I’m helping to
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take Magruder into the next level of perioperative health care and what we can do in that arena – and on top of that, I got to transition in the middle of a pandemic,” she said. Votino began her tenure at Magruder on April 4, 2020, “right in the thick of the halt to elective surgery in the state of Ohio” because of the novel coronavirus (COVID-19) pandemic. Her first introduction to many of those 30 new direct reports was over the telephone, as she began calling to see who among them would consider being voluntarily furloughed.
Rebecca Votino, in a scrub cap repping her Cleveland Indians, is the director of perioperative services at Magruder Hospital. WWW.ORTODAY.COM
Rebecca Votino in costume to perform songs from "Beehive: a 60s Musical" in a community theater production.
“I knew there was no way I was going to be able to keep people on the clock,” Votino said. “It offered me a really good opportunity very early on, to demonstrate my leadership style, and the way I’ve chosen to try to lead folks with as much autonomy as you can give.” With the support of senior hospital leadership and the human resources department, Votino engaged her staff about their individual circumstances, trying to discover what considerations were best for them, reassuring them that their positions were secure and offering guidance about available options. “I’m not just coming in here with a broadsword and making decisions, not giving people choice or autonomy,” she said. After the surge in COVID-19 cases in Ohio retreated from its spring peak, Votino transitioned staff back into the surgical setting amid ever-shifting pandemic guidance. In managing those leadership challenges, she has drawn upon the example set by one of her nursing mentors, Mary Jane Patterson, her former supervisor at Fisher-Titus Medical Center in Norwalk, Ohio. “[Patterson] was fair, consistent and transparent about her leadership style,” Votino said. “I’ve carried that with me. She was never one to talk out of both sides of her mouth; she was going to give the same answer to her staff as she would to the physicians. She held you highly accountable for your word, but she also would back you if she knew your work was good, your character was good.” Patterson’s approach to leadership reflected some of Votino’s first experiences with the “Just Culture” concept, WWW.ORTODAY.COM
which emphasizes isolating systemic points of failure rather than assigning individual blame when something goes wrong in the hospital. Votino views the Just Culture approach as emblematic of a professional transition to ownership and accountability from the blame and finger-pointing that reared its head earlier in her career. “It was terrifying to be a new nurse when I was young,” she said. “There were a lot of nurses who tried to trip you up, who thought that was how to make you better. Then there was a point in which it almost became too forgiving, too soft, to where we weren’t quite keeping people as accountable as we should have. Now we have found that happy medium.” “I like to give nurses my expectations, and follow it up with the promise that when they follow them, I will back them to the carpet,” Votino said. “That empowers them; I’m a conduit and an insulator.” Votino has seen the profession evolve significantly over the 24 years she’s spent in it. In high school, she worked as a candy striper even as she considered a career in medical school. Her time in the hospital made Votino realize that what she was really seeking was the nurse-patient relationship, not the physician-patient relationship, “and that switched my gears,” she said. Out of high school, Votino completed an eight-semester BSN consortium program led by Bowling Green State University and the University of Toledo Medical College, and began her nursing career in the summer of 1996. Subsequently, she attained certifications in neonatal resuscitation, critical care, obstetrics, advanced cardiac and pediatric life support, and orthopedic nursing, and presently helps write certification questions for her fellow nurses with the Orthopaedic Nurses Certification Board. Nonetheless, “I’ve come to realize that OR is where my heart is,” she said. “It’s a tough arena,” Votino said. “You’re in cases with physicians some-
times four, five, six hours in one case; see them day in and day out, hours at a time.” “It’s a much more collegial teamwork arena,” she said. “It can become challenging; it can become charged. You have to have a thick skin, so it’s not for everyone. But no specialty of nursing is for everyone. That’s something I’ve always told students is great about nursing: you can find a specialty that you’re drawn to, and you can find a schedule that fits your lifestyle.” Votino is living proof of that tenet: she’s worked in various care settings, from labor and delivery at Providence Hospital in Sandusky, Ohio to the intensive care unit at Fisher-Titus, where she met Patterson, to University Hospitals Elyria Medical Center, in Elyria, Ohio, where she built relationships that bridged the perioperative services center with the patient care side of the business. As she begins her new position at Magruder, Votino has high hopes for where the future of her nursing career will take her. “It’s a strong community hospital,” she said; “they have a focus on their patient population and their staff. I really feel like it’s a great place to be, and I’m hopeful that I continue to feel that way.”
Rebecca Votino with her husband, Adam.
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OUT OF THE OR fitness
Cardio for a Strong Heart By Miguel J. Ortiz here are plenty of reasons why you should do cardiovascular activity, but the most important is for a strong heart. Beyond the fact that the most important muscle in your body is your heart, the roll that oxygen plays in cardio or strength training is absolutely essential. When exercising, your muscles need to work harder which naturally increases demand for oxygen. Once the oxygen reaches the muscles it begins to convert glucose into ATP (energy). Regardless of how you look at it, when your body has more oxygen you will perform and recover better. You have your heart to thank for that. Yes, the lungs are important, but a strong heart helps move oxygenated blood through the body. So, let’s strengthen the heart. Here are some tips to get the most out of cardio training.
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First, warm up. Your basic 5 to 10
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minute light stretch is going to prepare the muscles for work and get the heart to start moving blood to the areas being stretched. You can do foam rolling, active stretching, light band work or a speed walk to a light jog and walk again to get the blood flowing. Whatever you do to warm up, don’t skip it. It will have your heart ready for action. Second, I usually recommend long slow distance (LSD) cardio training that can last 20 to 60 minutes at a low or medium intensity. This is great for beginners, someone looking to introduce cardio to their routine or someone who wants to burn fat. Remember fat can only be burned when oxygen is present in the body, so if you keep your heart rate too high for too long your body has the potential to burn less fat. So, keep a consistent pace to ensure your heart can handle the demand. If you start to cramp or you feel like your heart rate cannot last for the speed you’re at, then simply slow down but try to keep momentum. This way you can find your target “feel good” comfort zone and compare that to your actual heart
rate. I do have to add that highintensity interval training (HIIT) can help as well, but make sure your recovery times and ability are achievable. It is good to push yourself or test your abilities but make sure you are getting some longer, slower cardio in. The heart thrives in its ability to endure, so train endurance. Lastly, don’t forget to cool down as it helps lower the heart rate, further strengthening the heart and calming the nervous system. I personally like to perform some light active stretching when I’m done, nothing as intense as my warm up or my recovery days. I do a simple light stretch where I barely hold the movement for a second or two. So, when thinking of cardio, think about strengthening the most important muscle in your body – your heart. Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a member of the National Personal Trainer Institute and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz.
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OUT OF THE OR health
Acute Exercise has Beneficial Effects on the Immune System During Prostate Cancer ew research published this year in Experimental Physiology found that in prostate cancer survivors, a moderate session of exercise kept the cell count of a certain type of immune cells at a normal level, suggesting the exercise is safe for prostate cancer survivors. Twenty-four hours after a moderate session of cycling, the immune cell count of natural killer (NK) cells, part of the body’s first line of defense, had returned to resting levels.
N
Prostate cancer treatments, including androgen deprivation therapy (ADT), have numerous adverse effects that reduce physical function and quality of life. Exercise is recommended for cancer survivors to reduce the side effects of treatment and has been shown to have many benefits. However, the effects of prostate cancer treatment and acute exercise on the immune system have only been briefly examined. Exercise oncology guidelines were initially based on the responses seen in healthy, older adults. But individuals with cancer have different physiological responses to exercise, many of which we are only just beginning to understand. Exercise helps the immune system mobilize by causing NK cells to move into the blood and be transported to areas of need, such as sites of infection or tumors. At the tissues, these cells move out of circulation and in cancer patients
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they can then infiltrate the tumor and potentially slow the tumor’s rate of growth. This has been shown very elegantly in animal models but the exercise and immune response in cancer survivors is limited, with only a few studies in prostate cancer. The researchers, based at Victoria University in Australia, had volunteers (11 cancer survivors currently receiving ADT treatment, and 14 men with prostate cancer not on ADT, and 8 healthy controls) complete a cycling task to determine their maximal aerobic fitness. The researchers chose to use a moderate intensity exercise session that was consistent with current exercise oncology guidelines but was also a session that would be practical for prostate cancer survivors to perform on their own. To ensure that the exercise session used to stimulate the immune system was the same degree of difficulty for everyone, they standardized based on their maximal effort. To determine immune function, they obtained blood samples before exercise, immediately after and 2 hours after they finished cycling. The participants then came back the next day (24 hours after exercise), and immune function was assessed again after one night of recovery. They also measured several key hormone levels, including adrenaline and noradrenaline, as they play a role in activating and mobilizing the NK immune cells. The researchers found that 24 hours after a moderate session of cycling, the immune cell count of natural killer (NK)
cells, part of the body’s first line of defense, had returned to resting levels. They also showed that the immune cell mobilization with exercise does not appear to be significantly altered during prostate cancer treatment, which provides direct evidence that acute exercise that falls within current oncology guidelines also appears to be beneficial for the immune system. A limitation of the study is the modest sample size, and also that they examined cytokines and proteins that are related to NK cell function but did not directly assess the killing capacity of the NK cells. Erik D Hanson, first author on the study said, “One of the most enjoyable aspects of working with these men is how willing these men are to help their fellow prostate cancer survivors. Many of them realize that these studies are not likely to benefit them directly. However, they do not hesitate to volunteer and are willing to do just about whatever is asked of them for the collective good.” WWW.ORTODAY.COM
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OUT OF THE OR EQ factor
Life System Motivations By daniel bobinski his is the final installment in a series about the six learned (extrinsic) motivators. The first installment examined the different ways people are motivated by knowledge. Then, we looked at how tangible things – including money – may or may not motivate us. Following that, we looked at how we are driven by our surroundings. Then, we examined different ways people are motivated to give to others, and last month we looked at different ways people are motivated to exercise their power.
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In this final installment we’ll examine how different approaches to having a “life system” can drive our behavior. (Find all six columns at https://bit. ly/2Qu5Zhm.)
The motivational spectrum of ‘rules for living’ This last spectrum has to do with if and how we’re driven by systems for our personal values and beliefs. Before I dive in, you should know all six of the spectrums in our motivational model could be described as values, but this last category has to do with how much we adhere or don’t adhere to a defined system for living. At one end of the Life Systems WWW.ORTODAY.COM
scale are people we call structured; at the other end are those we call receptive. As the “structured” identifier implies, people who prefer that end of the spectrum are motivated to follow a structured set of guidelines. Conversely, receptive people often resist structure, being drawn instead to new ideas and opportunities for how to live life.
Traits of a structured person People on the structured side of the spectrum place a high value on working within a defined system or established structure that correlates to their chosen principles and beliefs. They desire consistency in how they organize their life and their work teams. Structured people often support causes that align with time-tested, traditional beliefs. Individuals with strong structured motivations enjoy working with others who hold beliefs similar to theirs.
Traits of a receptive person People with a receptive motivator have a drive to consider new systems and new ways of doing things, and will quickly adopt new practices if they see the possibility of a benefit. They may seek change for the sake of trying things a new way and can even be openly resistant to structured approaches. Individuals with receptive prefer-
ences are often good outside-thebox thinkers and get excited about exploring new options and new ways to do things.
Putting it all together A good student of emotional intelligence strives first to understand self, and a great framework for learning about oneself is “head, hands and heart.” Head is one’s cognitive style, hands is one’s behavioral style and heart is one’s motivational preferences. This series on motivators has provided an overview of the “heart” aspect – what drives, or motivates, people to do what they do. By knowing your own motivators, you can more effectively manage yourself for better productivity and effectiveness. That’s the foundation for building strong emotional intelligence. Become a student of these things, and you’re on your way. 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
The MIND Diet By Charlyn Fargo here’s a new diet plan that may help you remember things. It’s appropriately nicknamed the MIND diet. It stands for Mediterranean-DASH Intervention for Neurodegenerative Delay.
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A study at Rush University found people who followed the diet closely had a 53% lower risk of developing Alzheimer’s disease. Those who followed it moderately had a 35% lower risk. Those who followed the DASH diet lowered risk by 39%. The findings were published in the March 2017 Journal of the Alzheimer’s Association. So, how does the MIND diet work? The diet puts together the best from the Mediterranean diet – more fish, healthy fats, vegetables and whole grains – and the DASH diet, which stands for Dietary Approaches to Stop Hypertension. The DASH diet emphasizes fruits, vegetables and low-fat dairy. The DASH diet has been found to reduce the risk of hypertension, heart attack and stroke. The Mediterranean diet has been found to reduce the risk of heart disease and cancer. Together, they help reduce your risk of Alzheimer’s. Researchers found the MIND diet is easier to follow than the Mediterranean,
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which requires daily fish consumption and multiple servings of fruits and vegetables. A typical day’s intake on the MIND diet might include three servings of whole grains (brown rice, quinoa, wheat bread), a salad and another vegetable, a glass of wine, nuts for a snack, and blueberries or strawberries. Chicken or fish and beans are to be consumed every other day. Foods like butter, cheese, red meat, pastries, sweets and fried or processed foods are avoided. Overall, the MIND diet emphasizes natural, plant-based foods and limits intake of animal foods and saturated fats. However, it specifies adding berries and green, leafy vegetables. Rush researchers looked at food intake data from 900 older Americans already participating in the Rush Memory and Aging Project, which began in 1997. Over a five-year period, the team collected data on incidences of Alzheimer’s. Even when the MIND diet was only moderately followed, it still reduced the risk of Alzheimer’s by 35%. Moderate adherence to the Mediterranean and DASH diets had only negligible protective benefits, according to study authors. We know lots of factors, including genetics, environment and lifestyle, may contribute to the development of
Alzheimer’s. The MIND diet may help reduce risks.
Skin Nutrition Can what you eat really improve your skin? Absolutely. And despite the marketing, it’s much better to feed our skin from the inside (from food) than to slather on moisturizers and peels with the same nutrients. Think about this: We have 19 million cells per inch of skin. Our skin is the body’s first line of defense, a barrier that blocks other organs from environmental hazards. And like all organs, the skin needs nutrients to stay strong and do its job. There is no single nutrient that can maintain healthy skin. We need a balanced diet composed of a colorful variety of fruits and vegetables, lean meats, olive oil, nuts and seeds. All are important for skin health. Start with vitamin A. The beta carotene in vitamin A plays an important role in repairing skin tissue and replacing cells that contribute to the structure of the skin. It can help prevent dry, rough skin, a sign of deficiency. Choose foods that are orange and red – cantaloupe, carrots, pumpkin, squash, sweet potato, tomatoes and red bell peppers. Add vitamin E. It absorbs energy from
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ultraviolet light and helps prevent sun damage. It also helps with inflammation in the skin. Snack on almonds, asparagus, avocado, greens, mango, peanuts, pumpkin and spinach. Vitamin C can also help your skin health. It’s a powerful antioxidant that protects skin cells by warding off free radicals from UV rays. It’s needed for collagen synthesis wound healing. The best sources are berries, Brussels sprouts, grapefruit, green and red bell pepper, strawberries and oranges. For those fine lines and wrinkles, think collagen, a type of protein that makes up to 80% of the skin. Protein-rich foods encourage collagen production. Good sources of protein are beans, beef, bone broth, chickpeas, eggs, Greek yogurt, legumes, nuts, poultry and seafood. If your skin is flaky or dry, you may be dehydrated. Drinking more water helps keep your skin healthy. Healthy adults need at least eight glasses a day, perhaps more. Omega-3 fatty acids are critical for maintaining skin function, especially in the top outer layer of skin. Omega-3s can also protect against sun-damaged skin and aging. Good sources are chia seeds, flaxseeds, salmon, tuna, fortified eggs and walnuts. The key for healthy skin is to eat a colorful diet – lots of fruits and vegetables, lean protein, whole grains and water.
If You’re Just Using Reflective CAPS On Your Surgical Patients,
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 or follow her on Twitter @NutritionRD.
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OUT OF THE OR recipe
Easy Chicken Enchiladas with Black Beans INGREDIENTS: • Nonstick cooking spray • 1 medium onion, chopped
Recipe
Chicken:
the
• 1 pound chicken breasts • 1/4 teaspoon garlic powder • 1/4 teaspoon onion powder • 1/4 teaspoon chili powder • 1/4 teaspoon cumin • salt, to taste • pepper, to taste Enchiladas: • 15 ounces black beans, drained and rinsed • 10 ounces diced tomatoes and green chilies, drained • 2 cups shredded Mexican cheese, divided • 16 ounces restaurant-style salsa, divided • 10 whole-wheat tortillas Optional Toppings: • diced avocado • plain Greek yogurt • cilantro
By Family Features
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OUT OF THE OR recipe
School-Night Meals that Deliver Taste at a Low Cost
egardless of what back to school looks like this year, preparing family meals throughout the week does not have to be a challenge. Shopping at a store like ALDI can stretch your budget and help you make five different meals over five days for about $5 a meal pretax for a family of four.
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Using a mix of kitchen staples you already may have, along with fresh ingredients, you can make delicious, affordable recipes for the whole family. Simply select a protein or main ingredient and explore versatile ways to build other meals around it during the week. Grilled chicken breasts are ideal for on-the-go lunches or weekday dinners. Busy parents can get dinner on the table fast with simple prep-ahead Chicken Enchiladas. This convenient dish makes it a snap to add variety by substituting chicken with shrimp, beans or vegetables. Serving organic produce, fresh and frozen meats, seafood and on-the-go snacks can be easy when you shop at a store like ALDI. Plus, you can find foods to fit any dietary style without breaking the bank. Find more family meal solutions at aldi.us.
Easy Chicken Enchiladas with Black Beans Recipe courtesy of “Wellness for the Win� on behalf of ALDI Prep time: 25 minutes Cook time: 25 minutes Servings: 10 1. Preheat oven to 400 F. Spray 9-by-13-inch pan with nonstick cooking spray and set aside. 2. In medium skillet over medium-high heat, cook onion until translucent, about 3-5 minutes. Transfer to large bowl and set aside. 3. To make chicken: Season chicken breasts with garlic powder, onion powder, chili powder, cumin and salt and pepper, to taste. Add chicken to same skillet over medium-high heat. Cook 5-7 minutes on each side, or until cooked through. Use fork and knife to shred chicken. 4. To make enchiladas: In large bowl with cooked onion, add shredded chicken, black beans, diced tomatoes, green chilies and 1 cup shredded Mexican cheese. Use spoon to mix well. 5. Pour 1 cup salsa on bottom of greased pan and use spatula to spread evenly. Scoop about 1/2 cup chicken and veggie mixture into each tortilla. Roll tightly and place seam side down in pan. 6. Top enchiladas with 3/4 cup salsa and remaining shredded cheese; use spatula to spread evenly. 7. Cover pan tightly with foil and bake 25-30 minutes. Remove from oven; serve hot. Add avocado, yogurt and cilantro, if desired. WWW.ORTODAY.COM
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OUT OF THE OR pinboard
CHE C K O U T O U R N E W CO NTEST!
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YEAR OF THE NURSE OR Today magazine joins the World Health Organization in celebrating the 200th anniversary of Florence Nightingale’s birth and the Year of the Nurse in 2020. As part of the celebration, OR Today wants to feature nurses in a new contest! Every entry wins a gift card! To enter the contest, share a time when a nurse served as an inspiration to you or your team. This can be a peer, a mentor, an educator or anyone from the nursing profession. Help us shine a spotlight on these individuals. Please share your brief (1 to 3 sentences) contest entry at ORToday.com/Contest. One gift card per individual.
H QUOTE OF THE MONT
position.” a t o n , e ic o h c a is ip “Leadersh n Covey — Stephe
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The News and Photos
that Caught Our Eye This Month
OUT OF THE OR pinboard
RESEARCHERS PUT A PRICE TAG ON ALCOHOL USE A lcohol use disorders are associated with high social welfare and health care costs – but what causes them? A Finnish study looks at the magnitude and reasons behind the economic burden alcohol use disorders have on society. Earlier studies have shown that alcohol use disorders lead to various health and social problems, which cause an increase in the need and use of various services. However, the magnitude and distribution of the related costs have not been studied before. Researchers at the University of Eastern Finland used a machine learning technique that is based on a Bayesian network model to analyze causal relationships between different risk factors and the costs associated with them. The analysis included a total of 16 risk factors, including socioeconomic variables such as age, gender, marital status, unemployment status and social problems like homelessness, illicit drug use, criminal record and drunk driving. The researchers also looked at what happens when a patient goes into remission, i.e., stops drinking altogether. Funded by the Strategic Research Council at the Academy of Finland, the study was conducted in collaboration between researchers at the University of Eastern Finland, the Finnish Institute for Health and Welfare and Aalto University. They used a novel approach to control for confounding factors, allowing them to calculate a rough price tag for each risk factor. The study population comprised 363 Finnish alcohol use disorder patients diagnosed in 2011-2012. Their data were collected from various patient information
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systems and social welfare databases over a period of five years. Surprisingly, the number of diagnoses of chronic conditions played the biggest role in the overall cumulation of costs in patients with alcohol use disorder. In patients with at least two chronic conditions, the average five-year costs of care were 26,000 euros (around $30,000) higher than in patients without multiple diagnoses. The costs of care were also increased by earlier use of specialized care (and its high costs), receiving income support and being over 55 years old. In addition, drug use, homelessness and the number of psychiatric diagnoses also increased the costs of care. Sustained abstinence, on the other hand, lowered the costs. A model created by the researchers shows that roughly 43% of alcohol use disorder patients who quit drinking belong to the lowest cost quartile, compared with the respective figure of 24% for current drinkers. The findings shed light on how the cumulation of health and social problems increases the costs of social welfare and health care services. “Since sustained abstinence reduces the costs of care, it would be wise to develop rehabilitation services and provide easy access to care. In addition, people with alcohol use disorders should also get better treatment for their non-alcohol related conditions,” says Early Stage Researcher Elina Rautiainen from the University of Eastern Finland. For more information, visit bit.ly/30bI9wf.
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ORTL SCRAPBOOK
SURGICAL CONFERENCE
OR TODAY LIVE SCRAPBOOK erioperative and sterile processing professionals from across the country gathered at OR Today Live in Denver, Colorado August 16-18, 2020. Attendees earned valuable CE credits from world-class speakers, such as Phyllis Quinlin and Vangie Dennis, in an environment designed to motivate and empower them. OR Today Live provided a safe and clean environment for attendees to network and exchange ideas in the Rockies!
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1. With several safe and clean procedures implemented before and during the conference, OR Today Live was a success!
3. Ren Scott-Feagle of University Medical Center of Southern Nevada is seen at the OR Today magazine booth.
2. USOC Medical’s Amy Hobbs is pictured at the company's booth.
4. Presenter Sharon McNamara is pictured watching an AIV video presentation.
5. Brenda C. Ulmer is pictured during the educational session “Surgical Smoke Intervention and Implementation Plan to Effect Practice Change.”
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ORTL SCRAPBOOK 6. Attendees were able to earn up to 11 CE credits during OR Today Live.
network while maintaining social distancing protocols.
7. AIV sponsored the Rockin’ in the Rockies party.
9. In addition to the 11 CE credits, attendees could gain additional credit viewing poster presentations.
8. OR Today Live attendees and exhibitors
10. Phyllis Quinlin delivered educational sessions, including the keynote address titled “A Strength-Based Approach to Developing Your Personal Brand,” virtually from New York City.
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SURGICAL CONFERENCE
HOW TO ACCESS ON-DEMAND CLASSES.
1. Visit www.ortodaylive.com/on-demand-education/. 2. Purchase the access code. 3. Enjoy all recorded sessions.
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OCTOBER 2020
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N-DEMAND EDUCATION Check out the classes.
KEYNOTE ADDRESS: 2020 the Year of the Nurse, the Year to End Incivility in the Workplace Phyllis Quinlin, RN, MFW Consultants to Professionals
OSHA and You! Allan Brack, Managing Editor, ORsafe.org
Branding Yourself as a Thought Leader and Leveraging LinkedIn Phyllis Quinlin, RN, MFW Consultants to Professionals
Quick Escapes to Building the Team Sarah Bosserman Matulewicz, MSN, RN, CNOR, Perioperative Clinical Nurse Educator, WellSpan Health York Hospital
Challenging the “Jeopardy” in Patient Safety Sharon McNamara, RN, Perioperative Consultant, OR Dx+Rx Solutions for Surgical Safety
Surgical Site Infections: Could It Be the Instruments? Sharon McNamara, RN, Perioperative Consultant, OR Dx+Rx Solutions for Surgical Safety
Dirty Deeds Done Dirt Cheap Thomas Overbey, CCSVP, Marketing Director, Ultra Clean Systems
Surgical Smoke Intervention and Implementation Plan to Effect Practice Change Brenda C. Ulmer, RN, MN, CNOR, Perioperative Nurse Educator, and Vangie Dennis, MSN, RN, CNOR, CMLSO, Executive Director of Surgical Services, WellStar Health System, Atlanta Medical Center Downtown & Atlanta Medical Center South
Exams in ‘Jams: Obtaining Your CCI Nursing Certification from Home Carissa L. Homme, PhD, Senior Manager, Test Development and Certification, CCI Hold Your Form – Emotional Intelligence and Leadership Sharyn Combs, CHBC, JMT, CRCST, TAP Administrator/ Trainer, SIPS Consults New Nurse Graduate Pipeline: Building perioperative practice Vangie Dennis, MSN, RN, CNOR, CMLSO, Executive Director of Surgical Services, WellStar Health System, Atlanta Medical Center Downtown & Atlanta Medical Center South Not Another One: Leadership & Workplace Bullying Phyllis Quinlin, RN, MFW Consultants to Professionals Nursing Leaders Aren’t Born, They’re Made Brandon G Bennett, DNP, RN, CNS, CNOR, CNS-CP, CSSM, CEN, NE-BC, Chief Nursing Officer, SurgeryDirect
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The Shocking Truth of Insulated Instruments – Implementing a Strong Insulation Testing Program Cheron Rojo, CRCST, CIS, CER, CFER, CHL, Clinical Education Coordinator, Healthmark Industries Using Community Partnerships for Recruitment Stephanie Reed, RN, Clinical Educator, University of Maryland Medical Center We Are All In This Together: The practice of surgery and the need for intradisciplinary collaboration Carissa L. Homme, PhD, Senior Manager, Test Development and Certification, CCI What’s Your Energy IQ? Safe Use of Energy-based Devices During MIS Procedures Brenda C. Ulmer, RN, MN, CNOR, Perioperative Nurse Educator
OCTOBER 2020 | OR TODAY |
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INDEX
advertisers
ALPHABETICAL Action Products, Inc.…………………………………………15
Encompass Group…………………………………………… 53
OR Today Webinar Series……………………………… 25
AIV Inc.……………………………………………………………… 22
GelPro……………………………………………………………………21
Ruhof Corporation……………………………………………… 2
ALCO Sales & Service Co.……………………………… 53
Healthmark Industries Company, Inc.………… 39
SIPS Consults…………………………………………………… 49
ASCA………………………………………………………………… 47
MAC Medical, Inc………………………………………………IBC
Soma Technology…………………………………………… 47
Augustine Temperature Management…………… 7
MD Technologies Inc.……………………………………… 49
TBJ Incorporated………………………………………………… 4
Cygnus Medical………………………………………………… BC
MedWrench……………………………………………………… 50
Total Scope, Inc…………………………………………………… 11
ANESTHESIA
INFECTION CONTROL
Cygnus Medical………………………………………………… BC
Augustine Temperature Management…………… 7
ALCO Sales & Service Co.……………………………… 53
Soma Technology…………………………………………… 47
Soma Technology…………………………………………… 47
Cygnus Medical………………………………………………… BC
REPROCESSING STATIONS
ASSOCIATION
Encompass Group…………………………………………… 53
CATEGORICAL
ASCA………………………………………………………………… 47
C-ARM
Ruhof Corporation……………………………………………… 2
MD Technologies Inc.……………………………………… 49
TBJ Incorporated………………………………………………… 4
Ruhof Corporation……………………………………………… 2
Soma Technology…………………………………………… 47
SIPS Consults…………………………………………………… 49
CARTS/CABINETS
TBJ Incorporated………………………………………………… 4
ALCO Sales & Service Co.……………………………… 53
INSTRUMENT STORAGE/TRANSPORT
Cygnus Medical………………………………………………… BC
Cygnus Medical………………………………………………… BC
Healthmark Industries Company, Inc.………… 39
Ruhof Corporation……………………………………………… 2
MAC Medical, Inc………………………………………………IBC TBJ Incorporated………………………………………………… 4
CS/SPD MD Technologies Inc.……………………………………… 49 Ruhof Corporation……………………………………………… 2
DISINFECTION Cygnus Medical………………………………………………… BC Ruhof Corporation……………………………………………… 2
DISPOSABLES ALCO Sales & Service Co.……………………………… 53
MD Technologies Inc.……………………………………… 49
Healthmark Industries Company, Inc.………… 39
MONITORS Soma Technology…………………………………………… 47
ONLINE RESOURCE MedWrench……………………………………………………… 50 OR Today Webinar Series……………………………… 25
RESPIRATORY Soma Technology…………………………………………… 47
SAFETY GelPro……………………………………………………………………21 Healthmark Industries Company, Inc.………… 39
SINKS Ruhof Corporation……………………………………………… 2 TBJ Incorporated………………………………………………… 4
STERILIZATION Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.………… 39
OR TABLES/BOOMS/ACCESSORIES
MD Technologies Inc.……………………………………… 49
Action Products, Inc.…………………………………………15
TBJ Incorporated………………………………………………… 4
Soma Technology…………………………………………… 47
OTHER
SURGICAL MD Technologies Inc.……………………………………… 49
AIV Inc.……………………………………………………………… 22
SIPS Consults…………………………………………………… 49
OTHER: FLOOR MATS
Soma Technology…………………………………………… 47
GelPro……………………………………………………………………21
SURGICAL INSTRUMENT/ACCESSORIES
MD Technologies Inc.……………………………………… 49
PATIENT DATA MANAGEMENT
Cygnus Medical………………………………………………… BC
Ruhof Corporation……………………………………………… 2
MAC Medical, Inc………………………………………………IBC
Healthmark Industries Company, Inc.………… 39
Total Scope, Inc…………………………………………………… 11
PATIENT MONITORING
TELEMETRY
FALL PREVENTION
AIV Inc.……………………………………………………………… 22
AIV Inc.……………………………………………………………… 22
ALCO Sales & Service Co.……………………………… 53
PATIENT WARMING
TEMPERATURE MANAGEMENT
Encompass Group…………………………………………… 53
Augustine Temperature Management…………… 7
ENDOSCOPY Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.………… 39
Encompass Group…………………………………………… 53
FLUID MANAGEMENT MD Technologies Inc.……………………………………… 49
POSITIONING PRODUCTS Action Products, Inc.…………………………………………15
GENERAL
Cygnus Medical………………………………………………… BC
AIV Inc.……………………………………………………………… 22
PRESSURE ULCER MANAGEMENT
HOSPITAL BEDS/PARTS
Action Products, Inc.…………………………………………15
ALCO Sales & Service Co.……………………………… 53
REPAIR SERVICES
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Encompass Group…………………………………………… 53 MAC Medical, Inc………………………………………………IBC
WARMERS MAC Medical, Inc………………………………………………IBC
WASTE MANAGEMENT MD Technologies Inc.……………………………………… 49 TBJ Incorporated………………………………………………… 4
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Contact Cygnus Medical www.cygnusmedical.com 800.990.7489
