OR Today Magazine May 2021 by MD Publishing

INDUSTRY INSIGHTS TROUBLESHOOTING THE ALARIS 8000 INFUSION SYSTEM

LIFE IN AND OUT OF THE OR

PRODUCT FOCUS STERILIZATION EQUIPMENT

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OR TODAY | MAY 2021

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WAVE OF THE FUTURE Patients and health care facilities are enjoying a wide range of benefits from the widespread use of endoscopic surgery and MIS.

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INDUSTRY INSIGHTS

CIRCULATION

10 News & Notes 16 IAHCSMM: Trust Your Team, Spur Growth and Positive Outcomes 18 Troubleshooting and Tech Support Tips for the Alaris 8000 Infusion System 20 CCI: Change on the Horizon for Certification Programs, Recertification Methods 22 ASCA: Fighting Survey Fatigue Versus Collection the Data You Need 24 AAMI: Telemedicine Carves a Path for Remote Surgery 26 Corporate Profile: TBJ Incorporated

30 M arket Analysis: Sterilization Equipment Market Growth Continues 31 Product Focus: Sterilization Equipment 34 CE Article: Transformational Leadership: A Growing Promise for Nursing

OUT OF THE OR

62 Index 8

OR TODAY | May 2021

ACCOUNTING Diane Costea

WEBINARS Jennifer Godwin

EDITORIAL BOARD Hank Balch, President & Founder,

IN THE OR

46 Spotlight On: Ora Wood, ADN, BSN, MSHA 48 Fitness 50 Health 52 EQ Factor 54 Nutrition 56 Recipe 58 Pinboard

Lisa Lisle Jennifer Godwin

Beyond Clean Sharon A. McNamara, Perioperative Consultant, OR Dx + Rx Solutions for Surgical Safety Julie Mower, Nurse Manager,

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INDUSTRY INSIGHTS

news & notes

Asensus Surgical Earns Additional FDA Clearance Asensus Surgical Inc. (formerly TransEnterix Inc.) has received an additional FDA clearance for the Senhance Surgical System which allows for indication expansion in general surgery in the United States. A news release states that Asensus Surgical’s technology platform, Senhance Surgical System, is the first of its kind digital laparoscopic platform that leverages augmented intelligence to provide unmatched performance and patient outcomes through machine learning. Senhance goes beyond the typical surgical robotic systems, providing surgical assurance through haptic feedback, eye-tracking camera control, and 3D visualization, and is the first platform to offer 3 mm instruments (the smallest instrument available in the world on a robotic surgical platform). “The expansion into general surgery for the Senhance Surgical System is a major milestone for the growth and clinical applicability of our technology,” said Anthony Fernando, Asensus Surgical president and CEO. “General surgery is, by far, the largest area of manual laparoscopy which can benefit from the precision and insight of performance-guided surgery. The indication expansion allows Senhance to be used in many high-value, complex reconstructive surgeries such

OR TODAY | May 2021

as those used to treat reflux and obesity. Including previous indications granted, the Senhance Surgical System can now be utilized in over 2.7 million general surgical procedures performed in the U.S. annually.” “Many of the procedures we perform in general surgery require complex reconstruction throughout a wide surgical field,” said Dr. Sabino Zani, assistant professor of surgery at Duke University and an investigator in the clinical studies submitted for indication expansion. “Senhance can now be seen as a widely applicable tool for general surgeons across the broad range of procedures that may be performed from deep in the pelvis to the upper abdomen.” The Senhance Surgical System is intended to assist in the accurate control of laparoscopic instruments for visualization and endoscopic manipulation of tissue including grasping, cutting, blunt and sharp dissection, approximation, ligation, electrocautery, suturing, mobilization and retraction. The Senhance Surgical System is intended for use in general laparoscopic surgical procedures and laparoscopic gynecological surgery. The system is indicated for adult use. It is intended for use by trained physicians in an operating room environment in accordance with the instructions for use. •

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Healthmark Offers New Vendor Credentialing Program Healthmark Industries’ clinical affairs team has announced the creation of 13 training programs that will be offered for vendors and manufacturer representatives to satisfy vendor credentialing requirements. To access health care facilities, industry, manufacturer and sales representatives must fulfill the requirements of various vendor-credentialing systems, such as VendorMate (GHX), Intellicentrics and Symplr. Each session consists of a prerecorded 30-minute presentation given by a Healthmark clinical educator. The programs are easily accessible on-demand at http://healthmarkvendorcredentialing. com/. Upon completion of the program and a short knowledge-check, a PDF certificate of completion will be automatically emailed to the participant on the following day. The certificate should be uploaded into the vendor credential-

ing system as proof of completion of the required program. There is a $25 charge for each program. Additionally, 1.0 CEU (contact hour) is available through IAHCSMM, CBSPD, California Board of Registered Nursing (CBRN), CBIC and ACI toward recertification. The PDF certificate of completion can be saved and uploaded when recertifying through these organizations. The course list includes: Product and Service Competency Stephen Kovach, Clinical Educator Emeritus AdvaMed – Seth Hendee, Clinical Education Specialist National Safety Patient Goals – Seth Hendee, Clinical Education Specialist HIPAA Privacy and Security – Seth Hendee, Clinical Education Specialist OR Protocol – Kevin Anderson,

Clinical Education Specialist OSHA Bloodborne Pathogens – Mary Ann Drosnock, Director of Clinical Affairs Ethics – Mary Ann Drosnock, Director of Clinical Affairs Electrical Safety - Jahan Azizi, Special Projects Manager Fire Safety – Stephen Kovach, Clinical Educator Emeritus Radiation Safety – John Whelan, Clinical Education Specialist Medical Device Reporting – Jahan Azizi Special Projects Manager Pandemic Response & COVID Competency – Mary Ann Drosnock, Director of Clinical Affairs Aseptic Principles – John Whelan, Clinical Education Specialist • For more information, visit healthmarkvendorcredentialing.com.

AAAHC Publishes Toolkit for Improving Antimicrobial Stewardship The Accreditation Association for Ambulatory Health Care (AAAHC) has published an antimicrobial stewardship toolkit to help health care providers optimize how antibiotics are prescribed and used by patients in ambulatory care settings. “The most important factor contributing to antimicrobial resistance is unnecessary and inappropriate antimicrobial use,” said Noel Adachi, MBA, president and CEO of AAAHC. “Our new toolkit features guidance for optimizing clinical outcomes associated with antimicrobial use, minimizing adverse events, reducing costs of infections and limiting antimicrobial resistance.” The AAAHC Antimicrobial Stewardship Toolkit includes an overview of challenges and strategies for optimizing the use of these drugs and features guidance from the Centers for Disease Control and Prevention (CDC). The comprehensive toolkit provides specific considerations for unnecessary and inappropriate antibiotic use in ambulatory, dental, primary care and surgical/procedural settings. Featuring a core elements checklist for assessing policies and procedures, treatment recommendations from the

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CDC and a flow chart mapping surgical procedural considerations, the toolkit serves as a practical guide to developing and implementing an effective antimicrobial stewardship program. The toolkit also details up-to-date information on potential threats to antimicrobial stewardship activities due to COVID-19, which could increase antibiotic use. “A majority of antibiotic prescribing and expenditures occur in the outpatient setting, making this new toolkit a valuable resource for providers working toward better patient outcomes and operational excellence,” said Renee Greenfeld, MBA, senior vice president of marketing and business development for AAAHC. “Our AAAHC Quality Institute and the 1095 Strong, quality every day philosophy drive our development of educational resources, ensuring that organizations are equipped with tools and information to improve the quality of care not only on the day of their accreditation survey but every day of operation.” • For more information, visit AAAHC.org/quality/patient-safety-toolkits.

May 2021 | OR TODAY

INDUSTRY INSIGHTS

news & notes

Longeviti Launches ClearFit Covers Longeviti Neuro Solutions, a medtech company developing innovative solutions for complex brain surgery, has launched the Longeviti ClearFit Cover. The first-of-its-kind sonolucent ClearFit Cover is used to replace excised cranial bone following a neurosurgical procedure, enabling neurosurgeons to use ultrasound imaging to view neuroanatomy after brain surgery, and allowing long-term monitoring of a patient’s condition. Patients with hydrocephalus and other neurological conditions such as subdural hematoma, epidural hematoma, brain tumors and traumatic brain injuries often require neurosurgery, and imaging for life. These neurological procedures may leave small holes in the skull to allow for insertion of a drain or catheter. Now, surgeons can use a Longeviti ClearFit Cover to repair the cranial void and serve as a neuroimaging diagnostic tool. “For decades we neurosurgeons have used burr holes and catheters in

OR TODAY | May 2021

the treatment of hydrocephalus. We have often needed to use CT or MRI imaging to assess and optimize treatment. If we could use a similar burrhole, modified to fit an ultrasoundclear cover, to evaluate the size of the ventricles in our clinic, patient care would be greatly benefited. I think that burr hole ultrasounds have the potential of offering an easier, more convenient and less expensive way of optimizing our care, without radiation,” said Mark Luciano, MD, Ph.D., FACS, Director of Cerebral Fluid Center for Hydrocephalus and CSF Disorders at Johns Hopkins Hospital. Longeviti ClearFit devices are implantable prosthetics used by neurosurgeons to correct and/or restore bony voids of a patient’s cranium. The ClearFit Cover is now part of a platform of ClearFit offerings from Longeviti, which includes off-theshelf and customized patient-specific implants. “Infants to seniors with hydrocephalus require repeat imaging through CT and MRI, not only for

initial diagnosis of the condition, but in order to assess whether their treatment is working properly as well as post and pre-op for every surgical intervention. It is not uncommon for patients to require over 30 brain surgeries over the course of their lifetime,” said Diana Gray, president and CEO of the Hydrocephalus Association. “That translates into hundreds of imaging procedures, causing challenges including exposure to radiation, additional medical appointments and increased medical costs. Technology that enables bedside imaging of the brain would reduce the burden on our families and could improve patient care.” The ClearFit Cover is made of polymethyl-methacrylate (PMMA), a biocompatible material with over 40 years of proven clinical performance. It can also be used in conjunction with the Longeviti InvisiShunt, a neurosurgical implant that is placed in the cranium to restore the skull’s natural contour in patients undergoing complex brain surgeries. •

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INDUSTRY INSIGHTS

news & notes

IMP Announces Vice President of Sales and Marketing Mike Reilly is an important member of Innovative Medical Products (IMP). “As an IMP regional sales manager since 2019, Mike was committed to being a company advocate by consistently advancing and improving our sales and customer relationships. In collaboration with the entire IMP team, Mike has been instrumental in expanding training programs, field representation, creative purchasing and repair options that bolstered sales, profitability and customer support all within the difficult impacts of the COVID-19 environment,” says Alan Wasley, CEO, owner. Reilly is now responsible for leading IMP’s global sales and marketing strategic direction, managing all product brands and distribution channels, and developing tactical plans to accelerate sales growth. He will also be responsible for spearheading sales and marketing on new product launches, including an all-new IMP lateral hip positioner and a revolutionary knee positioner

developed to drive profitability and efficiency within ASCs. Reilly holds a bachelor’s degree in industrial engineering from Rowan University and brings over 20 years of sales and marketing management experience. Before joining IMP, he held several key marketing management positions at Terumo Medical Corporation, Medtronic (formerly Osteotech) and Biomet Spine. “As a leader in surgical patient positioning devices, IMP is poised to excel to the next level of growth and success,” Reilly said. “I am excited to lead a team of dynamic individuals built on a strong foundation of innovative medical devices and cuttingedge technology aimed to improve operating room efficiency, patient safety and surgical outcomes. My mission is to grow the IMP business through increased brand recognition, new product development and strategic partnerships.” • For more information, visit IMPmedical.com

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May 2021 | OR TODAY

INDUSTRY INSIGHTS

news & notes

ECRI, oneSOURCE Plan Alerts Management Collaboration ECRI and oneSOURCE Document Management Services have announced a joint collaboration focused on improving medical device safety and responsiveness of health care facilities. This new collaboration creates a link between ECRI’s medical device alerts and recall system and oneSOURCE’s Instructions for Use (IFU) and service manual database, helping health care providers ensure regulatory compliance and the ongoing safety of patients and their clinical staff. It integrates ECRI’s Alerts Workflow Solution and the oneSOURCE Document Management System to facilitate safer and more efficient recall and healthcare technology risk management. ECRI’s Alerts Workflow automatically notifies appropriate health care staff of safety-related risks and recommended actions associated with medical devices, pharmaceuticals, blood and food. “Prompt and efficient handling of medical device notifications can mean the difference between life and death, especially in today’s pandemic-paced health care environment,” says ECRI Vice President Michael Argentieri. “With oneSOURCE, we are speeding vital information directly to the appropriate hospital and ambulatory care facility staff who are charged with ensuring the safe use of medical products.” With the new integration, health care workers access-

OR TODAY | May 2021

ing an ECRI Alert will be able to directly link into their oneSOURCE account to access relevant IFUs and/or service manuals. Similarly, those accessing oneSOURCE documents for a particular medical device will be able to link into the ECRI system to search for any related recalls and active critical hazard alerts. Access to both the ECRI and oneSOURCE platforms is required and available for purchase separately. “By connecting ECRI’s alerts with oneSOURCE’s database, we are removing the barriers that hospital and ambulatory surgery center staff have had in managing multiple systems,” says Heather Thomas, CMO and executive vice president of sales and marketing, oneSOURCE. “Faster response time ultimately leads to better patient care.” COVID-19 has increased the need to have ready access to the latest infection prevention information based on the most recent hazard and recall reports. ECRI and oneSOURCE are working together to ensure that hospitals and ambulatory surgery centers have 24/7 access to the latest documentation and best practices for the proper sterilization and cleaning of medical equipment, including current IFUs, service manuals, recalls and hazard reports. • For more information, visit ecri.org or email clientservices@ecri.org.

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APIC Creates National Infection Prevention Academic Pathway The Association for Professionals in Infection Control and Epidemiology (APIC) recently announced its intention to create an infection prevention (IP) and control curriculum for colleges and universities. APIC’s IP Academic Pathway marks the first national effort to link undergraduate and graduate programs to the field of infection prevention and control, ultimately leading to certification in infection prevention and control. “The pandemic has brought to light the tremendous need for trained infection preventionists in our nation’s health care facilities,” said APIC CEO Devin Jopp, EdD, MS. “While APIC has a robust competency model and other resources to support professionals already practicing in the field, a clear pathway into infection prevention and control careers does not currently exist for college and university students. Through IP Academic Pathway, APIC plans to create an intentional track for infection prevention certification and degree programs. This will help not only the health care field, but also industries like entertainment, hospitality, and travel, which are increasingly hiring infection preventionists.” Infection preventionists work to prevent healthcareassociated infections by isolating sources of infections and developing and implementing evidence-based practices to prevent and contain the spread of dangerous organisms. They practice across myriad health care settings including hospitals, outpatient clinics, long-term care and ambulatory surgery centers. An APIC task force will develop the IP Academic Pathway core concepts, which will detail competencies needed to work successfully in infection prevention and control as outlined by the Certification Board of Infection Control and Epidemiology (CBIC). Once developed, the curriculum can be integrated into a higher education institution’s course of study through their undergraduate, graduate and continuing education programs. “Creating the IP Academic Pathway is a national imperative,” said Jopp. “As the leading organization in infection prevention and control, APIC is uniquely positioned to lead this initiative. APIC will be soliciting input from both the infection prevention and higher education communities and seeking university partners that are willing to help design and pilot the new program.” For more information, visit apic.org/IPAcademicPathway.

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May 2021 | OR TODAY

INDUSTRY INSIGHTS

IAHCSMM

Trust Your Team, Spur Growth and Positive Outcomes By David Taylor III, MSN, RN, CNOR ormer CEO of The Walt Disney Company Michael Eisner, once said, “A brand is a living entity – and it is enriched or undermined cumulatively over time, the product of a thousand small gestures.” Upon closer review, it’s clear how that quote is equally befitting of other business, including health care.

When the sterile processing department (SPD) functions well, it plays a fundamental role in quality and has a direct impact on positive clinical outcomes in the operating room and beyond. However, if any of the “thousand small gestures” cause it to deviate from its proper path and key responsibilities, it can have a serious and negative impact on patient care. An effective way to keep sterile processing professionals on the right track is to build a culture of inclusivity. When today’s leaders give their employees a voice and the power to share ideas, amazing things can be accomplished. Sterile processing leaders who build successful, empowered, team-based departments will see long-term positive benefits that will directly impact 16

OR TODAY | May 2021

the department, its customers and the health care organization as a whole. Some of those benefits can include: Improved recruitment opportunities Increased employee loyalty and satisfaction (long-term retention) A safer and more supportive work environment Reduced stress Increased productivity Greater employee inspiration and creativity Improved teamwork Positive outcomes According to Gallup, the culture of an organization not only drives its performance but gives its employees the authorization to accomplish goals by getting things done without the worry or uncertainty about negative implications.1 Fostering teamwork within the SPD will improve the quality of patient care by incorporating best practices and following recommended guidelines, which can create an overall culture of safety and quality.

Differing Views Can Strengthen Outcomes Encouraging information-sharing is

a great way to build trust across the SPD team because it demonstrates that everyone’s input and ideas matter and are valued and considered. When leaders foster an environment where employee opinions matter and differences can be expressed, it validates employee self-worth, improves employee satisfaction and creates a culture that advances the mission, vision and values of the organization. This is also a way for leaders to gauge their employees’ interests and strengths, which can help in delegating authority and tasks, based on each employee’s professional strengths – and, perhaps, guiding them in their professional development journey (e.g., becoming a certified instrument specialist or helping them advance their skill sets in other areas). When sterile processing leaders delegate authority, new departmental leaders emerge. Employees who may never have been thought of as a leader will discover they shine in these types of environments. One of the most important resources an organization possesses are the people who work there. Finding potential departmental leaders from within pays huge dividends and WWW.ORTODAY.COM

INDUSTRY INSIGHTS

IAHCSMM

helps lighten the workload for all. In addition, sterile processing leaders may find that some employees are better suited for different tasks. By delegating authority, sterile processing leaders can get a better sense of where their employees are within the career ladder – and for those who fall short, the development of mentoring programs can help not only their current department leaders but the up-andcoming ones as well. Effective leaders understand that how an organization collaborates can have a direct impact on its culture. Leaders who build a cohesive team, encourage information sharing by asking for input and inspire autonomous thinking (rooted in standards and best practices, of course) will create a highfunctioning SPD. When employees possess the skills to do a job well and have demonstrated competency in certain tasks, it’s important for leaders to trust that they will then get the job done well; this “trust and let go” approach is necessary for building an empowered team. Good leaders know that when they inspire and incorporate members of the team into various aspects of the department, it sends a clear and WWW.ORTODAY.COM

consistent message that everyone plays an integral role in driving quality and efficiencies and promoting improved patient care and employee engagement. There is no one “star”; in the SPD, it’s the collective actions of the team that helps it shine.

Conclusion The SPD plays a vitally important role within the surgical and procedural disciplines, but for sterile processing professionals to succeed, they need an environment and culture that not only recognizes their important contributions, but also encourages active participation, information sharing and differing ideas and opinions. Employees have the power to either amplify or detract from its culture.1 Sterile processing leaders who consistently work to deliver an inclusive, teambased culture will find they can avoid the silo mentality and draw the best out of each employee – all of whom bring their own unique experiences, ideas and strengths to the department. SPDs are complex; navigating them effectively requires sterile processing leaders to embrace the challenges head-on by promoting their team’s development and delegating greater

responsibilities to them as their strengths and skill sets evolve. When employees have the autonomy and flexibility to question concepts, practices and ideas; connect with and share information with their teammates; implement performance-enhancing changes; and make decisions about matters that affect their practice, they will become inspired to reach higher and achieve even more – all of which will not only benefit the employee, but the collective department, its customers and the patients. David Taylor III, MSN, RN, CNOR, is an executive health care consultant for Resolute Advisory Group LLC, based in San Antonio, Texas.

Reference 1. Gallup. Harness the Power of Your Organizational Culture in 3 Steps. https:// www.gallup.com/workplace/329312/ harness-power-organizational-culture-steps. aspx?utm_source=workplace_newsletter&utm_ medium=email&utm_campaign=workplace_ newsletter_feb_0209221&utm_ content=learnsteps_cta_1&elqTrackId=3098616 4c6bf4c4a95a7751a1a5727e1&elq=8726cabc08 804d30b7f103078b87921e&elqaid=5950&elqat =1&elqCampaignId=1246 May 2021 | OR TODAY

INDUSTRY INSIGHTS

news & notes Avante

Troubleshooting and Tech Support Tips

For the Alaris 8000 Infusion System The “What We Have Here is a Failure to Communicate” Error

o call for tech support or not to call for tech support? For many biomedical professionals, that is the question. While tech support will surely be able to help solve your issue, the convenience of being able to quickly fix your equipment on the spot is hard to ignore.

In this article, I will address two error codes for the Alaris 8000 Infusion System and show how they can be easily resolved with some experience and troubleshooting skills.

The “We Just Don’t Understand Each Other Anymore” Error This error, signified with the code 200.5040, results when the two units, one being the 8015 Point-of-Care unit and the other one of the attached modules, cannot interface due to a difference in the firmware. If you get this error, the first step is to determine what version of firmware the two units have by doing the following: 1. Stop the error message by hitting Confirm. 2. Press the Options key and the Page Down key. 18

OR TODAY | May 2021

This error code, 600.6835, is not listed in any of the recent service manuals but can be seen from time to time. The process for verifying this error is similar to the one above but requires a deeper dig into the software.

Wayne Mayberry Biomedical Technician III 3. Press the Software key and the View key for each unit (PCU, PUMP, SYRINGE, etc.)

Contact the account of the unit you are working on to determine what version firmware the account is running. If any of the units do not match the version the hospital or account is running, then they must be flashed to match. In general, any 9.1x version firmware will run with any 9.1x or lower firmware, but a 9.3x may not run with a 9.1x. Software 9.3x must run with 9.3x, and so on.

1. Press Confirm to stop the alarm. 2. Press the Options key. 3. Press the Page Down key twice to get to page 2. 4. Press the Network Status key and enter the passcode for the status.

If the wireless status is “disabled,” then the fix for this is fairly simple. If it is “enabled,” and you still get the error code, then you should call tech support for assistance. 1. To fix this error, open the unit up in the system maintenance software and:

Run the “Clear Network Configuration” task Run the “Transfer Network Configuration” task Run the “Network Connectivity” task to verify connection. 2. Turn the unit off and on to verify error has been cleared. 3. If not, then please contact tech support for help. WWW.ORTODAY.COM

SPONSORED CONTENT

corporate profile TBJ Incorporated

facturing company based in Florida that designed and developed a product called the SurgiSonic 1211X that features a patented dual hook-up method for pre-cleaning da Vinci instruments utilizing a filtered, independent flushing system combined with ultrasonic action. The unit is independently tested for cleaning effectiveness and exceeded AAMI TIR 30. Because a tight seal on robotic instruments separates the distal jaw/ pulley end from the proximal shaft/ control box end, the patented dual hook-up method was created for independently cleaning both the distal and the proximal segmented areas of the da Vinci robotic instrument at the same time. Three da Vinci robotic instruments can be cleaned at the same time using this dual hook-up-method. The system is also ideal for other

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

Q: What is TBJ’s mission statement or what is most important to you about the way you do business? Campbell: Our goal is to ALWAYS have a satisfied customer that is happy with their TBJ product. We go to great lengths to make sure the customer is happy with the equipment that they purchased from us and also that it is meeting their needs, not only when it is under warranty but for as long as they have the equipment in use. For more information, visit tbjinc.com. TOP: TBJ work sinks are customized for pre-cleaning surgical instruments and endoscopes. BELOW: TBJ’s health care product line consists of highly specialized equipment for use in hospitals in areas such as sterile processing departments, GI endoscopy labs, operating rooms, and more.

OR TODAY | May 2021

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NEW FEATURED PRODUCT

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

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

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

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market analysis

Sterilization Equipment Market Growth Continues Staff report ccording to analysts the global medical sterilization equipment market accounted for around $6.11 billion in 2019 and is slated to amass lucrative gains from 2020 to 2025.

A rising prevalence of chronic diseases and neurological as well as cardiovascular ailments, increasing cases of gastrointestinal disorders, growing geriatric population and soaring investments toward incorporating advanced sterilization technologies are stimulating the overall market outlook. Additionally, a growing focus of industry players toward offering advanced, high-quality sterilization technologies to hospitals amid the COVID-19 pandemic, coupled with the evolution of the trend of partially outsourced sterilization services, are positively swaying the global medical sterilization equipment market dynamics. Based on mode of sterilization, the market is split into radiation, low temperature and high temperature. Among these, the high temperature segment is projected to attain substantial expansion over the forecast period. This projected growth is based on an increasing prevalence of infectious diseases across the globe, surging demand for sterilization in hospitals and strategic alliances between manufacturers and pharmaceutical establishments. 30

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With regards to services offered, the industry is fragmented into contract sterilization and in-house sterilization. Moving on to end-user terrain, the worldwide medical sterilization equipment business sphere primarily comprises of pharmaceuticals, hospitals and others. The hospital segment is predicted to generate noteworthy profits over 2020-2025, primarily due to a high prevalence of infectious diseases, growing efforts of companies in developing effective sterilizers and escalating product demand from health care establishments to curb the coronavirus. A Market Study Report analysis states that Europe and North America are expected to emerge as major revenue generators for the market over the forecast period, owing to rising per capita expenditure on the health care. The report lists prominent organizations that influence global trends include MMM Group, Sterigenics International Inc., Andersen Products Ltd., Belimed Inc., Advanced Sterilization Products Services Inc., Cantel Medical Corp., 3M Company, Getinge AB, TSO3 Inc. and Steris Plc. A second report also predicts market growth. According to the current analysis of Reports and Data, the global sterilization equipment market was valued at $7.8 billion in 2018 and is expected to reach $13.3 billion by the year 2026. WWW.ORTODAY.COM

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product focus

Healthmark TOSI

TOSI is the first device to provide a consistent, repeatable and reliable method for evaluating the cleaning effectiveness of the automated instrument washer. This is possible because the blood soil is manufactured to exacting specifications each and every time. When metered onto the stainless-steel plate, the TOSI is completely analogous to a stainless-steel instrument soiled with dried blood. Placed in the see-through plastic holder, the challenge is identical to the areas of instruments typically hidden from view (i.e., box locks). The routine use of this test will help ensure that your instrument washer is performing at a consistent level, enhancing the routine visual inspection of instruments. • For more information, visit www.tbjinc.com.

InstruSafe

Stainless Steel Single Scope Tray InstruSafe collaborated with Intuitive Surgical Inc. to develop a new design for a single scope tray with updated silicone and brackets for improved endoscope fit. The tray is made of lightweight stainless steel for optimal sterilization and cleaning compatibility. The new tray is designed to fit your scope and the sterilization chamber better than any other tray on the market, reducing the possibility of tears in the wrap before, during and after sterilization. •

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product focus

Ruhof

Elementum AW

Surgistain

Elementum AW, featuring four new molecules of enzymes created for the medical device cleaning market, is a multi-tiered enzymatic detergent that has been optimized* for the automatic, ultrasonic and manual cleaning of surgical instruments. Elementum AW is synergistically blended to produce the most powerful detergent for use on clinically used medical devices. This best-inclass solution has superior soil penetration and suspension, rapidly breaks down tough-to-clean medical soils, including the multi-layers of bioburden, and prevents redeposition. •

Surgistain is a safe, efficient and quick revitalizing solution for stainless steel surgical instruments, trays, basins and case carts. The product removes rust, stains, spotting, hard water scale and mineral deposits frequently encountered from sterilization. It also helps to loosen stiff joints and locks. Regular use will enhance the life and efficiency of the instruments while lowering replacement costs. • For more information, visit www.ruhof.com.

*Elementum AW exclusively meets the qualifying characteristics of an optimal detergent per AORN, AAMI and ASTM D8179 guidelines.

OR TODAY | May 2021

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product focus

STERIS IMS

VerifEye Insulation Tester Mono-polar and bi-polar surgical instruments insulation integrity testing is critical for safe device handling/use and risk mitigation. Visual inspection is not enough to ensure that insulation failures are detected before the devices are used in the OR. STERIS IMS has a solution that easily allows a facility to test the insulation on these items at the point of processing before each case. The VerifEye Insulation Tester is equipped with an internal rechargeable battery and an array of next generation accessories. •

TBJ Inc.

Pre-cleaning Sinks TBJ manufactures a complete line of precleaning sinks designed specifically for cleaning instruments and utensils in sterile processing departments. The sinks incorporate innovative new features designed to both automate the pre-cleaning process and provide ergonomic features including push-button sink top height adjustment. Other innovative features include the Hydro-force system that is designed to recirculate water in the pre-rinse sink and automatically reduce gross debris from instruments thus reducing manual precleaning. The dual-purpose ultrasonic sink bowl provides technicians with the option of utilizing an in-line ultrasonic cycle or to use the sink bowl as a standard sink bowl. The automatic, push-button sink bowl filling feature fills the bowl automatically. All of the TBJ sinks are made to order and customized around specific needs and workspace. • For more information, visit TBJinc.com.

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CE605

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continuing education

Transformational Leadership: A Growing Promise for Nursing 34

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continuing education

By Rose O. Sherman, EdD, RN, NEA-BC, CNL, FAAN llison has been an assistant nurse manager in a Magnetdesignated hospital on the evening shift for the past year. Emily, her nurse manager, knows Allison is interested in a leadership role and has agreed to be her mentor. Before Emily goes on vacation, she asks Allison to move to the day shift for two weeks to oversee the unit. Emily suggests that Allison keep a notebook describing why and how she makes important decisions during her absence. Reviewing Allison’s notebook will allow Emily to reinforce effective decision-making skills and to identify areas for learning and mentoring. By developing a creative way to help Allison develop decision-making skills, Emily is demonstrating one of the characteristics of a transformational leader. In today’s healthcare environment, nurses seek leaders like Emily who help staff build self-esteem and empower them to realize their career aspirations.

Magnets Attract Transformational leadership is a key ingredient in establishing a nursing environment that achieves Magnet designation. More than two decades ago, the American Academy of Nursing began to look at hospitals that retained highly qualified nurses during serious nursing shortages.1 An analysis of these organizations revealed that they had several things in common; these commonalities became known as the forces of magnetism. As of June 2019, there are 498 Magnet facilities in the United States and five other countries recognized by the American Nurses WWW.ORTODAY.COM

Relias LLC guarantees this educational program free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See Page 41 to learn how to earn CE credit for this module.

Goal and Objectives The goal of this continuing education program is to inform nurses about transformational leadership in healthcare. After studying the information presented here, you will be able to: • State the four components of transformational leadership. • Compare transactional and transformational leadership styles. • Discuss the relationship between transformational leadership in healthcare organizations, workplace empowerment, job satisfaction among nurses, and positive patient outcomes.

Credentialing Center for their excellence in nursing practice.2 Magnet designation is considered the hallmark of nursing practice excellence. Research has demonstrated that Magnet-level nursing care positively affects nursing practice and patient care.3 The Magnet program was expanded to include long-term care facilities in 1998; in 2000, it was further expanded to include international healthcare organizations.1,2 In 2008, the American Nurses Credentialing Center published a Magnet model that emphasized the importance of using transformational leadership.4 May 2021 | OR TODAY

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continuing education

Transformational leadership has been shown to be particularly effective in turbulent and uncertain environments, such as those found in today’s healthcare organizations.3 Although not every organization will achieve Magnet status, nurses at all organizations can learn how to use the principles of transformational leadership to support a professional practice environment that results in outstanding patient care.

The Transformational Way In his book Leadership, published in 1978, James MacGregor Burns introduced a leadership theory that he called transformational leadership. Burns, a political scientist and historian, was interested in the leadership styles used by key figures in history, including Mahatma Gandhi, Franklin D. Roosevelt, and John F. Kennedy.5 Burns described transformational leadership as occurring when “two or more persons engage with others in such a way that the leader and

OR TODAY | May 2021

followers raise one another to high levels of motivation and morality.”5 This theory differed significantly from older leadership theories because it proposed that meeting the needs of followers was vital to achieving high work performance.6 Burns’ work was influenced by Maslow’s hierarchy of needs, a model familiar to nurses who have taken growth and development courses. Psychologist Abraham Maslow described basic human needs as physiological stability, safety, belongingness and love, self-esteem, and self-actualization. These needs are arranged in a hierarchical order starting with the need for physiological stability and ending with self-actualization. In general, higherlevel needs are not seen as important until basic needs are fulfilled. For example, most people do not strive for higher-level needs such as self-esteem or self-actualization until their basic physiological needs for food, water, and sleep are met. Historically, healthcare organiza-

tions have focused their energies on motivating employees by meeting the first three levels of Maslow’s hierarchy.5 For example, appropriate compensation allows employees to meet their basic physiological needs, workers’ safety is satisfied through a secure work environment, and tactics such as shared governance and participatory management promote a sense of belonging among employees.5 In Burns’ view, transformational leadership can motivate followers to satisfy higher-level needs, such as selfesteem and self-actualization. Those influenced by transformational leaders find meaning and value in their work, make significant contributions to the success of their employing organization, and become leaders themselves.5 Burns’ view is that transformational leadership makes a profound difference in the lives of employees and organizations.5 In the past several decades, there has been a paradigm shift concerning what leadership is and what it can do. From a model that emphasizes tasks and controls, leadership is now seen as vital in developing a work culture in which employees are successful. Essential to this effort are leaders who offer a positive and compelling vision and followers whose needs are met.3 Transformational leadership depends on a high level of engagement between leader and followers. Traditionally, nursing leaders have used management styles ranging from an autocratic style, in which engagement goes in only one direction, to a “handsoff” or laissez-faire style, in which the manager is nearly disengaged.6 A laissez-faire management style is basically an abdication of leadership; there are no followers in a work setting where a manager uses this style because there WWW.ORTODAY.COM

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continuing education

is no leader.6 A manager who is visible and collaborative is important for staff to perceive active and appropriate leadership. Two recent studies revealed that nurse leaders who practiced transformational leadership more effectively inspired and engaged staff.7

Stressing “Transactions” When Burns published the theory of transformational leadership, he also described a leadership style called transactional leadership. Transactional leadership is based on an understanding between a manager and subordinates; the transaction consists of an acceptable salary, benefits, and working conditions in exchange for job performance. Transactional leadership is based on contingent reward (i.e., a reward that depends on delivery of the work product). The leader establishes goals; provides direction; and uses praise, merit increases, and job promotion to reward employee progress in meeting goals.5 Leaders using a transactional style reward good behavior, punish negative behavior, and maintain control at the top of the hierarchy. In the exchange that occurs in a transactional management agreement, the basic needs of both the leader and the follower are met, but they may not have a common vision for nursing practice.6 The employee agrees to complete assigned tasks and to meet deadlines. Evaluation comments for a nurse working under this style of leadership might read: “Cathy Smith completes her work on time, has fewer than the standard number of allowed absences, and has made no medication errors during this rating period.” As is evident, this leadership style is unlikely to fuel a high level of job satisfacWWW.ORTODAY.COM

tion and organizational commitment. Nursing departments that use this leadership style may publish a vision statement and goals that have been developed by senior management, with minimal staff input. At the unit level, a nurse manager may be asked to develop a unit vision statement and goals that reflect senior management’s vision.9 The manager may reference this document in staff meetings or place it in orientation folders for new employees, but rarely does it affect nursing practice and patient care. Healthcare organizations, being highly bureaucratic, traditionally have used transactional leadership tactics, which include6: A task-and-reward orientation Management by exception Few opportunities for creative thinking Decision-making by senior management Limited opportunities for employees to be involved Although transactional leadership can help organizations meet their goals in the short term, it will not provide the inspiration to create and nourish a new culture for nursing practice and patient care. In contrast, because the vision resonates with staff members and they are involved in making it become a reality, a transformational leader can influence attitudes and behaviors to create a new culture for nursing practice and patient care.10,11,12

What It Looks Like Transformational leaders use the following four elements when leading others:13 Idealized influence Inspirational motivation Intellectual stimulation Individual consideration

Idealized influence (also referred to as charisma) describes a leader’s ability to lead by example and influence others to achieve outstanding professional practice. These leaders “walk the walk” and “gain the trust and respect of staff.”13 Inspirational motivation refers to the leader’s ability to communicate a vision others “can understand and of which they want to be a part. For example, a nurse leader with a transformational style would find creative ways to inspire staff with a vision for the future, including meeting with groups of staff or using staff emails to lay out goals and ways of reaching them.”13 Intellectual stimulation refers to a leader who “challenges followers to develop creative and innovative solutions.” This leader also “continually seeks ways to provide growth and development opportunities.” Intellectual stimulation “prompts staff to challenge assumptions, to reframe problems, and to look at new ways of doing things. For example, a transformational leader would provide time for nurses to work with resource staff to incorporate evidence-based practice findings into patient care. Leaders who support intellectual stimulation find ways to encourage nurses to voice their own ideas about improving patient care and pave the way for innovations to be tested and incorporated into the nursing culture.”13 Individualized consideration refers to “the commitment of the leader to coaching and mentoring, and the leader’s awareness of and concern for the needs of nursing staff. A transformational leader knows individual staff members’ career aspirations” and often can guide employees “to invaluable mentoring opportunities.”13 May 2021 | OR TODAY

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continuing education

Healthcare organizations face myriad challenges, including the need to transform the way patients receive high-quality, cost-effective care in the future. This paradigm shift begins with the input from those who provide hands-on care. For example, The Institute of Medicine report on the future of nursing emphasized the need for nurses to become involved in healthcare reform.14 The focus of transformational leadership on empowerment, viewing errors as learning opportunities, and valuing innovation means that staff members can provide input about how to improve care continually. Thus, transformational leadership can revitalize healthcare from the point of patient care and more.2 In addition, the leadership style of nurse managers has a critical impact on nurse job performance and on nurse retention — factors vital for providing excellent patient care.10 Managers who use transformational leadership principles create a climate in which nurses have a greater commitment to their organizations and high levels of morale, job satisfaction, and work performance. Several studies have found that nurse leaders who demonstrate a transformational leadership style promote an enhanced sense of job satisfaction, well-being, and organizational commitment in their staff.8,9,12 Nurses influenced by transformational leaders say they will devote significant effort to ensure that their organization is successful and remain employed in settings where they feel their work is valued.9,11 Nursing job satisfaction can significantly affect patient satisfaction, quality of care, nurses’ intent to leave or stay, associated turnover costs, and trust in management. One study showed that nurses 38

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Transformational Leadership in Action Nurses from St. Joseph Hospital in Orange, California, offer comments about the transformational leadership they have experienced. • “We’ve moved [from] griping about problems to having a powerful voice in changing practice through participation on unit-based councils and by using our unit suggestion box. We’re encouraged to try new ideas; if they don’t work, we find another way. Departmental and online resources help us to unearth evidence-based findings that are specific to our patients.” — Janine Herrera, RN, staff nurse 2, orthopedics • “Our vice president for nursing is visible and available; both qualities build trust and respect. We know when we see her that it isn’t because TJC [The Joint Commission] is on site or a problem has brought her on our unit. My nurse manager provides a lot of mentoring. When I raise an issue, she doesn’t automatically tell me how to solve the problem, but makes me do my own critical thinking. Being able to learn how to solve problems myself is a great self-esteem boost.” — Stacey Fischer, BSN, RN, OCN, nurse navigator, breast program • “Our leaders live the values of the organization and lead by example. The CNO makes herself available during a quarterly breakfast open to all staff. We have leadership development programs for both rising stars and current leaders. All staff [is] encouraged to publish clinical narratives as a way of sharing practice with colleagues. Nurses can also work with interdisciplinary colleagues on rapid improvement teams that quickly develop and test a change that improves patient care.” — Robert Garcia, RN, CMSRN, department manager, orthopedics • “Part of my role is to provide on-the-spot staff coaching. Through patient rounds, I can identify staff learning needs and help them with professional development.” — Donna Maggi, RN, ONC, clinical coordinator, orthopedics

who had not considered leaving their jobs reported experiencing transformational leadership much more often than had nurses who had considered leaving.15 The relationship between transformational leadership behaviors and staff role satisfaction also may play an important role in the rate of patient care errors. The Institute of Medicine (now functioning under the name the Health and Medicine Division of The National Academies of Sciences, Engineering, and Medicine) takes the position that transformational leadership and evidence-based practice create a work environment that promotes

patient safety. The results of a study in Belgium suggest that transformational leadership exerts a significant positive influence on the safety performance of nurses.16 A systematic review published in 2017 also identified the direct relationship between effective leadership and a high-quality work environment that leads to a positive safety climate with positive patient outcomes. However, the leadership style demonstrated to be the most effective with positive outcomes were management styles described as collaborative, multifaceted, and dynamic, as noted in transformational leadership.17 More research is needed about WWW.ORTODAY.COM

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continuing education

medical errors and staff turnover rates, as well as how leadership style affects these rates.14

Not Just for RN Execs Developing a culture in which transformational leadership takes root starts with chief nursing officers or vice presidents for nursing communicating their vision for the future, which must then be nurtured by managers.18 Because nurse managers work closely with patient care staff, evidence indicates that their leadership style significantly affects professional nursing practice and quality patient care.8,9 Although many managers are interested in a more participative management style, some studies have shown that nurse managers rate their transformational leadership qualities as more evident than their staff members.8,9,15 Nurse managers need to validate perceptions of their leadership style and look for opportunities for personal development and mentoring to strengthen their transformational leadership qualities. For example, managers can learn how to envision profound change, communicate a unit-based vision, and establish expectations for outstanding nursing care. They can learn to use body language, verbal skills, and role modeling to communicate effectively.18 Managers can learn to encourage staff involvement in activities that produce measurable positive outcomes, such as researching evidence-based practice findings or representing nursing in interdisciplinary activities. Managers also can develop skills to mentor and empower staff. Although nurse managers are accountable for specific transactional processes, such as budgeting, nurse executives can WWW.ORTODAY.COM

promote leadership education that emphasizes transformational leadership. Remaining visible and accessible to nurses who work evening and night shifts is a challenge.15 Nurse managers can work with nursing executives on ways to ensure that nurses on all shifts participate in a transformational leadership culture. The need for transformational leadership does not stop with nurses in formal leadership positions. Recent research demonstrates that any nurse who assumes clinical leadership responsibilities — whether as a charge nurse, preceptor, clinical specialist, or clinical nurse leader — can practice transformational leadership.10

Are You a Transformational Leader? Building off Burns’ research on transformational leadership, researchers Kouzes and Posner developed a theoretical framework, the Transformational Leadership Model.19 This model of exemplary leadership includes the following five practices:19,20 Model the Way- set example for others to follow, be visible, demonstrate enthusiasm and transparency Inspire a Shared Vision- focus on the future while engaging others with excitement Challenge the Process- make positive changes to the status quo based on data and strategic organization changes Enable Others to Act- engage others in collaborative activities with trust and empowerment Encourage the Heart- recognize, appreciate, and celebrate accomplishments Kouzes and Posner also developed a self-assessment tool based on these

five exemplary practices to measure specific leadership behaviors. The Leadership Practices Inventory-Self (LPI-S) is a 30-item, 10-point Likert scale questionnaire that measures engagement in leadership behavior. Self-reflecting and analyzing leadership behaviors provides insight into how we view ourselves as leaders and areas where we can improve.20 More information on the LPI-S assessments can be found on the Leadership Challenge website. Becoming a true transformational leader can be challenging. It is not a “cookie-cutter” leadership style in which one acts on a finite set of behaviors. Instead, it requires “a full understanding of the leadership style combined with professional maturity, excellent communication skills, a true belief in the organization, and ability to trust others. It takes many years in the nursing profession to develop the skills required for transformational leadership.”21

Beyond Expectations Today’s nurse executives, nurse managers, and unit nursing leaders face the challenge of finding ways to shape changes in healthcare. Transformational leadership, the preferred leadership style of Magnet hospitals, has been shown to motivate nurses to perform beyond expectations. Nurses, by their nature, are visionary, passionate, committed people who have innovative ideas about how to transform healthcare. Nursing executives, nurse managers, and both formal and informal nurse leaders with a transformational leadership style can use this source of nursing knowledge to move nursing and patient care in a positive direction for the future. May 2021 | OR TODAY

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continuing education

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

Barker AM, Sullivan DT, Emory MJ, eds. Lead-

15. Kleinman C. The relationship between

ership Competencies for Clinical Managers:

managerial leadership behaviors and staff

The Renaissance of Transformational Leader-

nurse retention. Hosp Top. 2004;82(4):2-9.

ship. Boston, MA: Jones & Bartlett; 2006:3-12.

doi: 10.3200/HTPS.82.4.2-9.

Relias LLC guarantees this educational activity is free from bias.

7. Brewer C, Kovner CT, Djukic M, et al. Impact

16. Lievens I, Vlerick P. Transformational

of transformational leadership on work

leadership and safety performance among

outcomes. J Adv Nurs. 2016;72(11):2879-2893.

nurses: The mediating role of knowledge-

doi: 10.1111/jan.13055.

related job characteristics. J Adv Nurs.

ROSE O. SHERMAN, EDD, RN, NEA-BC, CNL, FAAN, is an associate professor and director of the Nursing Leadership Institute at the Christine E. Lynn College of Nursing at Florida Atlantic University. She has 25 years of nursing leadership experience with the Department of Veterans Affairs and frequently writes and speaks on nursing leadership development.

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11. Kelly LA, McHugh MD, Aiken LH. Nurse out-

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Clinical Vignette Cindy Martinez has just been hired as a staff nurse on the night shift in a Magnet hospital. She is interested in seeing how the organization’s leadership style differs from her previous work experiences. 1. One of the first things Cindy notices is that her nurse manager regularly comes in to be available to nurses on the night shift. That practice is part of: a. Management by walking consideration. around. c. Transactional leadership. b. Individualized d. Shared governance. 2. Cindy attends a meeting in which the chief nursing officer talks about a vision for patient care that is exciting and energizing. A leader’s ability to articulate a clear and compelling vision is an example of: a. Inspirational motivation. communication. b. Intellectual stimulation. d. Individualized c. Effective consideration. 3. Cindy’s manager is interested in making a major change in patient care procedures. In starting that process, a manager using a transformational leadership style probably would: a. P ost a notice about the staff members to obtain change in the lounge. their input and ideas. b. S end staff an email d. Announce the change at describing the change. a staff meeting. c. S chedule meetings with 4. Cindy is interested in a management role. Using a transformational leadership style, her nurse manager would: a. P rovide Cindy with a c. R efer Cindy to a nursing website listing graduate program for more programs. information. b. Talk with Cindy about d. G ive Cindy articles on her aspirations and the nursing management and support she needs. administration.

Clinical VignettE ANSWERS 1. Answer: B, The individualized consideration component of transformational leadership refers to a leader’s ability to meet the needs of all staff. In this case, the manager is assuring staff on the night shift that she is accessible to them and concerned about their needs. 2. Answer: A, Leaders using a transformational leadership style can share inspiring ideas in a way that motivates others to follow their lead. 3. Answer: C, Leaders who use a transformational style solicit staff advice, opinions, and support, especially when making a change. 4. Answer: B, A transformational leader demonstrates a high level of involvement with staff. Taking time to meet with Cindy to discuss her future and finding out what support she needs are examples of individualized consideration. WWW.ORTODAY.COM

CE605

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

Deadline Courses must be completed by 7/29/2022 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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May 2021 | OR TODAY

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WAVE OF THE FUTURE MIS, Endoscopic Surgeries Benefit Patients, Facilities

OR TODAY | May 2021

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“ The main benefits of using endoscopic surgery and MIS technologies are enjoyed by the patients. With less postop discomfort, patients experience less pain and can resume their usual activities sooner.” – Raymond Dunia

By Don Sadler

ecent advances in endoscopic and minimally invasive surgery (MIS) are truly remarkable, bringing new approaches to both in-patient and out-patient surgeries. Today’s physicians and surgeons are looking to new technological advances in endoscopic surgery and MIS to help provide better patient care and improved surgical outcomes. “Endoscopic and minimally invasive surgery is the wave of the future,” says Julian J. Hamlet, RN, BSN, CNOR, OR service leader at INOVA Fairfax Medical Campus in Falls Church, Virginia. “Advances in this area are helping patients tremendously.”

Benefits of Endoscopic Surgery and MIS Patients and health care facilities are enjoying a wide range of benefits from the widespread use of endoscopic surgery and MIS, says Paula Cruz MSN, RN, CNOR, staff nurse, department of surgery at the Colorectal and Pelvic Malformation Center in Boston. “These include reduced OR time compared to open cases, less risk of bleeding, faster recovery times, shorter inpatient stays and reduced infection risk,” says Cruz. Smaller and fewer incisions, decreased incision site trauma, better ergonomics for surgeons and more flexibility in terms of where the system docks are located are other benefits, adds Hamlet. “The main benefits of using endoscopic surgery and MIS technologies are enjoyed by the patients,” says Raymond Dunia, LSA, CSA, AACS, senior surgical first assistant at INOVA WWW.ORTODAY.COM

Fairfax Medical Campus. “With less post-op discomfort, patients experience less pain and can resume their usual activities sooner.” Dunia acknowledges that adopting new technology like endoscopic and minimally invasive surgery takes time and training. “The investment may increase the cost of surgery initially,” he says. “But when used by skillful surgeons, robotic technologies reduce the amount of blood loss and post-surgical infections and help protect nerves and vessels, all of which sharply decrease costs in the long run.” Renae Wright, DNP, RN, CNOR, perioperative practice specialist with the Association of periOperative Registered Nurses (AORN), says that more cardiothoracic procedures are now being performed through a minimally invasive approach. “Procedures that previously required opening the chest are now done by threading thin catheters and wires endovascularly through vessels to replace valves in the heart or using video-assisted robotic technology to visualize and remove tumors in the lungs,” says Wright. “This allows patients to return to their lives sooner

after these minimally invasive lifesaving procedures.” Using a minimally invasive approach for cardiothoracic procedures combats the challenges and complications associated with an open approach, Wright adds. “These include the extended recovery, discomfort and physical restrictions suffered by patients that result from going through the sternum or ribs,” she says. “The minimally invasive approach translates to less discomfort, a shorter hospital stay, faster recovery and ultimately reduced overall costs.”

Lots of Specialties Covered Dunia believes that minimally invasive technology is a vast subject that covers many different specialties in surgery today including spine surgery, stereotactic brain biopsy and more. “In endoscopic surgery, abdominal laparoscopic made a big advance mainly with the use of the da Vinci robotics,” says Dunia. “The XI and Single Port (SP) robots are the latest technologies on the market. With 3D and magnified vision, the agility of the instrument’s rotations improved safety and precision along with more skills ability than regular laparoscopy.” May 2021 | OR TODAY

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Meanwhile, Intuitive Surgical has dominated the robotic surgery market for many years, notes Hamlet, creating what he calls “an excellent platform for surgeons to operate on.” Other companies have also launched or are making their way to the market, bringing exciting new features, he adds. One of these is haptic feedback. “This gives the surgeon a sensing of pressure through alerts, while a pivot point potentially helps with minimizing incision site trauma and pain,” says Hamlet. “Also, eye-tracking software allows camera control when the system senses the surgeon’s eye activity.” Hamlet says he had open abdominal surgery 29 years ago and was hospitalized for over a month. “Patients today with the same surgery can go home within days or in some cases even the day after surgery,” he says. “Advances in MIS are allowing patients to return to their regular lives and routines much sooner.” Amanda Heitman, BSN, RN, CNOR, education resource specialist/ surgical services at WakeMed Cary Hospital in Cary, North Carolina, says her hospital has recently added robotic-assisted orthopedic and spine procedures where patients receive a CT scan prior to surgery. “This allows the surgeon to have

more precise measurements during the surgery based on the scans, using the robotic technology to guide surgeons to exactly what they need,” Heitman explains. “Patients are able to have the ideal post-operative experience because the procedure was specific to them.” WakeMed Cary Hospital also uses endoscopic ultrasonography (EUS) to assess for GI and lung disease. “This procedure offers specific information for diagnostic findings to help treat patients efficiently,” says Heitman. “And we also offer ESG (endoscopic sleeve gastroplasty) to help patients in need of a less-invasive weight loss procedure or help with bariatric revisions.” Heitman says that laparoscopic and robotic laparoscopic surgeries have been around for a while but there have been vast improvements in the technology. “These improvements include HD cameras and different supporting devices for effective hemostasis and insufflation.” “Robotic procedures are optimal for patients and surgeons because they permit the 3D/360-degree approach for enhanced visualization and dissection,” Heitman adds. “All of these advancements can allow for a better surgical and post-operative experience.”

Maternal-Fetal Surgical Advances Wright points to advances in minimally invasive fetal surgery that allow babies to be treated in-utero for conditions like twin-to-twin transfusion syndrome and congenital diaphragmatic hernia before they are even born. “Maternal-fetal surgery reduces the risk of infant mortality before, during and after birth by improving conditions for development,” says Wright. “For example, it re-establishes healthy blood flow as in the case of twin-to-twin transfusion or inserting a balloon to encourage lung growth to counteract the effects of a congenital diaphragmatic hernia.” Meanwhile, collaboration among clinicians, the FDA, the Centers for Disease Control and Prevention (CDC) and manufacturers has led to the introduction of single-use endoscopes to replace reusable scopes that have been associated with infectious outbreaks, such as duodenoscopes and bronchoscopes. “This eliminates the risk of disease transmission from an ineffectively processed reusable endoscope,” says Wright. “It also eliminates the time needed for turnover between cases and may ultimately reduce costs by eliminating the need to pay for maintenance, reprocessing or repair.”

“ Patients are able to have the ideal post-operative experience because the procedure was specific to them.” – Amanda Heitman 44 OR TODAY | May 2021

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“Additionally, advances in fetoscopic surgery have improved the prognosis for conditions that previously had unfavorable outcomes,” Wright adds.

The Perioperative Nurse’s Role Perioperative nurses play a critical role in managing these technologies inside the OR and ASC and ensuring that they are used most effectively and efficiently and in ways that prevent patient injury. “A wide range of safety issues can be related to the use of MIS technology,” says Dunia, who lists fire hazards, patient positioning issues and CO2 insufflations among his main safety concerns. “The use of electricity to operate the machines and cautery devices always makes fire hazards a concern, but this can be managed by using compatible cables,” says Dunia. “And patient positioning has been a struggle for surgical teams in order to protect patients from post-surgery injuries like muscle strains or nerve damage.” Wright notes that some MIS approaches require the use of highly specialized equipment that requires specific training or involves placing the patient in extreme positions for an extended period of time that could increase the risk for injury. “Considerations for patient positioning might include a pre-operative assessment of the patient (such as the patient’s nutritional status, body habitus, pre-existing injuries or range of motion limitations), the surgeon’s preference for position and/or positioning devices, the condition and availability of the positioning devices to be used and the operating room bed capabilities,” says Wright. Also, when using robots to manipulate surgical arms, surgeons can accidentally hit the patient’s body in different places based on the surgery. “It’s up to the OR team as circuWWW.ORTODAY.COM

lators, scrubs and first assistants to position the patient in a safe way to protect sensitive areas like ulnar nerves, ankles and knees and adjust the robotic arms in a way that doesn’t cause harm to the patient,” says Dunia.

Safety Considerations for OR Nurses Hamlet lists some of the main safety considerations OR nurses should consider when caring for patients during minimally invasive surgeries. The list includes: Reduce risk of injury associated with gas insufflation (such as carbon dioxide) by setting the insufflation flow rate as specified by the surgeon and in accordance with the manufacturer’s recommendations. Monitor the amount of fluid used and collected during the procedure, as well as the patient’s core temperature and potential fluid retention. He cites AORN Guidelines which state that while fluid distention-related complications occur in less than one percent of procedures, the risk increases with the length of the procedure and degree of dissection of the surrounding tissue. Look for any movements in the patient’s position whenever the OR bed is repositioned during the case. Notify the surgeon if the patient’s position is moved or anyone will be moving the patient during the surgery. Clean the system between each surgical procedure to reduce the risk of cross-contamination between patients and surgical site infections. Also inspect the instruments and equipment for any defects and remove defective items from service. Cruz recommends that perioperative nurses help prepare for endoscopic and minimally invasive surgeries by

making sure the appropriate instruments are available beforehand and positioning the robot in an optimal place depending on the procedure. “OR nurses should also check the equipment pre-operatively to make sure it will be ready for the case,” she adds. “And during the case, OR nurses should be ready to not only care for the patients but also to assist with the robot as needed.” In addition, Cruz stresses the importance of always knowing where the emergency key is to manually move the robot off the field as needed. “And organize the wires in the operating room to reduce the chances of any falls or trips,” she says. As with any new technology, familiarity with the device or equipment and knowledge of the procedure are the main safety considerations, says Wright. “Engaging vendors in educating perioperative personnel is key to ensuring the instructions for use are followed so that medical devices are used as intended and in a manner that is safe for both patients and users,” she says. “Training the end-users is essential to providing patients with the safest care and best outcomes,” adds Hamlet. “Everyone touching the system should be knowledgeable in how it operates, how to troubleshoot and what to do in an emergency.” Heitman stresses that the main role of the perioperative nurse in managing endoscopic and MIS technologies is the same as it has always been – patient advocacy and safety. “OR nurses are there to prepare the rooms for our patients’ specific needs and ensure proper positioning, prepping, sterility monitoring and trouble shooting any issues that may arise during the case,” says Heitman. “We are the front line for our patients, which means keeping them safe and providing the best outcome possible.” May 2021 | OR TODAY

By Matt Skoufalos During her first assignment out of nursing school in 1976, Ora Wood described feeling that she was struggling with “the discrepancy between knowing what I was taught was the right thing to do and what was being practiced.” A self-described idealist, Wood had trouble reconciling the best-practices models she’d learned in the classroom with the lapses in real-world behaviors she observed firsthand as a health care professional. At the time, the dean of her nursing school introduced Wood to Marlene Kramer’s 1974 book “Reality Shock: Why Nurses Leave Nursing,” which coined the famous phrase in its title. The book helped her contextualize her feelings about her chosen profession enough to keep on track, but Wood never fully abandoned her belief in continuous improvement. Instead, she sought out other ways to realize it throughout her career. Upon graduating Southwestern Illinois College in 1977 with an associate 46

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degree, Wood began her career in the medical/surgical floor at St. Elizabeth’s Hospital in Belleville, Illinois. After marrying, she moved 10 miles away, and began working at Incarnate Word Hospital, a 336-bed acute-care hospital in St. Louis, Missouri. There, Wood started in the intensive care unit before first entering the operating room in 1981, where she has remained ever since. In a 26-year hospital career spanning a variety of clinical settings, most of them at St. Anthony’s Medical Center in St. Louis (now Mercy South), Wood has been a team leader, specialty lead and charge nurse. She earned her bachelor’s degree in nursing in 2009, and a master’s of science in health administration three years later. All the while, however, the operating room remained an integral part of Wood’s nursing career, and her interest in process improvement and leadership remained undiminished. “I enjoy taking care of people,” she said. “As I’ve grown into leadership, I like developing teams and having that

success for a team. Hardly anything feels better than developing a process and having better patient care.” In 2013, however, Wood pivoted to consulting, parlaying her expertise in clinical operations into a series of high-level, interim positions in surgical and perioperative services before finally leveraging her connections throughout the field into a career as a self-employed consultant. The work, she said, allows her to “help people realize their potential in patient care.” “As a consultant, a lot of times people have a picture of what they are,” Wood said. “Because of my deep clinical experience, 90 percent of what they’re thinking, I’ve been there and I know, so it helps me figure out what I need to do. I enjoy having those person-to-person relationships as a director and mentoring people to be leaders, and stepping up to the plate to help them implement best practices from a practical side and from a clinical safety standpoint. When you do it, nurses feel really good about it.” When she arrives on location, WWW.ORTODAY.COM

Ora Wood loves helping fellow nurses and spending time with her family including her dogs – Art and Honey.

Wood works to build trust among onsite staff, physicians and administration; the best way she knows to do that “is by being very transparent and up-front and dependable.” “I don’t say I’m going to do something and not do it,” Wood said. “Trust is a really hard thing; it’s what you have to work for the most when you’re building a team. I try to build relationships with people so there is trust.” Building trusted relationships builds teams, and by working through projects with the teams she helps build, Wood works to empower the facility for which she’s consulting to make their own decisions, “and then they go from there to owning it themselves versus us guiding them.” “That’s where the beauty is supposed to come in,” she said. “We transition that over. It ends up being a self-governance.” In an ideal circumstance, Wood said she would enter a leadership position on an interim basis and implement the processes she normally employs as a consultant. Having the authority of an WWW.ORTODAY.COM

interim director would enable her to implement process improvements that have proven efficacy, and enable her clients to achieve their goals quicker, while eliminating the effort it can sometimes take to earn the support of onsite supervisors. “When you’re a consultant, you’re very much dependent on the actual director who’s there to get something done, and that level of engagement always changes with each place,” she said. “A lot of people don’t want to go into leadership because of the responsibility; a lot of people are in leadership who shouldn’t be.” Leadership also remains one of the areas of the hospital in which nurses are seldom as well represented as some other specialties are. Wood believes that coaching nurses to focus on communication can help them learn to give voice to their ideas in a manner that befits the team-based health care model while also being true to their ideals. “I think you have to appreciate everybody,” she said. “You recognize more good in what you see, and that

does change the culture because you’re thinking positively. Instead of complaining about what you don’t have, you appreciate what you do have.” That approach has guided Wood through myriad assignments in 14 states across the country, from the Midwest to the East and West Coasts. The opportunities she’s been able to embrace throughout a flourishing career have also supported a 40year marriage, two grown children and a house full of well-loved dogs. When she’s not on the road, Wood loves spending time with her family, especially their biweekly game nights. And when she is working, she’s able to follow her vocational passions of process improvement and professional development. “The thing about nursing is I’ve had so many choices in my life,” Wood said. “I’ve worked in orthopedics, I’ve worked in open heart; I’ve been able to say, ‘I’ve done that, let’s move on to the next thing.’ And that’s what I like.”

May 2021 | OR TODAY

OUT OF THE OR fitness

Train the Mind and the Body Will Follow By Miguel J. Ortiz he first law of thermodynamics says energy can be changed from one form to another, however it cannot be created or destroyed. What does that mean for you or your body? Consider this, if everything you will ever want is already here, it is simply a matter of choosing the thoughts which will put you into harmonious vibration with what you desire.

So, essentially, the first thing we must change before we can change the body is the mind. Don’t get me wrong, changing the mind isn’t as easy as it sounds. It takes practice, patience and discipline with yourself over a period of time in order to create consistent changes. Let’s focus on a couple of mindful activities and daily behaviors that will have a positive effect on mind and body. First, let’s start to address how we are generally speaking to ourselves. We don’t need to turn into the most positive person in the world, but utilizing positive reinforcement to talk to yourself is an extremely beneficial practice. I’ve always said, watch your words when around others and watch your thoughts when you are alone. In 48

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order to change the body, we need to first appreciate it. You’re not going to build a strong body if you keep telling yourself things like, “You can’t do it” or “You’re not good enough.” Let go of the idea that you are bound to your current state. Replace that idea with the belief that you can simply start to make changes in order to get to where you want to be. Wake up every day and tell yourself one thing that you’re grateful for in your life or body – and mean it. Second, transition these new positive thoughts into consistent physical behaviors. Before we do so, what is the ultimate goal? In this case, we want a healthier or stronger body. Well, imagine yourself in that body. Imagine what that body can do. Now, in this new body, how would this “new you” behave physically to maintain this image? Remember the journey to a healthier life isn’t a one-stop shop – we age, we change, we get hurt. Life has a wild way of throwing us curve balls. Yet, we cannot let what “may happen” become our reality. We must begin to make changes in order to prepare ourselves as best as we can to respond to life’s circumstances. So, if you imagine yourself being more flexible – stretch daily. If you imagine yourself being stronger

– challenge your body daily. If you imagine yourself being faster on the track – pick up our feet a little more. Regardless, you must move and act. It may not be as you imagined but that’s OK. You are creating a “new you” daily and you must start somewhere. Lastly, be mindful of your surroundings, especially the people you spend time with. Are these people supporting you or the idea of this “new you?” You must begin to accept that your support system will undoubtedly change as you step into a more authentic self. So, don’t be afraid to let go of ideas, people or things in your life. You will never really leave anyone, separation is simply a biproduct of elevation. So, elevate and stop holding yourself back from doing what you love or becoming someone new. Embrace the beauty and challenges that come with change for everything you create in the body will always start in the mind. 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. WWW.ORTODAY.COM

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May 2021 | OR TODAY

OUT OF THE OR pinboard health

EVAR Linked to Higher Readmission Rates Compared to Open Repair uptured abdominal aortic aneurysms (rAAA) are responsible for nearly 2% of all deaths in U.S. men over the age of 65. Endovascular aneurysm repair (EVAR) has emerged as a newer and less invasive alternative to open repair for rAAA, and current guidelines recommend EVAR as a first-line option for treatment of rAAA when certain criteria are met. But researchers from the University of Missouri School of Medicine have discovered that while EVAR is more commonly utilized for rAA, shortens hospital stay and has a lower initial mortality rate, the odds of hospital readmission after EVAR are 1.5 times higher compared to traditional open repair.

“A high rate of readmissions in vascular surgery patients is associated with increased patient morbidity and mortality, along with increased costs 50 OR TODAY | May 2021

to both hospitals and patients,” said Todd Vogel, MD, associate professor of vascular and endovascular surgery. “Understanding contributing factors leading to hospital readmission after emergency rAAA procedures may lead to improved patient outcomes and decreased costs.” Vogel’s team analyzed 3,629 emergency or urgent open rAAA and 5,037 EVAR procedures over three years. They found EVAR had a significantly lower hospital mortality rate (21.4% for EVAR vs. 33.5% for open) and a 3.5-day shorter length of stay. However, EVAR patients had a significantly higher readmission rate within 30 days (EVAR 18.9% vs 14.3% for open). Infection complications were the most common reason for readmission for both types of procedures, but Vogel identified additional risk factors specific to EVAR. “After adjusting for comorbidities and procedure type, we found additional EVAR-specific risk factors for readmission included prior EVAR

repair, longer length of initial hospital stay and presence of chronic kidney disease or coronary artery disease,” Vogel said. “Further investigation into reasons why a less invasive procedure has a higher readmission rate are needed.” In addition, Vogel said understanding post-discharge infection complications will also be important to help lower readmission and subsequent health care utilization after rAAA. Other MU School of Medicine study authors include Drew Braet, MD, resident; John Taaffee, medical student; Priyanka Singh, Ph.D., data scientist; Jonathan Bath, MD, assistant professor of surgery; and Robin Kruse, Ph.D., research professor emerita. The study, “Readmission and Utilization After Repair of Ruptured Abdominal Aortic Aneurysms in the United States,” was recently published by the journal Vascular and Endovascular Surgery. The authors declare no potential conflicts of interest. WWW.ORTODAY.COM

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OUT OF THE OR EQ factor

Working With ‘Conscientious’ Styles By daniel bobinski, M.Ed. f you know what you’re looking for, it’s relatively easy to identify a person’s core behavioral style. In the past several issues, I’ve been writing about the four core styles. I have been highlighting each style’s ideal environment and motivations, value to the team and preferred communication methods.

By way of review, so far I’ve covered the “Dominant” style, the “Influencer” style and the “Steady” style. Dominant styles are more task-focused and comfortable making high-risk decisions quickly. Influencers are comfortable making high-risk decisions quickly but focus more on people than tasks. Steady styles focus on people but prefer lower-risk decisions and taking their time when making those decisions. In this installment we’ll examine the “Conscientious” style. To read all four columns, visit tinyurl. com/4ndscpcy. Like the Steady style, people with a Conscientious style also prefer lower risk decisions and taking their time when making them. However, they tend to focus more on the tasks rather than the people helping with the tasks.

Value to the team People with a strong “Conscientious” style are objective thinkers who set and maintain high standards. Typically, they are good at asking incisive ques52

OR TODAY | May 2021

tions that get to the heart of a matter while clarifying expectations along the way. In practical terms, this enables them to see gaps in plans, which makes them an asset to just about any team. They tend to be diplomatic with an eye for detail.

Ideal environment and motivations Conscientious people enjoy technical, task-oriented work that can be followed through to completion. They prefer working with small groups of people in an environment where quality and high standards are appreciated. They like knowing what rules and procedures are expected, and they want their team members and supervisors to follow established rules or company policies, too. They’re not fans of abrupt change nor noisy environments, but they’re big fans of having time to process information so they can analyze data. Conscientious types prefer avoiding the negative consequences of a bad decision.

Best communication methods People with a strong Conscientious style like action plans with scheduled dates and milestones. Details are important to them, so avoid vagaries. If you appear disorganized or are unclear about expectations, that will cause frustration and maybe a loss of trust. Objective facts and verifiable research are important, so avoid making emotional appeals or offering feelings as a reason for doing something.

When talking with strong Conscientious types, take your time. Prepare your case in advance and use a logical, straightforward delivery. Also, keep emotions to a minimum. Provide enough information so they can make a solid decision. In fact, if you present both the pros and the cons of an idea, you will gain much credibility. They know pros and cons exist for everything, so if you gloss over the cons they are likely to think you’re tying to hide something. Better to be totally transparent. Finally, give them time and space to think things through. Forcing quick decisions creates tension. They want time to examine both sides of an issue and be confident their decisions are the best ones possible.

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 him through his website at MyWorkplaceExcellence.com or call his office at 208-375-7606.

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May 2021 | OR TODAY

OUT OUTOF OFTHE THEOR OR recipe nutrition

Stress Eating? Try Chocolate! By KIRSTEN Serrano bet if I say stress eating, you think of a pint of ice cream or your favorite nachos. Stress can certainly drive you to make less than ideal food choices, but you can also eat to counteract its effects.

Magnesium is the magic mineral we are so often not eating enough of (about ¾ of us) that has the power to help us overcome life’s challenges. Stress is a complex foe, and it takes a multi-pronged strategy to overcome the effects, but what you eat is an important stress busting tool. Health care workers lead stressful lives under the best circumstances, and this past year plus has been some of the worst circumstances. Think of magnesium as the relaxation mineral. It is the reason an Epsom salt soak can calm your nerves and relieve your aches and pains. Magnesium plays a huge role in your stress response. Magnesium helps you cope with stress, but stress depletes it. Low magnesium levels trigger cortisol production, and cortisol is your main stress hormone. Magnesium supplementation lowers cortisol levels and calms the body’s stress response. Unless you intervene and get your body the magnesium you need, stress can really drag you under. It is hard to tell how much of your stress response 54

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is triggered by stressors themselves and how much is from missing magnesium. Many of the symptoms of stress are the symptoms of magnesium deficiency. A clenched jaw, insomnia, headaches, fatigue and body aches are all signs of magnesium deficiency and chronic stress. Low magnesium is also linked with depression, anxiety and suicidality. Small changes can make big differences. You can use food for stress relief by being intentional about eating magnesium-rich foods. Nuts, seeds and legumes like pumpkin seeds, almonds, lima beans and cashews are high in magnesium. Dark leafy greens like spinach and chard are also great choices. Brown rice, oats, avocados, salmon and potatoes are magnesium winners too. The Recommended Dietary Allowance (RDA) for an adult is 420 mg (remember, stress increases your need). A handful or pumpkin seeds or a cup of cooked spinach provides about 40% of the RDA. If chard and pumpkin seeds do not excite you, know this: chocolate is magnesium rich! Choose a highquality dark chocolate (the darker, the better) to get the maximum benefit without all the health-tanking sugar and additives. The next time you are feeling stressed out, try some prescriptive dark chocolate. One ounce of 85% dark chocolate provides 15% of the

recommended daily value. Eating magnesium rich foods is a great way to practice real self-care. Eating your magnesium is truly crucial for combating stress, but it is also vital for overall health. Magnesium is necessary for over 300 enzyme reactions in your body. You cannot make cellular energy without it. Pretty important stuff! You need it to move your muscles, make your heart beat, send nerve signals, have strong bones and so much more. If stress has its grip on you, I urge you to eat more magnesium and consider talking with a health professional about supplementing with magnesium. Sometimes food alone is just not enough when there is a serious deficiency (and serious stress.) Magnesium can be taken orally, in an IV or transdermally. Try an Epsom salt soak the next time you need to relax. Enjoy that dark chocolate. Kirsten Serrano is a nutrition consultant, chef, farmer, food literacy educator and the best-selling author of “Eat to Your Advantage.” You can find out more about her work at SmallWonderFood.com.

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OUT OF THE OR recipe

Baked Parmesan Chicken INGREDIENTS: • Cooking spray

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• 1 large egg

the

• 1 tablespoon water • 2 teaspoons olive oil • 1/3 cup finely crushed, low-sodium, wholegrain crispbread • 1/3 cup shredded or grated Parmesan cheese • 2 tablespoons minced fresh parsley • 1/2 teaspoon ground oregano • 1/4 teaspoon pepper • 4 boneless, skinless chicken breasts (about 4 ounces each), all visible fat discarded, flattened to 1/4-inch thickness

By Family Features

OR TODAY | May 2021

WWW.ORTODAY.COM

OUT OF THE OR

Protect Your Health with a Heart-Smart Eating Plan

recipe

By Family Features s people have spent more time at home, many have rediscovered the simple joy of home-cooking and stumbled upon a secret weapon for health at the same time. By making smart, intentional decisions from breakfast to dinner and every meal (and drink) inbetween, they are supporting strong bodies.

A heart-smart eating plan is especially important for more than 30 million people in the U.S. living with type 2 diabetes who are at double the risk for heart disease and stroke compared to those without diabetes, according to the American Heart Association and American Diabetes Association’s Know Diabetes by Heart initiative. When managing diabetes and heart health, building a consistent eating plan with the right balance can be a powerful tool.

Baked Parmesan Chicken Prep time: 15 minutes Cook time: 18 minutes Servings: 4 (3 ounces chicken per serving) 1. Preheat the oven to 400 F. Lightly spray a 13-by-9-by-2-inch baking dish with cooking spray. 2. In a shallow dish, whisk the egg, water and oil. In a separate shallow dish or pie pan, stir together the crispbread, Parmesan cheese, parsley, oregano and pepper. Dip the chicken in the egg mixture then

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Healthy eating provides benefits for the whole family whether members are managing existing health conditions or not. This recipe for Baked Parmesan Chicken is packed with 30 grams of protein in each serving yet delivers only 280 calories. For a tasty way to increase vegetable intake, try pairing the no-sugar chicken dish with Green Beans with Mushrooms and Onions. A key to feeling your best begins with the first meal of the day. Start the morning on a nutritious note with the Ham and Broccoli Frittata – a low-sugar, lowfat, low-calorie alternative to traditional fat- and sugar-laden breakfast foods. With this recipe, you’re setting yourself up for a healthy day and getting the energy you need to live it to the fullest. Find recipes and learn more about managing the connection between diabetes and heart health at KnowDiabetesbyHeart.org/Recipes.

in crumb mixture, turning to coat at each step and gently shaking off any excess. Using fingertips, gently press the coating mixture so it adheres to the chicken. Arrange the chicken in a single layer in the baking dish. Lightly spray the chicken with cooking spray. 3. Bake for 15-18 minutes, or until chicken is no longer pink in the center and the top coating is golden brown. Recipe courtesy of Know Diabetes by Heart

May 2021 | OR TODAY

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OR TODAY | May 2021

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The News and Photos

OUT OF THE OR

that Caught Our Eye This Month

pinboard

BOOK REVEALS WHAT HAPPENS PATIENTS ARE UNCONSCIOUS

on Whitchurch spent 50 years safely put-

sion. For example,

ting people to sleep, watching over them as

in an article about

they dozed through operations both planned and

his mother writ-

unplanned.

ten for a church

In his new book, “50 Years in the OR: True

bulletin, the writer

Stories of Life, Loss, and Laughter While Giving

mistakenly de-

Anesthesia” (Loon Lake Press), he takes read-

scribed him as an

ers along for some of his most memorable cases.

atheist – instead of

These incidents stood out in a long career in

an anesthetist.

which he enjoyed every minute of this life-anddeath job.

“I loved reading this wonderful collection of triumphs, tragedies, near misses, and so many

He writes about his first post in a rural area

funny situations in the OR. Ron is an anesthe-

near an Indian reservation, “We got almost every

sia historian, a keen observer of the quirks and

kind of emergency and trauma imaginable, from

ironies of life in surgery and a colorful storyteller.

shootings, stabbings, beatings, and car wrecks to

A fascinating and clearly explained glimpse at

appendicitis, ectopic pregnancies, bowel obstruc-

the world on the other side of the drapes,” said

tions, fishhooks in various body parts and frac-

Antonio J. Gayoso, M.D., ASPS, ASAPS.

tures. And, during deer hunting season in No-

“These are amazing, authentic memories of

vember, all the big-city hunters would converge

as broad a scope of cases as one could imagine,

on our north woods and fill the emergency room

stories that could not have been made up and

regularly with some of the most bizarre injuries

told with insight, transparency and an indomi-

imaginable.”

table sense of humor. Such a rich experience is a

Whitchurch worked in both rural and city envi-

must-read for anyone who has had or is interest-

ronments before retiring two years ago. He points

ed in anesthesia,” said Sondra Shields, M.D., Mayo

out that more than one-half of all the anesthetics

Clinic-trained, board-certified in anesthesiology

administered in the U.S. are provided by certified

and pain management.

registered nurse anesthetists (CRNAs) like himself, yet most people are unaware of this profes-

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For more information, visit https://50yearsintheor.com.

May 2021 | OR TODAY

TBJ

Incorporated

SurgiSonic 1211X ®

Patented cleaning method for cleaning da Vinci instruments. ®

Effective, affordable, versatile, counter-top size, easy to set up, easy to use, easy to maintain.

COUNTER-TOP SIZE

AFFORDABLE

Independently tested for cleaning effectiveness; exceeded AAMI TIR 30.

Cleans all types of submersible surgical instruments. • Specializes in cleaning tubular surgical instruments. Patented method for cleaning robotic instruments: Indenpendent pump and filter for da Vinci® tool end and shaft. Combines ultrasonic action with in-line flushing, suction, and filtration. Filter

Narrow interior and multiple holes creates powerful turbulence to remove debris from jaw/pulley areas.

Suction creates water jet spray to clean jaw

Pump

Filter

Suction flushes shaft clean

Because a tight seal separates the distal jaw/pulley end from the proximal shaft/control box end, a patented dual hook-up method was created for independently cleaning both the distal and the proximal segmented areas of the da Vinci® robotic instrument at the same time. Three “da Vinci® robotic instruments can be cleaned at the same time using this dual hook-up-method and test. *Results sent upon request.

SurgiClean.com for more information TBJ Incorporated Phone: 717-261-9700 • Fax: 717-261-1730 • sales@surgiclean.com

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INDUSTRY INSIGHTS NEWS & NOTES

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INDU STRY NEW S & NOINSIGHTS TES CE AR OUT OF THE OR TICLE WHAT YOU NEED TO KNOW POST-CES AREA N SE ABOUT YOUR THYROID CTIO N

CE ARTICLE CARDIAC INVASIVE PROCEDURES

PRODUCT FOCUS INSTRUMENT TRACKING SYSTEMS

m ay.co

20 E 20

.ortod www

SPOT LIGHT SHEL IA HO PROFILE LLER AN

JUN

LIFE

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LIFE IN AND OUT OF THE OR

THE

NUTR ITION HABI TS

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E UR SS RE P E TIV GA E N

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INDEX

advertisers

ALPHABETICAL Action Products, Inc………………………………………… 49

Cygnus Medical………………………………………………… BC

MedWrench…………………………………………………………51

AIV Inc.…………………………………………………………………15

Healthmark Industries Company, Inc.………… 63

OR Today Webinar Series……………………………… 55

AORN…………………………………………………………………… 6

Jac-Cell Medical……………………………………………… 53

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

ASCA………………………………………………………………… 49

Jet Medical Electronics Inc………………………………19

Sympliant…………………………………………………………… 53

ASP………………………………………………………………………… 5

Key Surgical……………………………………………………… 25

TBJ Incorporated…………………………………………29, 60

BD………………………………………………………………………… 9

Light Source & Video Repair, Inc……………………21

Calzuro.com…………………………………………………………13

MD Technologies Inc.………………………………………… 4

CATEGORICAL ASSOCIATION

Healthmark Industries Company, Inc.………… 63

REPROCESSING STATIONS

AORN…………………………………………………………………… 6

MD Technologies Inc.………………………………………… 4

ASCA………………………………………………………………… 49

Ruhof Corporation……………………………………………… 2

TBJ Incorporated……………………………………… 29, 60

Jet Medical Electronics Inc………………………………19

INSTRUMENT STORAGE/TRANSPORT

SAFETY

CARTS/CABINETS

Cygnus Medical………………………………………………… 64

Calzuro.com…………………………………………………………13

Key Surgical……………………………………………………… 25

Healthmark Industries Company, Inc.………… 63

Ruhof Corporation……………………………………………… 2

Key Surgical……………………………………………………… 25

TBJ Incorporated……………………………………… 29, 60

INVENTORY CONTROL

SINKS

CS/SPD

Key Surgical……………………………………………………… 25

Ruhof Corporation……………………………………………… 2

MD Technologies Inc.………………………………………… 4

LAPAROSCOPY

CARDIAC PRODUCTS

Cygnus Medical………………………………………………… 64 Healthmark Industries Company, Inc.………… 63

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

DISINFECTION ASP………………………………………………………………………… 5 Cygnus Medical………………………………………………… 64 Ruhof Corporation……………………………………………… 2

ENDOSCOPY Cygnus Medical………………………………………………… 64

Jac-Cell Medical……………………………………………… 53

ONLINE RESOURCE MedWrench…………………………………………………………51 OR Today Webinar Series……………………………… 55

OR TABLES/BOOMS/ACCESSORIES Action Products, Inc.……………………………………… 49

Healthmark Industries Company, Inc.………… 63

OTHER

Light Source & Video Repair, Inc……………………21

AIV Inc.…………………………………………………………………15

MD Technologies Inc.………………………………………… 4 Ruhof Corporation……………………………………………… 2

PATIENT MONITORING

Sympliant…………………………………………………………… 53

AIV Inc.…………………………………………………………………15

FLUID MANAGEMENT MD Technologies Inc.………………………………………… 4

FOOTWEAR Calzuro.com…………………………………………………………13

GENERAL AIV Inc.…………………………………………………………………15

Jet Medical Electronics Inc………………………………19

POSITIONING PRODUCTS Action Products, Inc.……………………………………… 49 Cygnus Medical………………………………………………… 64

PRESSURE ULCER MANAGEMENT Action Products, Inc.……………………………………… 49

TBJ Incorporated……………………………………… 29, 60

SKIN PREPARATION BD………………………………………………………………………… 9

STERILIZATION ASP………………………………………………………………………… 5 Cygnus Medical………………………………………………… 64 Healthmark Industries Company, Inc.………… 63 MD Technologies Inc.………………………………………… 4 TBJ Incorporated……………………………………… 29, 60

SURGICAL MD Technologies Inc.………………………………………… 4

SURGICAL INSTRUMENT/ACCESSORIES Cygnus Medical………………………………………………… 64 Healthmark Industries Company, Inc.………… 63 Key Surgical……………………………………………………… 25

TELEMETRY AIV Inc.…………………………………………………………………15

TEST EQUIPMENT Jac-Cell Medical……………………………………………… 53

INFECTION CONTROL

REPAIR SERVICES

WASTE MANAGEMENT

ASP………………………………………………………………………… 5

Cygnus Medical………………………………………………… 64

MD Technologies Inc.………………………………………… 4

Cygnus Medical………………………………………………… 64

Jet Medical Electronics Inc………………………………19

TBJ Incorporated……………………………………… 29, 60

OR TODAY | May 2021

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