OR Today Magazine November 2021 by MD Publishing

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LIFE IN AND OUT OF THE OR

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NOVEMBER 2021

TIMEOUTS and

HANDOFFS

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OR TODAY | November 2021

contents features

TIMEOUTS AND HANDOFFS When most people hear the terms “time out” and “handoff,” they think of football. In OR parlance, a time out is a pause that’s performed prior to the initiation of an operative or invasive procedure. A handoff is the transfer of a patient’s care from one practitioner to another.

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strategies for medication and solution

and improve efficiency in the operating

labeling in the perioperative setting.

room and hospital clinics where patient

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stability and positioning are required.

OR Today (Vol. 21, Issue #11) November 2021 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to OR Today at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2021

OR TODAY | November 2021

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PUBLISHER John M. Krieg

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VICE PRESIDENT

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SPOTLIGHT ON

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Darlene Murdock, BSN, BA, RN, CNOR, CSSM

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OR TODAY CONTEST

RECIPE OF THE MONTH

DIGITAL SERVICES Cindy Galindo Kennedy Krieg Erin Register

INDUSTRY INSIGHTS

EVENTS

9 News & Notes 16 IAHCSMM: Are Your Technicians Using PPE Correctly? 18 AAMI: Fall 2021 Sterilization Standards Week Highlights 20 ASCA: ASCs Offer Significant Savings, Face Growing Competition for Staff 22 CCI: Credentialing and the use of digital badges 24 OR Today Webinars

Kristin Leavoy

ACCOUNTING Diane Costea

WEBINARS Jennifer Godwin

IN THE OR

EDITORIAL BOARD

26 M arket Analysis: 27 Product Focus: 30 CE Article: Safe Labeling Helps Prevent OR Errors 40 IMP

Hank Balch, President & Founder, Beyond Clean Vangie Dennis, MSN, RN, CNOR, CMLSO, Assistant Vice President, Perioperative Services

OUT OF THE OR

48 Spotlight On: Darlene Murdock 50 Fitness 53 Health 54 EQ Factor 56 Nutrition 58 Recipe 60 Pinboard

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62 Index

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Credentialing Institute David Taylor, President, Resolute Advisory Group, LLC Elizabeth Vane, Health Science Teacher, Health Careers High School

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news & notes

PDI Healthcare Introduces Dual Access Lid on Sani-Cloth Products PDI Healthcare has announced a new dual access lid, designed to improve the convenience of disinfecting wipes for faster and easier access. Today’s fast-paced health care environment demands quicker and easier access to disinfecting wipes to maintain infection prevention protocol, but too often canister lids slow users down. The narrow lid opening can make it difficult to dispense wipes and the cap can be difficult to close so it’s frequently left open, leading to wipes drying out. The innovative wide opening of the dual access lid ensures users pull the appropriate number of wipes for the job, allowing them to dispense one wipe for small surfaces or multiple wipes for larger surfaces, with rapid threading in case of fall back. The flip cap is designed with “Snap & Close” technology to snap securely in place with just one tap and the definitive open/close positions provide better moisture protection. “PDI is focused on the next generation of products that will make a difference, and that includes packaging innovation,” said Earl Adamy, senior director of marketing. “Too often we observed customers struggle with canister lids including, loading the first wipe, dispensing multiple wipes and leaving lids open. We felt that with some innovation, we could address these issues and improve the customer experience. The dual access lid has a tremendous impact on saving staff time and reducing frustration so nurses can focus on what matters most – their patients.” The dual access lid is the latest in the company’s commitment to develop products and packaging innovations that improve operations and compliance throughout health care facilities. Launched in June, PDI’s portable softpack for the Super Sani-Cloth Wipes saves 80% in packaging and is ideal for daily use in fast-paced environments. SaniCloth Bleach Clinical Size Wipe, a 6” x 5” disinfecting wipe ideal for smaller medical equipment, provides more than double the disinfection applications per canister and helps reduce unnecessary waste. The dual access lid is being integrated in every PDI disinfecting wipe canister, beginning with Super Sani-Cloth wipes.

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OR Today Supports Perioperative Nurses Week OR Today magazine joins patients, surgeons and health care organizations in celebration of Perioperative Nurses Week this month. This year, Perioperative Nurses Week is November 14-20. It is a week set aside to celebrate the wonderful patient advocates known as perioperative nurses who do so many important tasks to make certain patients receive the safe quality and important care that they need. Perioperative nurses perform several roles depending on the country they practice in, including circulating, instrument (or scrub) nurse, preoperative (or patient reception) nurse, recovery nurse, registered nurse first assistant (RNFA), patient educator and more. OR Today says “Thank you!” to all of the perioperative nurses who have always filled critically important roles. Oftentimes perioperative nurses treat patients when they are most in need. Perioperative nurses have also been unsung heroes during the ongoing COVID-19 pandemic by stepping up and filling in where needed.

November 2021 | OR TODAY

INDUSTRY INSIGHTS

news & notes

Asensus Surgical Receives FDA 510(k) Clearance Asensus Surgical Inc. has received 510(k) clearance from the FDA for an expansion of machine vision capabilities on the previously cleared Intelligent Surgical Unit (ISU). The ISU is utilized with the company’s Senhance Surgical System which enables digital laparoscopy. “We are thrilled to have received FDA clearance for our next generation of augmented intelligence features on the ISU,” said Anthony Fernando, Asensus Surgical president and CEO. “The addition of these pioneering digital capabilities on our existing surgical platform provides real-time intraoperative digital tools to surgeons and underscores our commitment to delivering our vision for performance-guided surgery. This is the latest example of our progress toward delivering on our Surgical Assurance Framework by unlock-

ing the clinical intelligence necessary to enable consistently superior outcomes and a new standard of surgery.” The current features of the ISU enable machine visiondriven control of the camera for a surgeon by responding to commands and recognizing certain objects and locations in the surgical field and allow a surgeon to change the visualized field of view using the movement of their instruments. The newest ISU features expand upon these capabilities and introduce more advanced features including: 3D measurement, digital tagging, image enhancement and enhanced camera control based on real-time data from anatomical structures while performing surgery. This will be the first time any of these features will be clinically available in soft-tissue abdominal surgery.

Diversey Unveils Innovation Zone Research and Development Center Diversey Holdings Ltd. has opened its Innovation Zone Research and Development Center. Located on the campus of Diversey’s corporate headquarters in Fort Mill, S.C., the facility houses numerous state-of-the-art labs where scientists and specialists can develop the industry’s next generation of cleaning and hygiene solutions. “We’re incredibly excited to open the doors of the Innovation Zone because it will help us fast track the development of new solutions that care for and protect people around the world,” Diversey North America President Paul

OR TODAY | November 2021

Budsworth said. “This investment is an important step for advancing commercial cleaning capabilities and helping us to better support our global customer base.” The Innovation Zone brings Diversey’s North American R&D groups into a single facility. It includes Diversey’s analytical lab, formulation lab, microbiology lab, and dosing, dispensing and application lab. Having all R&D staff in one facility creates a more collaborative environment for streamlining the development of innovative products.

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UVDI Awarded ASCEND Contract for UV-C Room Disinfection with Premier Inc. UltraViolet Devices Inc. (UVDI) has been awarded a contract with Premier’s highly committed ASCEND (Accelerated Supply Chain Endeavor) program in the category of Room Environment Infection Prevention. Effective August 1, 2021, the agreement provides Premier ASCEND members with special pre-negotiated pricing for the UVDI-360 Room Sanitizer, trusted by over 1,000 hospitals in more than 25 countries for advanced UV-C room disinfection. The UVDI-360 Room Sanitizer is proven to reduce

INDUSTRY INSIGHTS

news & notes

both healthcare-associated infections and high-risk pathogens in over 15 peer-reviewed, published clinical studies, as well as independently tested to eliminate 99.99% of over 35 high-risk pathogens in 5 minutes at 8 feet distance, and SARS-CoV-2 at 12 feet. The agreement with Premier’s ASCEND program will accelerate UVDI’s position as a market leader in UV room disinfection by providing even greater device access and value to Premier’s 4,100 hospital members in the United States.

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November 2021 | OR TODAY

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news & notes

First MIRA Miniature Robotic System Surgery Performed Virtual Incision Corporation, a medical device company pioneering miniaturized robots for laparoscopic surgery, has announced that the world’s first surgery using the MIRA (miniaturized in vivo robotic assistant) Surgical Platform has been successfully performed by Michael A. Jobst, M.D., at Bryan Medical Center in Lincoln, Nebraska. The robotically assisted right hemicolectomy procedure, which was completed using the MIRA surgical platform via a single incision within the navel, was performed as part of a clinical study of MIRA under an Investigational Device Exemption (IDE) from the U.S. Food and Drug Administration (FDA). The study will be conducted at a limited number of U.S. hospitals in support of the system’s regulatory pathway to approval. MIRA is an investigational device that is limited to investigational use in the United States. “The MIRA platform is a true breakthrough platform for general surgery, and it is extremely gratifying to be the first surgeon in the world to use the system,” said Jobst. “The procedure went smoothly,

and the patient is recovering well. I’m excited to play a part in taking the first steps toward increasing access to robotically assisted surgery, which has clear benefits for patients.” The MIRA Surgical Platform is a portable robot that allows surgeons to perform real-time minimally invasive single incision surgeries, without the need for the dedicated space or infrastructure typically required for “mainframe” robotic systems. Weighing only two pounds, the miniature platform has full robotic capabilities, and can easily be moved from room to room. The system is designed to enable complex, multi-quadrant abdominal surgeries using a simple, handheld device. Many hospitals currently offering robotic surgeries face challenges with scheduling because the demand for minimally invasive procedures exceeds the number of available robots. Capital costs often prohibit hospitals from purchasing additional platforms. MIRA aims to present a cost-effective option that will expand access to a larger number of patients.

IAHCSMM Announces 2021 Award Recipients The International Association of Healthcare Central Service Materiel Management’s (IAHCSMM’s) awards program honors sterile processing (SP) professionals each year who demonstrate exceptional leadership, dedication and service in the SP discipline. Numerous qualified candidates submitted nominations for the 2021 IAHCSMM Awards. The IAHCSMM Board of Directors carefully reviewed each submission and has named the following as this year’s award recipients: • Confidence Builder Award: St. Luke’s Hospital Sterile Processing Department in Chesterfield, Mo. • CS Leadership Award: Mohammed Shariyar Haji, CRCST, CSSD Manager at Sultan Bin Abdulaziz Humanitarian City in Riyadh, Saudi Arabia

OR TODAY | November 2021

• Decontaminator of the Year Award: Kelly Kincaid, CST, CRCST, CIS, CHL, CER, CPHQ, MST, Medical Supply Technician at Syracuse Veterans Health Administration Medical Centerin Syracuse, N.Y. • Technician Achievement Award: Janet Vos, CRCST, CIS, Sterile Processing Tech III at Idaho Surgery Center in Caldwell, Idaho • Chapter of the Year Award: • Large Chapter: California Central Service Association • Medium Chapter: Northeast Ohio Central Service Association • Small Chapter: Western Wisconsin Chapter of IAHCSMM

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INDUSTRY INSIGHTS

Encompass Group LLC Earns Patent for Airisana Therapeutic Support Surface Encompass Group LLC has received issuance of patent for Airisana as recognized by the U.S. Patent and Trademark Office (USPTO). Airisana was developed to represent a unique, new approach in alternating pressure and microclimate management that would support care teams by combining many of the best practices devised to prevent healthcare-acquired pressure injuries into one device, according to the Encompass Group website. “The issuance of a patent for Airisana is important to Encompass Group. It affirms the years of effort we’ve devoted to this game-changing product, and we have several other additional patents currently pending for Airisana. Encompass understands everyday care and this system provides opportunities to support a reduction in pressure injury risks, drives reductions in patient repositioning injuries among staff, and improves clinical efficiencies,” said Michelle Daniels, Encompass Group vice president, product strategy, development and administration. “We’re delighted by how well Airisana has been received by the nursing community.” Each Airisana system comes with an intuitive soft-touch user control panel that’s quiet enough to ensure a comfortable healing environment and keeps control in the care provider’s hands. The repeating pressure therapy patterns employed by traditional therapeutic support surfaces increase the probability that

news & notes

a patient’s body can adjust to the process, which can impede healing. Airisana reduces this risk with randomized pressure therapy modes that promote sustained pressure reduction and combine the benefits of multiple pressure therapies into a constantly changing surface a patient’s body doesn’t get used to. Airisana conforms evenly to irregularities such as body contours. This puts the greatest amount of contact between skin and surface and ensures decreased pressure without interfering with patient mobility. With turn-assist reducing friction and shear risk, and reducing caregiver injury, nurses and clinicians can now easily reposition patients as needed. For more information, visit www.encompassgroup.com/airisana-reducing-pressure-injuries.

Study: LightStrike Eliminated Superbug Contamination Researchers from Hiroshima University Hospital in Hiroshima, Japan, recently published a study confirming the efficacy of LightStrike pulsed xenon ultraviolet (UV) light disinfection technology on surfaces contaminated with the superbug vancomycin-resistant Enterococci (VRE). This is the 45th peer-reviewed and published study validating Xenex Disinfection Services’ patented pulsed xenon UV room disinfection technology, and the third published study verifying LightStrike’s efficacy against VRE, a deadly pathogen that can live on hospital surfaces for days to weeks. While the world’s attention has been focused on COVID-19 in recent months,

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hospitals continue to struggle with pathogens like Clostridioides difficile, VRE and Candida auris that lurk on surfaces and can cause healthcare associated infections. This most recent study provides further validation that using Xenex’s LightStrike robot should be a priority and a critical part of a hospital’s decontamination strategy because of the dangerous pathogens in the hospital environment that pose a risk to patients and health care workers. “The effect of pulsed-xenon ultraviolet disinfection on surfaces contaminated with vancomycin-resistant Enterococci in a Japanese hospital” is published in The Journal of Infection and Chemotherapy

(JIC), the official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. According to the study, researchers sampled numerous surfaces (toilet seat, toilet assist bar, bedrail, over-bed table, TV remote control, sink counter, etc.) in rooms that had been occupied by patients colonized with VRE before and after traditional manual cleaning, and then after disinfection with LightStrike pulsed xenon UV robots. The study showed that VRE was still present on surfaces in the patient rooms after manual cleaning, but there was no VRE remaining after LightStrike disinfection.

November 2021 | OR TODAY

INDUSTRY INSIGHTS

news & notes

IMP Launches De Mayo Adapt2Fit Modular Knee Positioner Because of the sudden impact of the COVID-19 pandemic, many hospitals specializing in total joints moved their orthopedic procedures over to freestanding and outpatient surgery centers, where there is minimal storage and sterile processing space. Thus, logistical challenges surfaced in processing patient positioning equipment in the smaller soak sinks and autoclaves generally found in these facilities. “These and other challenges prompted the development and engineering team at Innovative Medical Products Inc. to rethink and adapt its market-leading De Mayo Knee Positioners to today’s surgical environment. The result was an innovative next-generation version called De Mayo Adapt2Fit Modular Knee Positioner,” according to a press release. “The Adapt2Fit was specifically designed for space and performance challenges of an ASC. It’s quick to assemble and easy to clean, sterilize and store, making it an ideal fit for ASCs,” Rich Larkin, chief operating officer of Innovative Medical Products, said.

OR TODAY | November 2021

“There are absolutely no compromises,” explained Mike Reilly, vice president of sales and marketing at IMP. “The new De Mayo Adapt2Fit Modular Knee Positioner expands on all the benefits of our previous models while also allowing the ASC’s to more efficiently process the positioners. The baseplate separates into two pieces to allow the Adapt2Fitto to be fully submerged in standard cleaning vessels like sinks and tubs and comes with a smaller sterilization tray that fits in standard filtered trays and autoclaves.” A rigid, toolless connector securely attaches the two baseplates. Once connected, the Adapt2Fit’s key surgeon benefit is the overall length of the positioner. “We were able to take advantage of this opportunity to add an additional two inches of travel to our baseplate to increase the surgeons’ range of available motion, flexion, and extension while enhancing lateral stability,” Larkin said. “We now have the longest baseplate on the market to fit all leg lengths, without having to adjust the unit after secured to the OR bed.”

Adapt2Fit is sold with a convenient sterilization and storage tray to securely hold its components and parts. The tray is lightweight and easy to handle. In addition to safeguarding the equipment during storage, IMP’s new tray requires less space and improves sterile processing capability in smaller chambers. When used with IMP’s specifically designed and trademark green OR Table Pads, the Adapt2Fit fits perfectly into the table-well and is secured to the OR table with an all-new IMP Quad Clamp. The new Quad Clamp comes apart for effortless cleaning. It is cross-compatible with several other IMP Positioners, like the De Mayo D2 Knee Positioner and the forthcoming Exact-Fit De Mayo Lateral Positioner. Facilities will find transitioning to the new Adapt2Fit a breeze. The product is compatible with all IMP’s standard and radiolucent boots, the De Mayo Universal Distractor and fully compatible with the existing IMP premiumgrade patient protective pads, the press release states.

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news & notes

Provation Acquires endoPRO Software Portfolio Provation has announced its acquisition of the endoPRO endoscopy informatics and software portfolio from PENTAX Medical. Terms of the carve-out transaction were not disclosed. The acquisition supports Provation’s continued expansion of its global customer base of more than 5,000 health systems, hospitals, surgery centers, and medical offices, and 700 physician groups. “Our goal with the acquisition of endoPRO is to increase productivity for more health care providers by bringing the latest Provation software solutions to an underserved market segment,”

said Daniel Hamburger, CEO of Provation. “Growth through acquisition is essential to Provation’s success in developing a comprehensive portfolio of leading clinical productivity solutions, and we are proud to welcome the dedicated endoPRO team to the Provation family.” Developed by PENTAX Medical, endoPRO is a comprehensive image and information management system that streamlines clinical workflows and EHR integration. PENTAX Medical continues to drive innovation in the gastroenterology (GI) endoscopy, pulmonary endoscopy and speech, voice and swallowing (ENT) space with cutting edge diagnostic

and therapeutic solutions. To continue building on the core business, PENTAX Medical has made the strategic decision to divest endoPRO, and focus on hardware and software solutions for diagnostic and therapeutic endoscopy. The Provation-acquired endoPRO portfolio of software solutions includes endoPRO iQ endoscopy procedure information management and image capture system, endoPRO 20|20 advanced image management and patient data management and analysis system, and more.

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IAHCSMM

SPD Leaders: Are Your Technicians Using PPE Correctly? By Julie E. Williamson ersonal protective equipment (PPE) is a critical aspect of standard precautions for all health care workers because its proper use helps protect skin and mucous membranes from blood, bodily fluid and chemical exposure. The importance of PPE for infection prevention, which for the sterile processing (SP) environment includes fluid-resistant protective attire (gowns or jumpsuits) with sleeves, utility gloves, eye protection, fluidresistant surgical masks and fluid-resistant shoe covers, has always been known, but many employees still aren’t properly trained on its correct use.

The International Association of Healthcare Central Service Materiel Management’s education department routinely fields calls and emails from SP professionals inquiring about attire requirements and what is necessary in the different areas of the sterile processing department. Here are the basics on attire/PPE: � All attire should be clean, provided by the facility and not worn outside the facility. Technicians should change out of their street clothing (clothes worn at home) and shoes, and into scrubs and shoes kept at the facility. Scrubs should be left behind at the facility’s laundry to protect employees from infecting 16

OR TODAY | November 2021

anyone at home or elsewhere outside the facility. Note: Jewelry of all kinds (including necklaces, watches and rings can harbor microorganisms and should not be worn in the department. Also, lanyards – if worn – should remain at the facility and be cleaned on a regular basis.). � Basic attire should be word in every area of the department and by everyone working in the department. This includes scrub attire consisting of at least clean pants and a top (some facilities provide long-sleeve jackets). If T-shirts are worn, they should be completely covered by the scrub top, with no parts of the T-shirt visible outside the scrub attire. Scrub attire should always be put on just prior to starting work and then removed before leaving work. If attire becomes soiled during work (e.g. fluid strikethrough in decontam), it should be changed. � A disposable, bouffant-type head covering should be worn in all areas of the department, and should cover all head hair, except eyelashes and eyebrows. If reusable head covers are allowed in the facility, they should be covered with a bouffant cover. Skull-type caps are not recommended because they do not always cover all head hair. Beards and mustaches should be covered with an approved facial cover. � Sturdy shoes with non-skid soles should be worn in all areas of the department. Again, to prevent

contamination, it is good practice to have shoes dedicated to the area and not worn outside the facility. � Depending on facility policy, a cover gown/lab coat may be used to protect scrub attire when leaving the department for another area in the same facility. For the decontamination area, all aforementioned basic attire/PPE should be worn to ensure compliance with Occupational Safety and Health Administration requirements and facility policy, and additional PPE is also required. Decontamination PPE includes the following: � Gloves approved for the decontamination area (these are thicker to protect the hands and also have longer cuffs, so they can be placed over the gown cuff to keep fluids from flowing into the glove or up the gown sleeve). � Mask that fits around the ear or ties on the head to protect the nose and mouth � Fluid-resistant gown or jumpsuit to protect clothing and skin. � Goggles or face shield to protect the face, including eyes, nose and mouth. Note: Wearing a face shield does not replace the need to also wear a face mask. � Shoe covers protect the shoes from contamination. These should be worn even if the shoes are dedicated to department use only. Donning and doffing PPE requires some specific steps for employee WWW.ORTODAY.COM

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IAHCSMM

safety. Donning steps are as follows: � Prior to beginning the shift, employees should don surgical scrubs, a head cover and appropriate shoes. � Don an impervious gown or jumpsuit. Tie, snap or zip completely. � Don face mask, using care to ensure a proper fit (securing ties, fitting flexible band to bridge of nose, and ensure snug fit to face and below chin). � Don goggles or face shield and adjust for a proper fit (goggles should wrap around the side of the face). � Don shoe covers and ensure shoes are fully covered. � Don gloves and ensure they are placed over the gown cuff. All PPE should be removed in the following order as recommended by the Centers for Disease Control and Prevention (CDC). Note: All PPE will be contaminated, so care must be taken to minimize risks of touching/spreading potentially infectious materials: � Shoe covers � Gloves (Using a gloved hand, grasp the palm area of the other gloved hand and peel off first glove. Hold removed glove in gloved hand. Slide fingers of ungloved hand under remaining glove at the wrist and peel off second glove over the first one. Discard. If hands become contamination during glove removal, immediately wash hands or use an WWW.ORTODAY.COM

alcohol-based hand sanitizer.) � Goggles or face shield (remove from the back by lifting head band and without touching the front of the goggles or face shield. If hands become contaminated during removal, immediately wash hands or use an alcohol-based hand sanitizer.). � Gown (gown front and sleeves will be most contaminated. If hands become contaminated during gown removal, immediately wash hands or use an alcoholbased hand sanitizer. Unfasten gown ties, using care to ensure sleeves don’t contact the body when reaching for ties. Pull gown away from neck and shoulders, touching only the inside of the gown. Turn gown inside out and then fold or roll into a bundle and discard in a waste receptable.) � Mask (grasp bottom ties or elastic, followed by the ones at the top and then remove without touching the front of the mask) � Head cover � Wash hands or use an alcoholbased sanitizer immediately after PPE removal. Employees should be educated on the purpose and proper use of PPE upon hire and annually thereafter. Training documents (competencies) should be kept on file.

pdf . These image-based instructions can help take the guesswork out of the process. Julie E. Williamson is IAHCSMM’s director of communications and senior editor.

REFERENCES 1.

IAHCSMM. Central Service Technical Manual, Eighth Ed. 2016.

American National Standards Institute/Association for the Advancement of Medical Instrumentation. ANSI/AAMI ST79:2017 Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities.

Centers for Disease Control and Prevention. Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. https://www.cdc. gov/hai/pdfs/ppe/PPEslides6-29-04.pdf and Sequence of Putting on (and Safely Removing) Personal Protective Equipment. https://www.cdc.gov/hai/pdfs/ppe/PPESequence.pdf

Occupational Health and Safety Administration. 1910.1030 Bloodborne Pathogens. 1910.1030 - Bloodborne pathogens. | Occupational Safety and Health Administration (osha.gov).

For a downloadable/printable reference on proper PPE use, including donning and doffing diagrams, visit: https://www. cdc.gov/hai/pdfs/ppe/ppe-sequence. November 2021 | OR TODAY

INDUSTRY INSIGHTS AAMI

Fall 2021 Sterilization Standards Week Highlights: Progress and New Guidance epresentatives from all corners of the sterilization space – including sterile processing technicians, academics, government regulators and medical device industry leaders – convened during AAMI’s Fall 2021 Sterilization Standards Week, hosted September 13 to 16 at AAMI’s offices in Arlington, Virginia.

September’s meeting marked a return to the hybrid in-person and virtual meetings format. It was the first time since the October 2019 Sterilization Standards Week that the sterilization and protective barriers committees and most of the sterilization working groups have met in person. Over the course of four days, thought leaders discussed updates to important technical documents, which standardize best practices for various medical device sterilization modalities and safety and performance for sterilizing equipment. “Participants were thrilled to once again have the option to attend virtually or meet in person at the AAMI Center for Excellence in Arlington, Virginia. The atmosphere was almost like a reunion,” said Amanda Benedict, vice president of standards at AAMI. During the first hybrid Sterilization Standards Week meetings in early 2019, some online participants struggled with joining in key discussions with in-person participants. Fortunately, using best practices learned from managing fully virtual meetings over the past 18 months, AAMI standards meetings have undergone a welcome transformation, creating 18

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a culture that utilizes a hybrid meeting model to its fullest. “I think this was the smoothest hybrid Sterilization Standards Weeks meeting we’ve ever had,” Benedict said. “The online option helps with a pipeline for participation. We’re finding that companies are willing to virtually introduce more employees into the standards process earlier in their careers even while we still benefit from the excitement and atmosphere of an in-person meeting.” Highlights from Sterilization Standards Week include:

Ethylene Oxide Sterilization: A Crucial Conversation A popular gas sterilization modality, ethylene oxide (EO) has become something of a buzzword because of its recent use for sterilizing testing swabs during the COVID-19 pandemic. A key revision to AAMI TIR16, Microbiological aspects of ethylene oxide sterilization, continues to progress. Currently, the project is still in working draft stage, and the industrial EO sterilization working group (ST-WG01) is open to additional members wishing to participate in this project. The International Standards Organization (ISO) technical committee 194 has opened a revision of the standard ISO 10993-7, which specifies allowable limits for residual EO and ethylene chlorohydrin (ECH) in individual EO-sterilized medical devices, among other important guidance. An update was provided to AAMI’s industrial EO sterilization working group (ST-WG01). Additionally, AAMI BE-WG11 has been assigned the

important responsibility of developing the U.S. position and comments that will inform the international work on the revision of this crucial standard. Relevant U.S. based parties interested in joining this important conversation can request to join AAMI’s working group at standards@aami.org.

Radiation Sterilization: Looking Ahead Employing modalities such as gamma, electron beam and X-ray radiation sterilization is celebrated as a safe and costeffective method for sterilizing single-use medical devices such as syringes and surgical gloves. However, irradiating a medical product does not come without risks. By pooling their expertise, members of AAMI ST-WG02 are working to ensure the continued safe and effective use of radiation sterilization. A new document AAMI TIR104, which is designed to help sterilization professionals maintain sterility assurance and sufficient dosage when transitioning from one radiation sterilization method to another, just passed an important vote. AAMI TIR104, Guidance on Transferring Health Care Products Between Radiation Sterilization Sites or Modalities is expected to progress through additional points of process for final approval and publish before the end of 2021. AAMI ST-WG02 has also agreed to progress the U.S. national adoption of ISO/TS 11137-4, Sterilization of health care products — Radiation — Part 4: Guidance on process control, through the approval and ANSI registration process. The ultimate endgame will be recognition by the U.S. FDA.

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INDUSTRY INSIGHTS ASCA

ASCs Offer Significant Savings, Face Growing Competition for Staff By Bill prentice esearch results released in early September demonstrate, once again, that ASCs deliver significant savings to patients, employers and insurers and could save all those entities substantially more. What sets this research apart from much of the other research we have seen on this topic in recent years is that this analysis, conducted by UnitedHealth Group, is based entirely on private claims data. In addition, the researchers took the steps needed to avoid inappropriately assigning potential cost savings to patients who could not reasonably expect to get the outpatient care they needed in an ASC due to complex health conditions or their distance from an ASC.

Two of the study’s key findings are: • The average price of common procedures performed in a hospital outpatient department (HOPD) in 2019 was $7,716 – 144 percent more than the average price of the same procedures performed in ASCs ($3,157). • Shifting procedures from HOPDs to ASCs would reduce the cost of a procedure by an average of 59% and save con20

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sumers $684 per procedure. To produce those findings, the researchers looked at 12 months of data on outpatient procedures and surgeries performed from March 2019 through February 2020. The outpatient procedures and surgeries the analysts considered included operations performed on the digestive system, musculoskeletal system, urinary system, nervous system, integumentary system, hemic and lymphatic system, cardiovascular system, respiratory system, endocrine system, nose, mouth, pharynx, eye, ear, and female and male genital organs Analyzing United Healthcare data and using the patterns they observed there to estimate statistics nationwide, the researchers determined that of the more than six million routine outpatient procedures performed in hospital outpatient departments: • only 10 percent of procedures are for complex patients, such as those with morbid obesity or those suffering from end stage renal disease, and • 35 percent of procedures are for patients who do not have an ASC near their homes. Based on those observations, the researchers concluded that 56 percent of HOPD procedures are for non-complex patients and can be performed at ASCs within a short

distance of the patient’s home. They also concluded that commercially insured individuals are responsible for approximately 15 percent of the cost of outpatient procedures, which led to the finding that shifting these common procedures to ASCs would save consumers $684 on average per procedure. The savings ASCs deliver to Medicare and its beneficiaries are already well-documented in numerous studies including a recent KNG Health Consulting analysis titled “Reducing Medicare Costs by Migrating Volume from Hospital Outpatient Departments to Ambulatory Surgery Centers.” That report also demonstrates that potential future savings are even greater than what has been seen in the past. The savings ASCs offer are also immediately obvious to patients who use the Procedure Price Lookup Tool that Medicare makes available on its website. Unfortunately, that tool also reveals a flaw in the Medicare payment system that affects patient copays for several higher-cost procedures that are now available in both HOPDs and ASCs. More than 20 years ago, Congress agreed to cap patient copays for these procedures when they are performed in the HOPD setting and to make the hospitals whole for the entire amount patients would otherwise pay. The

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same policy is not in place for ASC patient copays. The result is that while ASCs provide the Medicare program with significant savings when they perform these higher-cost procedures, patients pay more, so many elect to have them in HOPDs instead. When they do, the procedures cost Medicare more. ASCA is working with Congress to have this situation corrected.

Nurse Recruitment and Retention As the pandemic continues, the popularity and number of ASCs continue to grow, with patients and physicians turning to ASCs as a high-quality, low-cost alternative to hospitals stretched to their limits providing care to COVID-19 patients. In response, this summer, the number of CMS-certified ASCs rose to more than 6,000 for the first time in the industry’s history. At the same time ASCs are pleased to see this recognition of their ability to treat more patients and provide expanded services without compromising on the quality of care provided, they are facing a national nursing shortage that is requiring all health care providers to go the extra mile to recruit and retain skilled staff. In fact, in September, the American Nurses Association, asked the U.S. Department of Health & Human Services to declare the current nursing staffing shortage a national crisis and outlined steps the department could take to address the issue. The more flexible hours ASCs offer and the lack of COVID-19 patients in the ASC setting can provide an attractive alternative for some nurses who are exhausted from working long hours in the hospital providing care to COVID-19 patients. ASCA’s 2021 Salary & Benefits Survey can also help ASCs evaluate the salaries and benefits they are offering and develop competitive packages. ASCA also offers a Career Center ASC professionals can use to post openings or look for jobs.

Looking Ahead Despite the challenges, as the U.S. continues to look for ways to reduce the cost of health care, ASCs are already part of the solution and have the capacity to do more. Health policymakers, insurers and care providers across the country need to explore more ways to give patients whose care can be provided in an ASC access to the many benefits ASCs provide.

Thank YOU

NURSES 3 2021 Perioperative Nurses Week November 14-20, 2021

LIFE IN AND OUT OF THE OR

Bill Prentice is the chief executive officer of the Ambulatory Surgery Center Association (ASCA).

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November 2021 | OR TODAY

INDUSTRY INSIGHTS CCI

Credentialing and the Use of Digital Badges By Skyllar roach and James X. Stobinski

ertificates have long been used to signify accomplishments such as earning a credential like CNOR or CNAMB. But significant changes in documentation and verification processes are on the horizon. The capabilities of digital badges, which document the CFPN credential, far exceed that of traditional physical badges and certificates. Digital badges are not yet extensively used by nurse credentialing bodies but this innovative approach to documentation and verification holds much promise. What exactly are digital badges and how are they used? Iafrate (2017) states that, “Simply put, a digital badge is an indicator of accomplishment or skill that can be displayed, accessed and verified online. These badges can be earned in a wide variety of environments, an increasing number of which are online.”

Digital badges are not just for recognizing credentials, they are a valid representation of the individual’s learning or achievement as well as proof of an accomplishment. This allows professionals to demonstrate their broad range of knowledge and these badges, at their optimal state, can substantiate competency. Traditional certificates can document dates but the medium is distinctly limited in how much data can be displayed. 22

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Dates can document experience, which is important, but dates alone cannot document a person’s proficiency or performance level. Digital badges are supported by metadata and when accessed a vast trove of data can be displayed providing context and depth regarding the credential. By shifting the focus from credentials and physical certificates, individuals can acquire, document, demonstrate and display their skills in a way that better reflects their capabilities. Digital badges are also more easily accessed, displayed and verified online. In our current technological age, this distinction is vital for quick access to professionals and potential employers. With online badges, more details can be presented than are possible with traditional certificates. Badges not only delineate an individual achievement but also describe the specific skill set and provide context such as the job analysis findings on which the skill is based. In June 2021, CCI introduced the new Certified Foundational Perioperative Nurse credential (CFPN). This credential provides a solid foundation for perioperative nurses just starting out in their careers and is a steppingstone to professional development over a career. Upon completion of each of the four components of CFPN, each candidate has the option to accept a digital badge issued through Credly which can be shared on social media. Upon completion of all segments, a final badge showcasing

the CFPN credential is issued. More information on digital badging and our partner Credly can be found at credly.com. CCI recently launched a diversity, equity and inclusion (DEI) initiative led by our board of directors. The use of digital badges dovetails nicely with these efforts. As Credly maintains in its whitepaper on gender equity (2021) digital badges provide, “ … a portable, verified and secure representation of acquired knowledge and skills.” Skills are highly valued in perioperative nursing and these specialtyspecific skills can be thoroughly documented through digital badges. This method of documentation and verification facilitates skills-based hiring and is a means to document the detail of training programs and techniques such as competency-based education. You will soon begin seeing digital badges from nurses just entering the profession that have earned the CFPN credential. As of September 7 CCI, in partnership with Credly, has issued 804 digital badges related to the CFPN credential or one of its components. There are now 110 CFPN certificants. For now, digital badges are used mainly with the CFPN credential but in 2022 CCI will expand usage to other credentials. We see great potential for digital badges to add value to our certificants.

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REFERENCES 1.

Credly (2021). About Credly. Accessed August 2, 2021 at: About Us (credly.com.

Credly (2021). How Digital Credentials Can Help Dismantle Gender Bias in the Workplace. Accessed August 2, 2021 at: CredlyDismantleGenderBias-Whitepaper.pdf

Iafrate, M. (2017). A Guide to Digital Badges: What They Are and Where They’re Coming From.

Accessed August 2, 2021 at: Digital Badges: What Are They and How Are They Used? eLearning Industry

Skyllar Roach, BA, is a credentialing associate with the Competency and Credentialing Institute. James X. Stobinski, PhD, RN, CNOR, CSSM(E), is Chief Executive Officer at Competency & Credentialing Institute (CCI).

2022

DALLAS A PRIL 27–30

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INDUSTRY INSIGHTS

WEBINAR SERIES

Webinar

Reprocessing Remains a Hot Topic Staff report

ecent OR Today webinar presentations have focused on the reprocessing of flexible endoscopes and device processing myths. The webinars continue to receive positive feedback from attendees as it delivers valuable knowledge to health care professionals.

Reprocessing Flexible Endoscopes The webinar “FDA Safety Communications: Implications for the Future of Reprocessing Flexible Endoscopes” was sponsored by ASP. Expert Anastasia Johnson, clinical education consultant of ASP, discussed patient safety related to current endoscope reprocessing methods. Attendees heard about the FDA Safety Communications released in 2020 and 2021 related to endoscope reprocessing and how to apply the evidence to plan for reprocessing endoscopes in the future. One aspect of the webinar was a discussion of the Spaulding Classification. In 1968, Earle H. Spaulding devised a rational approach to disinfection and sterilization of patient-care items and equipment. This classification scheme is so clear and logical that it has been retained, refined and successfully used by infection control professionals and others when planning methods for disinfection or sterilization. Spaulding believed the nature of disinfection could be understood readily if instruments and items for patient care were categorized as critical, semi-critical 24

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and noncritical according to the degree of risk for infection involved in use of the items. Johnson also discussed William A. Rutala, Ph.D., MPH, CIC, and his 2015 suggestion to modify the Spaulding Classification. She provided additional insights during an informative question-and-answer session that is included in the recording of the webinar available at ortodaywebinars.live. More than 200 health care professionals registered for the webinar with 115 logging in for the inaugural presentation. A recording of the webinar is available for on-demand viewing. Attendees provided feedback in a post-webinar survey that generated positive comments. “Relevant, educational and helpful,” said C. DeLandra, NDPS Perioperative Services. “I’m going to use your thoughts to try and get my small facility to think about adding an ERS to our budget. I have been cleaning all of our scopes manually for five years. We have never had an endoscope reprocessor besides a person,” said C. Avalos, CSPDT, CFER. “I found it interesting how we are moving away from Spalding classifications, and why,” said D. Candy, RN. “Thank you for the relevant information on the scope reprocessing,” said J. Wilkinson, quality coordinator, infection control coordinator.

Device Processing Myths The OR Today webinar “Bad Answers

to Good Questions - Busting Myths in Device Processing” was sponsored by Healthmark. It was eligible for 1 CE credit. OR Today has been approved and is licensed to be a Continuing Education Provider with the California Board of Registered Nurses, License #16623. Almost 400 health care professionals registered for the webinar. In the webinar, a panel of experts discussed industry questions that are often answered incorrectly or poorly. Healthmark Industries provided the expert panel made up of Clinical Education Specialist Seth Hendee, Clinical Education Specialist John Whelan, Clinical Education Specialist Kevin Anderson and Special Projects Manager Jahan Azizi. The panel closed the presentation with a question-and-answer session that included the question, “I am following AAMI standards and other recommendations, why do I need to use manufacturer IFUs?” Azizi answered the question. He said that an IFU may not be validated but the burden then falls on the health care professional. He explained that if one can show that the IFU is not correct and why they are supplementing. However, he did caution that this could cause for some difficult questions in regard to a court case. Attendees provided feedback via a survey that include the question, “Why did you attend today’s webinar? And, was it worth your time?” “This was excellent information shared in the webinar. It was shared with me by another OR Manager and I WWW.ORTODAY.COM

OPERATING ROOM SOLUTIONS was available so thought I would take advantage of the CEU and see what information would be shared. It was very engaging; the speakers were very knowledgeable,” CVOR Manager E. Arnold said. “Love to see and hear most up-to-date recommendations for caring of equipment/supplies/etc. Was great to hear from this group of experts,” said T. Ralls, AVP CEE. “Always interested in learning something. It was long overdue. This webinar presented things that should be frequently discussed,” said J. Gay, CEO

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market analysis

Reports Forecast Medical Device Cleaning Market Growth Staff report t least three organizations predict continued growth in the global medical device cleaning market.

Acumen Research and Consulting, a global provider of market research studies, reports that the global medical device cleaning market is expected to grow at a compound annual growth rate (CAGR) of around 7.8% from 2020 to 2027 and reach the market value of more than $3.7 billion by 2027. According to a comprehensive research report by Market Research Future (MRFR), the market is projected to exceed $4.1 billion by 2026 at 7.2% CAGR. Reportlinker.com reports that the global medical device cleaning market is expected to grow from $1.86 billion in 2020 to $2.01 billion in 2021 at a CAGR of 8.2%. The change in growth trend is mainly due to the companies stabilizing their output after catering to the demand that grew exponentially during the COVID-19 pandemic in 2020. The market is expected to reach $2.69 billion in 2025 at a CAGR of 7.5%. The medical device cleaning market consists of sales of medical devices cleaning disinfectants, detergents and related products by entities that are used for cleaning and sanitization of medical instruments, and other medical devices. Medical device cleaning is a vital part of any surgical process. It is a method of sterilizing medical devices and equipment to avoid 26

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infecting patients or causing illness. The common methods used for cleaning medical devices are ultrasonic cleaners, automatic washers and manual washing. The main type of medical device cleaning processes includes disinfection, automatic cleaning, manual cleaning and presoak/precleaning. Manual cleaning is the physical removal of all visible soil (gross debris) from an item to render it safe for handling and further processing for patient care. It is used for cleaning surgical instruments, endoscopes, ultrasound probes, dental instruments and other instruments in hospitals, clinics, diagnostic centers, dental clinics and others facilities. North America was the largest region in the medical device cleaning market in 2020. The Asia Pacific region is expected to be the fastest-growing region in the forecast period. Players in the medical devices cleaning market are increasingly focusing on UV sanitizer devices. The UV sanitizer is effective in treating bacteria present on medical devices and in operating rooms. For instance, PurpleSun Inc. a U.S.based company developed ultraviolet (UV) technology to reduce more than 96% of microorganisms in operating rooms (ORs) and on medical equipment, compared to 38% using manual cleaning methods that rely on chemicals to sanitize surfaces. In April 2019, Fortive Corporation, a U.S.-based company that operates as a diversified business acquired the Advanced Sterilization Products Ser-

vices Inc, business from Ethicon Inc., a subsidiary of Johnson & Johnson, for approximately $2.7 billion in cash. With this acquisition, Fortive Corporation will expand its business in the area of hospital and health care cleaning products. Advanced Sterilization Products Services Inc. is a U.S.-based company that specializes in manufacturing and selling products in the area of sterilization and disinfectant. The increasing number of surgical procedures with a surge in the prevalence of chronic diseases is driving the growth of the medical device cleaning market. The increasing prevalence of various chronic conditions such as cancer, cardiovascular diseases, gynecology-related issues and orthopedic cases has led to a significant increase in the number of medical device cleaning disinfectants and other products. For instance, according to the Global Cancer Observatory (GLOBOCAN), the global incidence of cancer cases in 2020 was estimated to be around 19.3 million cases. Moreover, as per the American Cancer Society estimates, the global cancer burden will increase to 27.5 million new cancer cases by 2040. The number of people affected with chronic diseases continues to grow across the globe increasing the number of surgical procedures. The increasing number of surgical procedures is expected to boost the growth of the medical device cleaning market size during the forecast period.

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product focus

CIVCO

ASTRA Automated Probe Disinfection ASTRA automated high-level disinfection systems for transesophageal (TEE) and endovaginal/ endorectal ultrasound probes help simplify compliance with disinfection guidelines and manufacturer instructions. The ASTRA disinfects up to two probes at once, reprocesses probes in 10-16 minutes without sleep cycles and electronically documents the full disinfection cycle history. ASTRA helps reduce long-term operating costs by offering three reusable, industry-leading disinfectant options: Revital-Ox RESERT HLD (hydrogen peroxide), CIDEX OPA and MetriCide OPA Plus. ASTRA ensures the correct use of disinfection consumables and tracks all necessary disinfectant and test strip information. •

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product focus

Diversey Oxivir Tb

Diversey has been recognized by Newsweek and the Leapfrog Group for its Oxivir Tb, which has been rated as a Best Infection Prevention Product in 2021. Diversey’s Oxivir Tb was evaluated and selected, using four criteria: effectiveness, safety (to both patients and health care workers), successful real-world implementation and the stability of the company. “Oxivir disinfectants powered by Accelerated Hydrogen Peroxide (AHP) technology, provide an alternative to traditional disinfectants, marrying fast and effective disinfection with safety for users and surfaces. Effective against bacteria, viruses, and fungi in as little as in one minute, including powerful threats like Candida auris and SARS-CoV-2, the pathogen that causes COVID,” said Carolyn Cooke, vice president of healthcare in North America, Diversey. “The Oxivir family of disinfectants has the best possible safety rating, allowing it to be used at the point of care without risk to patients, their loved ones or health care personnel. It is non-irritating to skin and eyes, requires no personal protective equipment and is compatible with most common health care surfaces and equipment. Peer reviewed studies have demonstrated that this powerful disinfectant has the ability to reduce health care associated infections, such as MRSA, VRE and C.difficile, versus traditional disinfectants in health care settings.”• For more information, visit www.diversey.com.

Getinge

86-Series Washer-Disinfectors Getinge 86-Series Washer-Disinfectors accommodate up to 18 DIN/12 US trays per cycle to help eliminate the risk of critical instrument sets not being available when and where they are needed. The S-8668T Washer-Disinfector features multi-tasking functionality to reduce the non-productive time needed for filling and draining process water that reduces total cycle time by as much as 25%.•

OR TODAY | November 2021

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product focus

STERIS IMS

Single-Use Sterile Instruments and Procedure Packs The strain on resources presented by the COVID-19 pandemic has become a regular part of any news cycle. The challenge of supplying multiple clinical areas away from a centralized SPD continues to evolve. Single-use sterile instruments are a great way to support multiple clinical areas while reducing the sterilization workload. STERIS IMS has partnered with Robinson Healthcare to exclusively offer the award-winning Instrapac line of single-use sterile instruments in the United States. Robinson is the UK’s leading provider of single-use sterile surgical instruments and sterile procedure packs. •

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November 2021 | OR TODAY

CE666

IN THE OR

continuing education

Effective Communication with Patients n 2008, The Joint Commission, with funding from the Commonwealth Fund, began an initiative to advance effective communication, cultural competence, and patient- and family-centered care in hospitals. The focus was to develop accreditation standards for the hospital program and create a report to help hospitals better meet patient needs. The result was the development of new and revised accreditation standards related to these concerns and the creation of a report titled “Advancing Effective Communication, Cultural Competence and Patientand Family-Centered Care: A Roadmap for Hospitals,” which provides methods for hospitals to begin or improve upon efforts to ensure that all patients affected by these issues receive the same high quality of care, regardless of health literacy, language, culture, or ethnicity.

A growing body of research has shown a variety of patient populations experience decreased patient safety, poorer health outcomes, and lower quality of care based on race, ethnicity, language, disability, and sexual orientation. Effective communication with all patients is crucial to providing safe care. The healthcare team should 30

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aspire to meet the unique communication, cultural, and familial needs of all patients. The content in this course is applicable to nurses, dieticians, social workers, occupational therapists, lab technicians, physicians, speech therapist, and advance practice registered nurses in the hospital setting.

The Joint Commission Members of the healthcare team are traditionally focused on meeting the clinical needs of patients. But patients also have important nonclinical needs and characteristics that affect the way they perceive, accept, and participate in their healthcare. Research shows a variety of patient populations experience less safety, more chronic disease, poorer health outcomes, and a lower quality of healthcare. Primary risk factors for communication barriers and culturally incompetent care because of nonclinical risk factors that are often overlooked when patients seek and receive care include (Centers for Medicare and Medicaid Services [CMS], 2015): • Race • Ethnicity • Language • Disability • Sexual orientation • Living in rural location If the nonclinical characteristics of individual patients are not addressed, hospitals may put themselves and patients at risk because of nonclinical barriers to care. Effective communica-

tion with all patients is crucial to providing safe care. The healthcare team should aspire to meet the communication, cultural, and familial needs of all patients. In 2008, The Joint Commission (TJC), with funding from the 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 37 to learn how to earn CE credit for this module.

LEARNING and Objectives After taking this course, you should be able to: • Identify three specific elements of effective communication, cultural competence, and patientand family-centered care. • Identify health illiteracy and discuss two strategies for minimizing poor outcomes. • Recall six reasons why people may experience lower quality of healthcare. • Discuss the role of The Joint Commission and its partners in reducing poor health outcomes because of poor communication, cultural incompetence, and a lack of patient- and familycentered care.

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continuing education monwealth Fund, began an effort to advance the issues of effective communication, cultural competence, and patient- and family-centered care in hospitals. The focus was on developing accreditation standards for the hospital program and creating a report to help hospitals better meet patient needs. The result was new and revised accreditation standards related to these concerns and the creation of a report titled “Advancing Effective Communication, Cultural Competence and Patient- and Family-Centered Care: A Roadmap for Hospitals,” which provides ways for hospitals to ensure that all patients receive the same high quality of care regardless of health literacy, language, culture, or ethnicity (The Joint Commission [TJC], 2010). Patients and providers often do not speak the same language. Some patients may have difficulty hearing, may have speech or language disorders, or cognitive issues that affect their ability to communicate. Patients from nondominant cultures or of different sexual orientation may also be impacted by barriers in healthcare communication. Hospitals and their providers need to be prepared to overcome these barriers to effective communication (TJC, 2010).

The Roadmap The primary purpose of Roadmap was to improve communication, develop language access services for non-English speaking patients, and recognize the importance of translating written materials into other languages along with, other learning modalities that promote health literacy. The importance of meeting patient’s speech, physical, and cognitive communication needs, including blindness and hearing deficits, is discussed along with a foundational awareness for differences in cultures, sexual orientation, individual religious and spiritual beliefs by healthcare providers. The purpose of the roadmap is for healthcare WWW.ORTODAY.COM

systems to use it to improve organizational performance, train staff, inform staff of policy changes, and evaluate compliance with laws, regulations, and standards of healthcare delivery (TJC, 2010).

Cultural and Linguistic Standard Between 2003 and 2007 TJC in conjunction with other partnering healthcare systems compared their cultural and linguistic standards to other national healthcare standards. They looked at how hospitals were currently addressing low health literacy and limited English proficiency patient issues, and then reviewed adverse event data from accredited hospitals that related to these two issues. In 2009 TJC received funding from The Commonwealth Fund to begin developing accreditation requirements for hospitals to improve effective communication, cultural competence, and patient- and family-centered care. As a result of its research, study, and investigation, TJC approved revised standards for patient-centered communication (TJC, 2010). Full standards compliance went into effect beginning with surveys on July 1, 2012.

The Patient-Centered Communication Standard The patient-centered communication standards are designed to improve patient-provider communication and the quality and safety of hospital care. They focus on all vulnerable patients, including those who (TJC, 2011; TJC, 2014): • Have no voice • Have hearing, vision, or cognitive impairment • Speak a language other than English • Have limited literacy or knowledge about healthcare • Have sexual orientation, cultural, or religious differences

The Human Resource Standard The Joint Commission human resource standards focus primarily on the skill sets and competencies staff need to perform their jobs. The standards address orientation on cultural diversity and sensitivity, expecting ongoing education and other training to be appropriate to the needs of the population served and responsive to the learning needs identified through performance improvement results and data analysis. It is also appropriate to provide staff training on the cultural health beliefs and practices because they often differ from those of the staff.

Culture Culture is defined as “the customary beliefs, social forms, and material traits of a racial, religious, or social group” (Merriam Webster n.d.). Culture is often overlooked or assumed to be addressed in other interactions or methods of communication, however culture strongly influences how a patient cares for themselves, how they make healthcare decisions, and how they interpret the care they have been provided (Agency for Healthcare Research and Quality [AHRQ], 2015).

Leadership Standard Leadership standards should focus on ensuring that hospitals provide the support for effective patient-provider communication, cultural competence, and patient- and family-centered care. A hospital’s leadership must have effective communication mechanisms in place that are timely, accurate, and user friendly. An example of a hospital’s compliance with leadership standards might be to provide language access services after determining that local interpretation services did not have the resources to promptly meet the needs of the hospital’s diverse patient population. Compliance with the standard also supports education

November 2021 | OR TODAY

IN THE OR

continuing education that is current about cultural diversity and specific considerations for the patient care populations they serve. Leadership must clearly articulate the hospital’s commitment to the unique needs of patients. Some suggestions from TJC include communicating this commitment through staff orientation and engaging staff regularly during rounds. Hospitals are also required to collect patient demographic data to identify unique needs of their patient populations.

The Continuum of Care To make informed health decisions, patients need effective communication with all providers. This is made clear in the provision of care, treatment, and services standards. Part of the patient assessment process is to determine the patient’s learning and communication needs, as well as other needs that may influence the patient’s ability to engage with the healthcare team. This includes establishing what the patient’s preferred language is for discussing healthcare issues and whether the patient needs an interpreter or such personal devices as hearing aids or glasses, communication boards, or translated materials.

Admission Admission is the first point of contact a patient has with a hospital and provides the first chance to identify and address his or her unique needs. Informing patients of their rights is one of the first and most important things to be done during the admission process. Patient rights should be posted in waiting rooms, and available in multiple languages. These rights include the “right to have a language interpreter, the right to receive accommodation for a disability, the right to be free from discrimination, the right to identify a support person to be present during the hospital stay, and the right to designate a surrogate decision maker (TJC, 2010, p. 9).” 32

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Patients who have limited English proficiency or visual, hearing, and cognitive issues will need assistance during the admission process. It is important to make sure that patient rights are available in a usable form to patients who have hearing, visual, or other challenges. Many hospitals provide patients with a handbook in the language most frequently encountered in the local area. Another idea is to provide a prerecorded message that patients may listen to that describes patient rights, along with other important information in their preferred language.

Language Interpreters Identifying the patient’s preferred language for discussing healthcare is one of the first tasks that staff should accomplish. Patients should be asked: “In what language do you prefer to discuss your healthcare?” The patient’s response should be noted in the medical record and communicated to all staff and, if appropriate, arrangements made for translation services (TJC, 2010). One of the most significant standards involves the qualifications of language interpreters and translators. Hospitals must have defined qualifications and competencies for people in these roles. TJC standards and other Federal regulations require hospitals to provide language assistance, including certified language and sign language interpreters. Professionals meeting the hospital’s definition of competency must be assessed for proficiency in both English and the target language. Hospitals must also validate competencies of interpreters provided by external vendors. Research shows relying on untrained interpreters, including family members, friends, other patients, or untrained staff, can result in misinterpretation and a lower quality of care. It has also been found to contribute to adverse events (TJC, 2010). Untrained

people may be used for social conversations or simple messages. Competent interpreters are required for healthcare-related communication, such as informed consents, results of diagnostics, the plan of care and health insurance, or financial information related to healthcare in the hospital.

Disability and LEP 56% of the U.S. population have a disability and 8% of Medicare recipients experience Limited English Proficiency (LEP) (CMS, 2015). It is important to assess and determine each patient’s need for language assistance or devices they may need to communicate e.g., hearing aids, glasses, or assistive devices. Hospital leadership must ensure that the resources are available to provide each patient with the assistance they need and that alternative resources have been identified for times in which the primary resource is not available or not functioning.

Literacy Many patients face literacy challenges. Literacy is a sensitive issue and must be approached cautiously to prevent anger or embarrassment. As patients participate in the admission process, staff should be alert for signs of health literacy problems, such as the patient’s asking to fill out a form later or stating that their spouse usually does this. Offer respectful assistance if indicated.

Race and ethnicity Determining the patient’s race and ethnicity is a TJC requirement that is completed during admission. Again, this is a sensitive issue; assure the patient and family that these questions are to ensure that patients receive the highest quality care regardless of their race or ethnic background (TJC, 2010). As the admission phase draws to a close, ask the patient if there are any additional concerns or questions that WWW.ORTODAY.COM

IN THE OR

continuing education may affect their care. There may be additional cultural, religious, spiritual, mobility, or other needs to consider. A good example might be cultural/religious-based modesty concerns related to care received from the opposite sex (TJC, 2010). Finally, note all relevant data in the patient’s medical record and make sure it is communicated to the care team.

Assessment After the patient is admitted, members of the clinical staff perform an assessment to determine the care, treatment, and services to meet the patient’s needs. Several actions during assessment will ensure that the requirements of effective communication, cultural competence, and patientand family-centered care are met. Communication needs identified during admission should be recognized and the patient provided with appropriate assistance. The patient’s communication needs and supports should be recorded in the medical record and trigger staff to arrange for such items as language services or assistive devices. Ensure that all members of the healthcare team introduce themselves to the patient and explain their roles. Ask patients their preferred name and make sure this is communicated to the team. When asking the patient about their relationship status providing the option of partnered or other is culturally sensitive to people from the LGBTQ community. All patients, regardless of race or ethnicity, family construct, or sexual orientation should be asked if there are cultural considerations of which staff should be aware. Assessment should determine patients’ health literacy and ability to understand health information, participate in treatment decisions, and follow through with treatment plans. Patients should be asked a screening question such as “Do you need help understanding healthcare informaWWW.ORTODAY.COM

tion?” Some suggestions for dealing with patients who have difficulty include (TJC, 2010): • Determine the patient’s preference for receiving information (i.e., reading, hearing, or viewing it). • Speak as plainly as possible, avoiding medical jargon. • Use examples, visual models, diagrams, or pictures to illustrate a point. • Use the “teach-back” method to evaluate the patient’s understanding, asking the patient to repeat back in their own words the information provided or provide a return demonstration of skill taught; avoid asking patients if they understand (many will nod or answer yes even if they do not understand). • Encourage the patient to take notes during the discussion. Some options for assisting patients is to ensure that they get answers to questions or concerns expressed include providing note pads for the patient to take notes, listing questions on the patient communication board, or writing the question down for the patient to give the physician when the physician visits. The assessment should identify any cultural, religious, or spiritual beliefs that will affect how the patient and the people who support them, perceive illness and how they approach treatment. There may be unique needs associated with their beliefs that must be integrated into the plan of care. Many cultures and religions have special beliefs about modesty and restrictions on touching and physical proximity. Dietary needs and restrictions are closely associated with cultural, religious, and spiritual beliefs. Ask the patient if there are any prohibited food items. All information from the patient about his or her understanding of the illness and beliefs and their impact on the treatment

plan must be noted in the medical record and communicated to all staff members. The assessment process is a good time to ask the patient whether they have a person who could be at the bedside to provide support and comfort and to alleviate fears. The support person should, with the patient’s approval, be allowed unlimited access to the patient as long as their presence does not infringe on others’ rights, compromise safety, or affect the medical or therapeutic regimen. The identification of a support person is strongly encouraged because they can help the patient understand the illness and instructions and help the patient make decisions (TJC, 2010).

Treatment The treatment stage provides an opportunity for hospitals to integrate effective communication, cultural competence, and patient- and familycentered care into the patient’s care, treatment, and services. Needs identified during the admission and assessment process are now incorporated into the plan of care. The team should be aware that these needs may change throughout the course of treatment. Staff members should review the patient’s medical record for any specific communication needs, including the patient’s preferred language and any sensory or communication impairments. If the patient’s preferred language is not English, arrangements must be made for language services to help with interpretation and translation of educational materials and consents. Remember, interpretation for medical-related issues must be done by a qualified medical interpreter (TJC, 2010). Staff as well as physicians who are providing care should be able to access resources for interpreters at any time. Ongoing education and alerts for changes in process secondary to contract changes for example, availability November 2021 | OR TODAY

IN THE OR

continuing education of one resource vs. another resource, should be communicated often. Staff members must involve the patient in developing the plan of care and encourage, with the patient’s permission, the participation of the support person and family members in care discussions. For the purpose of this course “family member” is defined to include friends and samesex partners, it is the person or people most important to the patient. During treatment, patients should become involved participants on the healthcare team. Patients and the people who are important to them, should be encouraged to question unfamiliar medications, treatments, and unscheduled procedures. They should be encouraged to ask if each healthcare provider has washed their hands before providing care, treatment, or services to the patient. Literature supports that families and friends who are involved in the patient’s care and ask questions lessen the chance of the patient experiencing an adverse event (AHRQ, 2017). The treatment stage of care will use many of the best practices mentioned under the admission and assessment stages, including: • Assess and address the patient’s needs to overcome a disability. • Accommodate cultural, religious, and spiritual beliefs, especially dietary considerations. • Communicate any special needs of the patient to the entire care team. Due to changes in the patient’s condition or as a result of treatments or procedures, the patient’s communication needs may change during hospitalization. Patients may develop new or more severe impairments. Staff should assess patients for changes in communication status as needed. Patients in ICUs particularly feel isolated and have complex communication needs. Ensuring that the patient’s designated support person is allowed 34

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to remain with them at all times helps decrease the patient’s anxiety as well as prevent adverse events.

Discharge and Transfer Patients and the people who are important to them may be overwhelmed by the information provided during the discharge process. If the patient’s preferred language is not English, make certain that language services are available to help communicate discharge instructions. The patient should be asked who, if anyone, they would like to involve in discharge or transfer planning instructions. If the patient has a primary caregiver at home, they should be involved in discharge planning and instruction. The patient and people important to the patient should be encouraged to ask questions during discharge. Staff members should be aware of the patient’s level of health literacy and ability to understand health instructions from information obtained during assessment. In providing discharge instructions, use all the methods mentioned to ensure patient comprehension (use the patient’s preference for receiving information for example, reading, hearing, or viewing it, speak as plainly as possible, use examples and visual models, diagrams, or pictures, use the “teach-back” method to assess the patient’s understanding of information provided, avoid asking the patient if they understand, encourage the patient to take notes during the discussion). For written discharge instructions, the staff should have materials translated into the most frequently encountered languages. Written material should consider patients’ health literacy needs. If the hospital makes follow-up phone calls, the patient and family should be told to expect a call and what the call will entail (TJC, 2010). Prepare a list of providers who offer services to meet the patient’s language, culture, religious, or mobility needs.

Evaluate patients and determine the need for providing discharge instructions in the preferred language even when the language may be other than the most frequently encountered one. An example may be a new mother who speaks a language that is not common to the hospital; her husband may speak English and understand the discharge instructions, but he plans to return to work once his wife and the baby are released. Staff should be encouraged to think ahead to help the patient and family discuss how they will ensure the patient understands the instructions if she and the baby will be alone after discharge. When transferring a patient to another facility for example, a nursing home, hospice, or rehabilitation center, a staff member should convey the patient’s unique needs to the receiving facility to ensure services and accommodations can be provided.

Health Literacy Health literacy is impacted by religious beliefs, cultural influences, ethnicity, socioeconomics, disabilities, or when people are perceived as being different. The outcomes of inadequate health literacy are known to affect timely access to care, continuity of care, to create safety issues, leave patients dissatisfied, waste valuable resources, and create extra work for members of the healthcare team (Heath, 2017; National LGBT Health Education Center, n.d.; Vermeir, 2015;). Health literacy is directly related to how healthcare providers directly and indirectly communicate and interact with their patients (Chichirez & Purcarea, 2018). Health literacy can be promoted by (Chichirez & Purcarea, 2018; TJC, 2014): • Supporting an inclusive care environment where assumptions are not made about sexual or gender orientation. • Understanding your patient’s WWW.ORTODAY.COM

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continuing education

• •

•

cultural beliefs before you engage in providing care. Understanding your patient’s health customs. Identifying the decision maker for the patient. The patient may not be the decision maker for him or herself. Understanding spiritual and religious beliefs and how they may impact the treatments a patient may accept. Be knowledgeable about your patient’s dietary customs as they can be a barrier to treatment compliance. Be cognizant of physical boundaries and interactions with patients. (e.g. touching or eye contact).

In addition to promoting health literacy through the items discussed above. Members of the healthcare team can improve communication by making sure they take the time to listen to the patient. Verbal and nonverbal communication can rush patient interactions which can cause them to withhold information and fail to understand the importance of their prescribed treatments. Barring the presence of cultural norms facial expressions should be relaxed implying interest and direct eye contact should be maintained. Practitioners should be self-aware and actively encourage patients to speak openly and at their own pace followed by actively listening to what the patient is saying. All of these steps help the practitioner to understand and convey understanding of the patient’s health (Chichirez & Purcarea, 2018)

LGBTQ In 2011, TJC and The California Endowment published “Advancing Effective Communication, Cultural Competence, and Patient- and FamilyCentered Care for the Lesbian, Gay, Bisexual, and Transgender Community” (TJC, 2014). This project was WWW.ORTODAY.COM

undertaken to further define health disparities in healthcare specific to the LGBTQ population. The guide was modeled after the Roadmap published in 2010 and includes guidelines for caregivers to improve the care they provide to the LGBTQ population. “Family involvement is a critical issue for lesbian, gay, bisexual, and transgender patients and families. In some cases, biological family members may disapprove of the patient’s” sexual orientation and “may try to exclude the patient’s partner from visiting or decision making” (TJC, 2010, p. 18). Changes in legislation and the ruling of the Supreme Court in June 2015 have clarified the issue of same-sex marriage throughout the United States. Although the legislation may have improved the ability of lesbian, gay, bisexual, transgender, and questioning/ queer (LGBTQ) patients to openly access healthcare services, persistent prejudices among healthcare practitioners, and sometimes the patient’s biological family, may continue to interfere with care and communication. Building an inclusive environment is key to ending healthcare disparities in the LGBTQ population. Healthcare practitioners have an obligation to build a trusting relationship with people who are LGBTQ. The following bullet points are key strategies for building an inclusive environment (National LGBT Health Education Center, n.d.): • Use the terms the patient prefers to describe themselves or their partners. • Ask about relationships as opposed to assuming the patient is married. • Use preferred pronouns. If the preferred pronoun is unknown use “they.” • Refrain from using gender pronouns. • Be sensitive to names and genders on formal documents that do not match the patient’s

•

preferred name or gender. Refrain from judging the patient or imposing your beliefs on him or her. Apologize if you use the wrong name or pronoun.

Building an inclusive care environment supports TJC’s goal for cultural competence and patient centered care for the LGBTQ community. The beginning stages of creating an inclusive care environment can be a challenge however, the elimination of care disparities should be the driving force for change.

End-of-Life Care End-of-life care includes supportive and palliative care. Each patient experiences the dying process differently. The requirements for effective communication, cultural competence, and patient- and family-centered care are essentially the same as in other stages of care (TJC, 2010): • Ensure communication needs are met, including those that occurred during hospitalization. • Involve the family and surrogate decision maker in the patient’s care. • Address the patient’s mobility needs. • Identify and respect cultural, religious, or spiritual beliefs and practices. • Make certain that the patient has access to his or her support person. Several issues associated with this stage in life should be addressed and actions taken to comfort the patient and family. One issue is the development of new or more severe communication impairments. Patients often have a compromised ability to communicate because of physical or neurological changes or impeding medical devices. Anticipating such problems can result in proactive implementation of measures to meet changed communication needs. Another issue is the participation of the patient’s family and support November 2021 | OR TODAY

IN THE OR

person in end-of-life care. With the patient’s consent, staff should allow the family and support person to provide comfort during the dying process by touching and talking to the patient, playing music, or participating in care activities, such as bathing. Ensure the patient always has access to their support person. A chaplain can inform the staff about the patient’s religious practices and requirements, including: • Religious garments, items, or rituals important to the patient. • Space to accommodate the family’s need to pray together. • Times of day to avoid scheduling tests or procedures in order to respect religious or spiritual practices (this may include a time after death in which the body is not to be touched or moved). Sometimes staff’s own needs at the time of death can interfere with the family’s beliefs, traditions, and personal preferences during the immediate postdeath period. Respecting a patient’s beliefs and personal preferences requires the healthcare team to be sensitive about topics such as openly discussing death and dying, acknowledging end of life, discussing organ donation, using sedation, and washing the body.

CONCLUSION To establish effective communication, cultural competence, and patient- and family-centered care, a hospital’s staff should have a guide to follow to begin the process of improvement. Following expert recommendations provides staff members with methods to improve their efforts to meet the unique needs of individual patients. Because of hospitals’ variations in size, setting, and resources, there is no “one-size-fits-all” approach. Hospitals have a TJC mandate to comply with standards on effective communication, cultural competence, and patient- and family-centered care. Meeting the standards ensures that communication with patients will be in a language 36

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Agency for Healthcare Research and Quality

that they understand, that their cultural values with be recognized, and that their care will be delivered in partnership with their families.

Course Contributors The content for this course was created or revised by Holly Carlson MS, RN, CCRN. Holly Carlson, MS, RN, CCRN, was a subject matter expert for Relias. She has 25 years of healthcare experience in both acute and post-acute healthcare environments. Her experience includes leadership and management across the healthcare spectrum. She has owned and operated an assisted living business. Carlson’s clinical practice includes acute care, long-term acute care, home health and hospice. Carlson has served for over a decade in various board positions for State Nursing Associations, including president. She has been a nurse planner for multiple continuing education events and has experience as a leader in the design and implementation of an ANCC-CNE accredited approver unit for a multi-state nursing consortium. Carlson is certified as Critical Care Registered Nurse. Editor’s note: Charles F. Bombard, MHA, RN, CPHQ, FACHE, and Joyce Lahue, MS, BSN, RN, CPHRM, FASHRM are past authors of this educational activity and have not had an opportunity to influence the content of this current version.

References Agency for Healthcare Research and Quality (2015). Health Literacy Universal Precautions Toolkit (2nd Ed.). Retrieved from https://www. ahrq.gov/professionals/quality-patient-safety/ quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool10.html

(2017). Guide to Patient and Family Engagement in Hospital Quality and Safety. Retrieved from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/guide.html Centers for Medicare and Medicaid Services office of Minority Health (2015). The CMS Equity Plan for Improving Quality in Medicare. Retrieved from https://www.cms.gov/About-CMS/AgencyInformation/OMH/OMH_Dwnld-CMS_EquityPlanforMedicare_090615.pdf Chichirez, C.M., & Purcarea V.L. (2018). Interpersonal communication in healthcare. Journal of Medicine and Life. 11(12), 119-122. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6101690/ Heath, S. (2017). Low-Income Patients Cite Financial, Cultural Barriers to Care. Retrieved from https://patientengagementhit.com/news/ low-income-patients-cite-financial-culturalbarriers-to-care Merriam Webster. Culture. Retrieved from https:// www.merriam-webster.com/dictionary/culture. National LGBT Health Education Center (n.d.). Providing Inclusive Services and Care for LGBT People: A Guide for Health Care Staff. Retrieved from https://www.lgbthealtheducation.org/wpcontent/uploads/Providing-Inclusive-Servicesand-Care-for-LGBT-People.pdf The Joint Commission (2010). Advancing Effective Communication, Cultural Competence, and Patient- and Family Centered-Care: A Roadmap for Hospitals. Retrieved from https://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf The Joint Commission (2011). R3: Report Requirement, Rationale, Reference, 1,1-4. Retrieved from http://leader.pubs.asha.org/article. aspx?articleid=2278968 The Joint Commission (2014). Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community. Retrieved from https://www.jointcommission.org/lgbt/ Vermeir, P., Vandijck, D., Degroote, S., Peleman, R., Verhaeghe, R., Mortier, E…. Vogelaers, D. (2015). Communication in healthcare: a narrative Review of the literature and practical recommendations. International Journal of Clinical Practice, 69(11),1257-1267. doi: 10.1111/ijcp.12686

Clinical VignettE ANSWERS 1. Answer: d. The hospital will provide professional translation services for clinical interpretation requirements, but the family can provide translation for social conversation. 2. Answer: a. Notify the patient’s attending physician if it is a new deficit and provide assistive devices while he is in the hospital. 3. Answer: b. Ensuring that Mr. Rodriguez’ preferred way of receiving information (reading, hearing, viewing) is taken into consideration and that the information is professionally translated. 4. Answer: c. If there are any Hispanic cultural considerations that the staff should be made aware of (e.g., dietary, physical, religious, etc.).

continuing education

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Clinical Vignette Manuel Rodriguez, age 72, has lung cancer and will undergo a pneumonectomy. Spanish is his primary and preferred language; he speaks little English. Mr. Rodriguez has never been in a hospital before. He has difficulty hearing but does not wear a hearing aid. His wife and daughters, who speak both Spanish and English, accompany him. 1. Mr. Rodriguez’s wife and daughters should be informed that: a. They may act as interpreters when they are present; the hospital will obtain translation services when they are not present. b. They may act as interpreters when they are present and must remain available at home should the patient need translation assistance. c. The hospital will provide professional translation services for both clinical and social language services. d. The hospital will provide professional translation services for clinical interpretation requirements, but the family can provide translation for social conversation. 2. Since Mr. Rodriguez has a hearing difficulty, the staff should: a. N otify the patient’s attending physician if it is a new deficit and provide assistive devices while he is in the hospital. b. Take no action as the patient has accommodated to his hearing loss. c. Ask the family if they would provide assistance in helping the patient understand when he experiences hearing difficulties. d. Admonish the patient for having gone so long without having his hearing loss evaluated. 3. In addition to having professional interpretive services available, the most important aspect of preoperative teaching is: a. I ntroducing Mr. Rodriguez to the team that will be caring for him as he goes to the OR. b. E nsuring that Mr. Rodriguez’ preferred way of receiving information (reading, hearing, viewing) is taken into consideration and that the information is professionally translated. c. Asking Mr. Rodriguez if he understands the material presented. d. D etermining what approach the surgeon will use for the pneumonectomy. 4. Taking Mr. Rodriguez’s Hispanic cultural history into account, the most appropriate line of questioning would be to ask him: a. About how he brought up his daughters in the Hispanic tradition. b. H ow someone from the Hispanic culture views surgical procedures. c. I f there are any Hispanic cultural considerations that the staff should be made aware of (e.g., dietary, physical, religious, etc.). d. I f he grew up outside of the United States. WWW.ORTODAY.COM

CE666

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 10/15/2022 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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Nurse.com You can take this test online or select from the list of courses available. Prices subject to change.

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

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corporate PROFILE IMP

Shown: De Mayo Adapt2Fit™ Modular Knee Positioner

ADAPTING TO THE EVOLVING SURGICAL ENVIRONMENT Innovative Medical Products

he orthopedic healthcare industry is moving forward on an ever-changing course, challenging sterile processing logistics in facilities performing orthopedic procedures for the first time, while also experiencing expanded adoption of advanced robotic technology in operating rooms around the globe.

Innovating to Support Orthopedic Service Lines Many ASCs and outpatient clinics report that the smaller autoclaves, limited storage space and smaller soak sinks present a variety of logistical and sterile processing challenges. While outpatient facilities are insisting on maintaining consistency in training and how they approach procedures, they need a new solution to overcome the limited resources in smaller facilities. 40 OR TODAY | November 2021

During AAOS (American Academy of Orthopedic Surgeons) in September 2021, IMP showcased its all-new De Mayo Adapt2Fit™ Modular Knee Positioner, which solves these pain points with a two-piece baseplate that quickly separates the positioner down to half of its overall length. When stored in its standard sterilization tray, the resulting smaller footprint allows the positioner to fit in smaller autoclaves typically found at

Outpatient Centers. When disassembled, the Adapt2Fit’s reduced size also allows it to be fully submerged in standard sinks and cleaning vessels in a single pass, saving SPD valuable time.

Shown: Adapt2Fit® included Sterilization Tray

In order to accomodate longer legs and overcoming space constraints, IMP’s engineers designed the the Adapt2Fit to be the longest positioner on the market when WWW.ORTODAY.COM

CORPORATE PROFILE

IMP

assembled. The end result is that the Adapt2Fit is a full 2-7” longer than previous models. The increased length provides more surface area for full flexion and extension without moving the baseplate.

Adapt2Fit® vs. previous IMP De Mayo models.

Robotic Surgery Requires Improved Limb Stability and Access to the Knee Joint The introduction of roboticassisted surgery in knee replacement continued to increase the value of the De Mayo Knee Positioner to increase limb stability during a total knee procedure. Holding the leg in a fixed position in a total knee procedure had always required a second set of hands to assist the surgeon until IMP developed a knee positioner capable of the WWW.ORTODAY.COM

challenge. This idea made the De Mayo Knee Positioner® the market-leading positioner used in orthopedic ORs today. For years IMP has included a distractor block on the posterior side of the aluminum boot with the De Mayo Knee Positioners that enables a surgeon to install the IMP De Mayo Universal Distractor® between the lower calf and the patient’s thigh above the knee while flexing to approximately 90 degrees. A hand lever on the distractor enables a surgeon to apply force from the boot’s distractor block, approximating the tibia, through a patented patient protective pad approximating the distal femur. The resulting controlled extraarticular distraction force moves the femur away from the tibia, improving visibility into the joint during surgery. In the traditional use of the De Mayo Knee Positioner®, the boot secures motion of the ankle, leaving two joint locations where movement can produce limb instability. This instability would then affect the navigation system used to determine the robot’s movement during bone resections, the knee, and the hip joints. Initial research at IMP, in collaboration with a valued business partner, has demonstrated that the use of the De Mayo Universal Distractor

reduces varus/valgus swing at the knee to better isolate movement at the hip joint. The De Mayo Knee Positioner used in conjunction with the De Mayo Universal Distractor effectively stabilizes the leg to improve the robot’s efficiency during surgery.

Shown: De Mayo Universal Distractor®

REDefining Rigid Patient Positioning in Total Hip Reconstruction Patient positioning during reconstructive hip surgery was traditionally accomplished using various positioning aids, from bean bags to pegboards to rigid clamping frames using experience as the guide. In 1984, Innovative Medical Products became the gold standard with their original IMP McGuire Hip Positioner, many of which are still in use today. In 2001, IMP improved hip positioner stability by partnering with orthopedic surgeon Ed De Mayo, MD. He invented the De Mayo Hip Positioner® as advanced technology began to support implant placement accuracy in total hip procedures. IMP felt November 2021 | OR TODAY

corporate PROFILE IMP

initial scientific data was needed to better understand how rigid positioners behave to stabilize the pelvis and and correctly match the positioner to the surgeon’s procedure objective. While in the early stages of development, IMP brought its lateral positioner to St. Mary’s Medical Center in San Francisco, California, for further research. It concluded that minimizing pelvic rotation, an objective thought to improve implant accuracy during total hip procedures, is directly influenced by the positioning device used during surgery. IMP’s newest lateral positioner, the Exact-Fit® De Mayo Lateral Positioner®, delivered the best pelvic stability when compared to existing options.

Shown: Exact-Fit® De Mayo Lateral Positioner® 42

OR TODAY | November 2021

MVP: IMP’s Value Added Commitment Transforms into the Most Valued Partnership

er artn le P luab Most Va

As part of IMP’s shared commitment to its customers, Orthopedic facilities will now be able to gain special access to IMP’s premiere partnership level service and support by using genuine IMP patient protective pads for each procedure. MVP, otherwise referred to as “Most Valuable Partner,” is a new program that helps facilities maximize their initial investment. Perks like discounted or complimentary upgrades, complimentary service loaners, repair exchanges for out-of-spec hardware, and even on-site service are just a few of the perks that facility administrators will find helps protect the initial investment’s value. IMP’s patient protective pads have been extensively tested during clinical trials to provide maximum patient protection from pressure sores and ulcers. By consistently using IMP’s premium patient protective pads, like their

proprietary gel-infused memory foam pads, orthopedic healthcare providers may reduce liability by assuring that they meet AORN and AAMI standards for using the manufacturer’s recommended pad as defined in the IFU. Customer Valued Products Remains the imp Focus IMP’s vision for success has always been to collaborate with customers to design, manufacture, and distribute unique, innovative products where surgical patient positioning or supporting logistics has been problematic. IMP’s solutions to universal positioning problems come from years of collaboration with busy orthopedic surgeons, marketleading orthopedic companies, and hands-on med/surg support teams. Ideas have been shared for product improvements with perceptive opinions on improving patient positioning in the surgical environment. Having completed ISO 13485 registration successfully in 2021 to expand IMP’s products outside of the US, the company is now supporting surgeries in new global markets and the rapidly growing outpatient facility network in the US. For more information, please visit www.IMPmedical.com. WWW.ORTODAY.COM

ADAPT 2

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COVER STORY

by Don sadler

hen most people hear

W the terms “time out”

and “handoff,” they think of football. But these terms have very different meanings in the operating room. 44 OR TODAY | November 2021

In OR parlance, a time out is a pause that’s performed prior to the initiation of an operative or invasive procedure. The goal is to ensure that it is the correct patient, the consent form matches the procedure to be performed, and

the procedure is being performed on the correct side. All activities should be stopped and all team members should participate in the time out. A handoff is the transfer of a patient’s care from one practitioner to WWW.ORTODAY.COM

COVER STORY

another. In the perioperative setting, a handoff occurs when the pre-operative preparation nurse hands off the patient to the OR circulator, when the OR circulator is relieved to go on a break or lunch, or at the end of the procedure when the circulator hands off the patient to the PACU RN.

Measure Twice, Cut Once William J. Duffy, RN, MJ, CNOR, FAAN, program director, nursing and health care administration at the Marcella Niehoff School of Nursing at Loyola University of Chicago, has been a proponent of surgical time outs and handoffs for many years. Duffy was instrumental in the creation of National Time Out Day and the Time Out Toolkit produced by the Association of periOperative Registered Nurses (AORN). When he appeared on the CBS morning show in 2004, Duffy described a surgical time out by comparing it to the old carpenter’s saying of “measure twice and cut once.” “The time out process is our effort to stop and do a final check before we start the procedure on patients,” says Duffy. According to Duffy, the word “time out” comes from the belief that “we need to step away from the multitude of tasks and focus for this minute on making sure we have the correct patient, the correct procedure and are working on the correct site. If every member of the team focuses on these questions before we begin, we can catch potential errors.” The Joint Commission defines a handoff as “a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patientspecific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care.” Inadequate handoff communication is a contributing factor to adWWW.ORTODAY.COM

verse events, including many types of sentinel events, according to The Joint Commission. A 2018 study found that nearly 30 percent of surgical adverse events occurring at Veterans Health Administration facilities could be attributed to an incomplete or incorrectly performed surgical time out. Paul Wafer, BS, MBA, RN, says that in some organizations the surgeon takes the lead in initiating the time out while in others, the circulating nurse takes the lead. “During the time out, all other activities should be suspended so that all members of the perioperative team are paying attention,” says Wafer. “All team members should introduce themselves and the patient should be verified using two patient identifiers,” Wafer adds. “The consent is then reviewed and the marking of the surgical site is confirmed.” Other relevant information that Wafer says may be shared during the time out includes the fire risk assessment, confirmation of imaging, equipment concerns, the time of antibiotic prophylaxis, confirmation of sterilization indicators and any anticipated critical events by the surgeon. “During time outs in our facility, the physician states the procedure and CRNAs confirm antibiotics,” says Erin Keeney, MSN, RN, CNOR, director of perioperative services at AnMed Health in Anderson, S.C. Other elements of the time out at AnMed Health include: Correct patient, site, procedure and laterality • Team introduction • Anesthesia review • DVT prophylaxis • Antibiotics given • Any safety concerns “Our nurses also use a handoff sheet to ensure that all important details about the patient are relayed to the next phase of care,” Keeney adds.

Standardizing Time Outs Renae Wright, DNP, RN, CNOR, perioperative practice specialist with AORN, says that AORN recommends standardizing the time out process by using a checklist that has been customized to meet the needs of the facility. “This gives members of the surgical team the opportunity to speak up and voice concerns if they notice something amiss,” says Wright.

“The time out is intended to prevent medical errors involving wrong-site, wrong-procedure, wrong-patient or wrong-implant surgery.” Wright cites data from The Joint Commission noting that among the main causes of wrong-site surgeries are ineffective handoff process, distractions or rushing that interfered with time outs and not having full participation in time outs. “Communication is the foundation for both time outs and handoffs,” says Melanie Perry, BSN, RN, CNOR, the creator of The Circulating Life and co-host of the First Case podcast. “Taking the time to communicate properly prioritizes our patients and their safety and ensures the best surgical outcomes.” November 2021 | OR TODAY

COVER STORY

“You and the team are all on the same For Wright, the saying “the buck stops here” comes to mind with regard to why time outs and handoffs are important. “Most patients are under general anesthesia when these critical communication points occur so they are

any perioperative team intentionally perform a wrong-site or wrong-patient procedure. “But as the statistics show, this still happens even with the time out process,” he says. “The human factor and our belief in our capabilities to manage the situation reduces our defense mechanism,” Duffy adds. “The fact that these errors don’t occur 99.9% of the time lulls us into security and we miss the .1% of the time they do happen, which can change both the patient and the practitioner’s lives forever.”

Normalizing Danger

entirely dependent on the surgical team to keep them safe,” she says. “In other words, the buck stops with us.” Like most perioperative professionals, Duffy says he has never seen 46

OR TODAY | November 2021

The benefits of surgical time outs and handoffs seem obvious, which leads to the question: Why would perioperative teams not perform them before every surgery? One obstacle is what Duffy calls the “normalization of danger.” “It’s like the Allstate TV commercial where the actor says mayhem can happen at any time,” he says. “But we usually don’t think it can happen to our team in the OR.” Establishing a culture of safety will help reduce the normalization of danger. “If we can keep staff members on the lookout for danger, they can better spot it and then take steps to prevent harm from happening,” says Duffy.

In her experience, Perry says that while time outs are always performed, they aren’t always done properly or with the appropriate level of involvement by all team members. “I’ve seen fully engaged teams perform a time out, and I’ve seen time outs be mostly ignored,” she says. “Time outs work well when they’re standardized, prioritized and enforced by hospital leadership,” says Perry. “But it’s difficult to do the time out when the RN has to yell to get the team’s attention, when the surgeon wants to keep working while the time out is being performed or when the surgeon acts so annoyed that everyone has to stop.” “Circulators are often frustrated that such an important safety measure is ignored or treated as unimportant,” Perry adds. Wafer agrees that time outs are generally performed on a consistent basis. “However, the quality of how and when they are performed varies widely across the country,” he says. “I have done assessments in over 40 states and the quality is not really based on geography as much as the culture of an individual organization.” It has been nearly 20 years since the initiation of the surgical time out, notes Wafer, but there are still surgeons who feel it is a waste of time. “If this attitude emanates throughout the OR, it can be WWW.ORTODAY.COM

COVER STORY

e page when caring for your patients” - Erin Keeney, MSN,RN, CNOR

challenging to get all of the staff members to stand up to intimidation and bullying that can occur,” he says. Wafer believes that overcoming this obstacle requires support from the very top of the organization. “It can be a real problem if the highest volume surgeon in a facility fights the time out,” he says. “Time outs have to be enforced even if a high-volume surgeon threatens to leave.”

Common Obstacles and Best Practices One of the biggest obstacles to effective time outs and handoffs are distractions in the OR that lead to inattention among surgical team members, says Wright. “During the time out and handoff, all music should be turned off, electronic devices including cellphones, tablets and computers should be silenced and conversations and all other activity suspended,” she says. “Eliminating distractions and interruptions during the time out and handoff are critical so the team can focus on and comprehend the information being communicated, assess its accuracy and recognize any incongruencies,” Wright adds. Duffy stresses the importance of performing a complete counting of surgical items (including instruments, needles, sponges and other devices) WWW.ORTODAY.COM

before a handoff. “It’s critical that the onboarding team member have an accurate count of which items have been placed on the field and where they are currently located,” he says. “Also, whenever possible there should not be a complete changing of the original team,” Duffy adds. “The person who did the original count should be present throughout the procedure to help ensure no items are missed in the counting process.” Wafer offers additional best practices for ensuring effective surgical time outs and handoffs: • Develop a culture in which surgeons, nurses and technicians all reinforce the importance of time outs and handoffs. “You have to get everyone to buy in to these practices,” says Wafer. • Standardize a script so the time out is done the same way by everyone in the organization. • Create a checklist with all of the pertinent information that should be communicated to everyone in the room. “I like to use a whiteboard on the wall for this so if someone is relieved from the room, they can look at the whiteboard to verify all of the information,” says Wafer. • Designate a physician champion who will address any variations in time out and handoff practices.

Evidenced-Based Recommendations Wright encourages perioperative team members to consult the AORN Guideline for Team Communication when standardizing surgical time out and handoff procedures. “This contains evidence-based recommendations for developing time out and handoff process, implementation and monitoring quality,” she says. The goal should be for time out and handoffs to become “hardwired habits” and “ingrained components” of the culture of safety within the organization, says Wright. “This will not only help keep patients safe from medical errors, but it will also help ensure that surgical team members don’t have to experience the trauma associated with sentinel events that can seriously harm patients.” Keeney believes that having a strong patient safety culture and an engaged team, as evidenced by consistently performing thorough timeouts and handoffs, promotes exceptionalism. “You and the team are all on the same page when caring for your patients,” she says. “Patients put their trust in us and it is our responsibility to keep them safe during their procedures and through all phases of care.”

November 2021 | OR TODAY

SPOTLIGHT ON:

DARLENE MURDOCK rowing up the youngest of three sisters in Laurel, Mississippi, Darlene Murdock remembers well the values her mother instilled in her from childhood: always do your best, don’t worry about what other people say about you, and work hard.

“Took an internal review that brought us to the conclusion we can, and must, be doing more to include and represent people of color and other diverse backgrounds” - Darlene Murdock

OR TODAY | November 2021

Murdock held down a job throughout high school – full-time in the summer, part-time during the academic year – but she was equally devoted to her studies. When an advisor told her she’d have to relocate to find better career opportunities, Murdock decided to pursue a business administration degree at the University of North Carolina. But it wasn’t until she produced the plane ticket that her mother actually believed she’d leave. “In Mississippi 50 years ago, it was not a good place for Black people,” Murdock said. “My junior college teacher told me if I wanted to get a good job, I would have to leave Mississippi.” “When my mother saw the plane ticket, she cried,” Murdock said. “It was a dream of both of ours; we just didn’t know how to make it come true. I was the first one in my family to finish college, so this was really a big deal for us.” Murdock continued to work a full-time job throughout college to pay for her education (“While everybody was going off to parties, I was going off to work,” she recalled), but after graduation, she landed a career in banking in Houston, Texas. By then it was the 1980s, and “banking was rough,” Murdock said; “every month, I was worried about my job.” One evening, while she was out on a double-date, WWW.ORTODAY.COM

Murdock met a nurse who told her there was much greater career stability in her profession than in banking. She mulled it over for a couple of months, and then enrolled at the University of Texas Health and Science Center in Houston to earn a nursing degree. Of course, Murdock maintained full-time hours working overnights in banking operations … which meant that she’d occasionally nod off during class. “I do remember being called in the office and told that I couldn’t sleep through class, and maybe I should try something else,” she laughed. “I politely told her I pay my money to come here, not disturbing anybody, and as long as I’m making the grades, I should not have to quit. When I finished class, I got an award for the one who slept the most in class and had the highest GPA. They gave me a pillow and a box of No-Doze.” If Murdock had been preparing all her life for the intensity of work in a hospital by holding down jobs and school, her secondary collegiate career taught her how to manage nursing duties and sleeplessness. Right after graduating, she began working at Memorial Hermann Hospital in the Texas Medical Center, one of the busiest Level I trauma centers in the nation. The ophthalmology nurses there “took me in and molded me, and made me feel part of a team,” Murdock said. “I couldn’t decide between labor and delivery and the operating room, and a director during one of my clinicals pulled me to the side and said, ‘I want you to come here when you finish school,’ ” Murdock said. “I went to the operating room, and here I am. I’ve been an OR nurse 30 years, and at the same facility for 28 years.” Murdock describes herself as having always been “a night person,” and when her son, Ryan, was born, she stayed WWW.ORTODAY.COM

with him days and continued to work nights. Among the benefits of taking those evening shifts, she was able to dedicate herself to working with the Association of periOperative Registered Nurses (AORN), first at her local chapter, and then, in 2018, at the national level. Today she is the national secretary for the association, an office she earned after having previously chaired its Neurosurgery, Orthopedics, and Trauma Specialty Assembly. At the time she was seeking office, AORN had not had a Black member of its executive board in nearly a decade, and during her candidacy, “some unprofessional things [were] said to me,” Murdock recalled. “I had somebody ask me, ‘How can you run for something?’ ” she remembered. “But I persevered and I won. The second year on the board, I did encounter a racial slur.” For Murdock, who’d experienced moments of bias and negativity like these since childhood, it was nothing new, but no less frustrating. In June 2020, AORN released a statement “condemning racism, brutality, and senseless violence against Black communities, and took an internal review that brought us to the conclusion we can, and must, be doing more to include and represent people of color and other diverse backgrounds,” Murdock said. “I just keep working at it,” she said. “You’ve just got to keep pinching at it, every little bit, to do your part. My mother has taught me to always do your best; don’t worry about what other people say about you, just do your best, and things will always go your way. And I’ve found that to be the truth.” While that’s a fine personal motto, she also knows there’s institutional work to be done to chip away at unconscious bias in health care, and Murdock said she’s proud to be a part of the AORN response to those

circumstances. “A lot of people don’t know what is going on; they don’t know the health disparities,” she said. “And I think one way is to teach; to get it out on the table; to talk about how there’s not many Black doctors, there’s not many Black nurses, Indian nurses, Hispanic nurses.” “It’s going to take time to get more diversity in health care, but in the meantime, we need to be educating everybody else, and addressing racism and unconscious biases up-front,” Murdock said. “Our organizations need to be teaching their employees about unconscious and conscious biases. Both of them definitely hurt.” “I have been in Wal-Mart and people just assume I work there,” she said. “I have been in a room helping the surgeon position the patient, and he looks up, and asks, ‘Where’s the nurse?’ I said, ‘Oh, I guess I don’t look like a regular nurse, huh?’ ” “I have to always go back to what my mother has taught me – be nice and respectful,” Murdock said. “I also find that when people are mean and you’re nice to them, in return, it makes them think twice.” Murdock also mentors young nurses, helping them to develop the communication techniques that will help them confront similar situations in the future. Her leadership work also extends to chairing two magnet councils within the professional nurse advancement program at Memorial Hermann, whereby she helps nurses learn how to earn additional certifications.

OUT OF THE OR fitness

Better Posture for Stronger Shoulders By Miguel J. Ortiz he shoulder is arguably one of the most intricate joints in the body. One of the reasons for this is that the muscle groups in the surrounding area can have a serious effect on how it moves.

For example, if your pectoralis (chest) muscles or latissimus dorsi (lats) are tight you may have rounded shoulders which will affect reaching over head. If you have tight trapezius (traps), it will not only raise your shoulders up but have a drastic effect on how you reach in all directions. The traps are an area where people tend to carry stress. These muscles are located to the side, back of the neck and upper body. The point is that these surrounding muscles heavily affect the shoulder joint. Where does posture come into play? Posture is important because it impacts those major muscles groups and a lot of that comes from general movement. So, if you’re having shoulder issues it makes sense to try and fix or focus on that area directly. However, to make sure we have some quality shoulder mobility, let’s look at our posture. Let’s check off these three daily musts dos to make sure the pain isn’t being aggravated by poor posture. First, are we utilizing our core 50 OR TODAY | November 2021

properly? We already understand that slouching isn’t good however we continue to do it. It’s usually not practiced because it’s not as often thought about and we’re pretty distracted. So, to open up the chest and lengthen your core, begin in a seated position. Place your hands on your chest with a clenched fist as if your superman and your ripping open your shirt. While doing so extended your arms down to the floor making the letter A and reach with your fingers opening your hand. Make sure not to arch the lower back but rather (while taking a deep breath) draw your navel in and get tall instead of arching. We want to practice this at least 20 times a day. We want to take this next move to the floor. Start in a quadruped position (hands and knees) on the floor. These are yoga moves that involve doing a “cat” pose and “cow” pose. We want to practice our breathing while preforming both movements and do it slow and under control. This will not only stretch the back but also help the shoulder stretch the shoulder blades which will help relax the shoulders. Do 20 reps of each movement daily. Find a YouTube video of these yoga poses at youtu.be/EX3eZOi-YBU. Third, we need to foam roll our lats. I have had a lot of clients with

tight shoulders and most people I have worked with were not regularly stretching or foam rolling there lats properly. This can internally rotate the shoulder and cause other impingements during movement. So, grab your favorite foam roller, lay your side on the roller just underneath the arm pit, thumbs to the ceiling and if rolling your right arm your right leg should be straight or lightly bent, also on the floor with your left leg pushing to guide you up and down the roller. Use your left arm to guide you as well and monitor pressure to ensure tolerability. Do this for 5 minutes a day on each arm. A YouTube video of these exercise can be found online at youtu.be/i-gYAkuYzDI. Practice these three habits daily and continue to think more about your posture and breathing and your shoulders will be well on their way to better health and movement. Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a member of the National Personal Trainer Institute and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz.

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OUT OF THE OR health

5 Simple, Natural Ways to Boost Immunity By family features our body’s immune system protects against illness and infection, fighting off threats before you even know there’s a problem. Even though your immune system usually does its job automatically, you can give it a boost with habits that promote wellness and support immunity.

1. Eat healthy fruits and vegetables. Although you may not be aware they contain flavonoids, these phytochemicals found in some fruits and veggies are a vital part of maintaining health. Flavonoids are found in colorful fruits and vegetables like cranberries and elderberries. When it comes to power foods, elderberries’ exceptional flavanol levels make them an immune system powerhouse. Especially important during cold and flu season, elderberries can also be enjoyed in a cup of warm tea for instant comfort. 2. Reduce stress with outdoor activity. Keeping physically fit provides numerous health benefits such as reducing stress by being one with nature through taking a walk outside. WWW.ORTODAY.COM

The sun’s UV rays help your body produce vitamin D, which is important for your bones, blood cells and immune system, as well as helping absorb and use certain nutrients. Yoga and massage can also be used to help stimulate the immune system and promote well-being. 3. Keep a regular sleep schedule. Sleep gives you an opportunity to recharge. This is when cellular regeneration and other healing is most efficient. Keeping a regular routine helps signal to your system that it’s time to rest so you can fall asleep easier and reap the whole-body benefits of a healthy sleep cycle. 4. Wash hands frequently. Especially during the school year, when germs are rampant and easily carried from school to home, you can give your immune system a hand, literally, by frequently scrubbing away germs before they have the chance to attack. 5. Rely on natural remedies. Modern, stressful lifestyles and exposure to environmental pollutants can put immune systems under pressure. However, some of your existing

soothing rituals can actually support better health, too. One example is relaxing with a hot cup of tea. The natural and organic ingredients found in Buddha Teas provide numerous health benefits. Options like Mushroom Wellness, Divine Immunity, Elderberry Tea and Reiki Mushroom blends all contain immunity-boosting ingredients. While they’re not an obvious ingredient, mushrooms have been incorporated into healing practices for thousands of years for their immuneboosting, anti-inflammatory and antioxidant-rich properties. There are several powerful medicinal mushrooms but one stand-out is the reishi mushroom, known as the “mushroom of immortality” and “divine plant of longevity.” This anti-inflammatory powerhouse is known to promote healthy cell growth and healthy blood pressure, along with improving immune function. Learn more about boosting immunity naturally at buddhateas.com.

November 2021 | OR TODAY

OUT OF THE OR EQ Factor

The Power of Showing Gratitude By daniel bobinski, M.Ed. n the workplace, being thankful for something and verbalizing that thankfulness are two very different things. Oftentimes people are thankful, but they don’t express that gratitude in words. If that’s you, allow me to suggest expressing your appreciation out loud, because a little positivity goes a long way these days.

It was Mark Twain who allegedly said, “I can last two months on a good compliment,” and many people would agree. The key is that the compliment must be sincere. Just saying, “Good job” to someone rarely does it. A specific action observed and acknowledged form the heart of a good compliment, such as, “I like how you remained so calm when that situation yesterday went sideways.” The cool thing is that behaviorism works. It’s just human nature. When someone feels valued for doing something, they connect that positive feeling with the behavior. Think of it this way: behavior that gets rewarded or recognized in a positive way usually gets repeated. It’s a good idea to practice this as a way of life, but workplace programs can also be implemented to foster the giving of compliments. One hospital laboratory in my town instituted a “Caught You at Your Best” program. In this program, 54

OR TODAY | November 2021

any employee can submit a compliment about another employee. The process is simple: • Submissions must have a specific description of a praiseworthy action or attitude • Recipients are acknowledged both verbally and in writing by a member of the “Caught You at Your Best” team soon after the praiseworthy event • All employees are eligible to receive recognition • All employees are eligible to give recognition The team of volunteers take the submissions, write up brief, one-sentence descriptions, and then deliver the note along with a verbal, one-on-one “thank you” during the workday. One such acknowledgement read, “Thank you for staying after your normal shift to help out in Chemistry when they were shorthanded but overloaded with work.” As one lab employee said, “It’s nice when your manager notices you did something, but when co-workers take time to write about their observations, it really fosters esprit-de-corps.” Each recipient of a compliment gets a candy bar placed in his or her “inbox.” Even with 180 lab employees, the program at this hospital is inexpensive to operate – about $30 per month to cover the cost of candy bars. When employees acknowledge and

celebrate the above average performance and attitudes of their co-workers, it becomes part of the culture. What’s the benefit? People get in the habit of seeing the value of each other’s contributions, and that habit serves as a glue to strengthen even the most burdened work team. Too many organizations say their employees are their greatest asset, but don’t support that statement with action. My view is that employees don’t need to wait for management or leadership to care for their greatest assets. Employees can say, “thank you” directly to their co-workers. Just remember to keep it specific and genuine. It’s like what Mark Twain said – people can live two months on a good compliment. 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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OUT OF THE OR pinboard nutrition

Feeding Gut Bugs for Better Blood Pressure By Kirsten serrano ut health” and the “gut microbiome” are big buzzwords in the nutrition and health world these days. Food companies are harnessing that buzz to bring us products promising to improve our gut health and, in turn, our overall health. Is it just hype or is there science behind all the buzz? It is both. I caution you to not be sucked in by front of the box marketing, but we do know that the health benefits (or risks) of what we eat have a lot to do with how our gut microbes react to and are molded by our diet. There is so much that we do not know, but what we do know is pretty amazing.

If you are wondering what the gut microbiome is, here is a quick rundown: Your gut microbiome consists of roughly three pounds of microorganisms living in your digestive tract. You are not biologically an individual. You are an ecosystem inhabited by bacteria, fungus, viruses and other microbial life. In fact, you have 100 times more microbial genes than you do your own1. Simply put, you 56

OR TODAY | November 2021

are more than just an individual; you are a microbial us. Your gut microbiome is the middle man between what you eat and how it affects your body. These microbes are digesting our food and, in doing so, affecting processes in our entire body. The science emerging about the gut microbiome is astounding. A new study shows that what you feed your gut microbes can lower your blood pressure too. The American Heart Association recently shared a study linking flavonoid-rich foods with improved blood pressure. Flavonoids are the compounds responsible for the colors in fruits and vegetables. They are powerful nutrition and part of that power is their effect on the microbiome. Some of the flavonoid effect is from improved gut health. Study subjects showed increased gut microbiome diversity that improved blood pressure. The study, which came out recently in the journal Hypertension, studied foods like berries, red wine and apples. Flavonoid consumption increased microbes in the parabacteroides group and lowered systolic blood pressure.2 This study leads the way for further research into gut health and blood pressure. Your microbiome changes and develops with you. Unlike a fingerprint, your microbiome is morphing all the time in

reaction to its environment. That’s a very good thing because that means we can do a lot of very important remodeling. Food is the most profound tool we have to do that. It really is the best medicine. When my daughter was little, we had a friendly family competition in which each family member tried to “win” by eating a rainbow of fruits and vegetables every day. That challenge is a great way to get kids on board with healthier eating, but it is well worth your effort too. Not only will all that produce nourish you with plenty of flavonoids, but it also comes with fiber, vitamins, minerals and more. Here are some “out of the ordinary” ideas for getting diverse, colorful produce: Red – red currant, rhubarb, pomegranate, blood orange, red carrot, watermelon radish (pink inside), red-fleshed potato Orange – kumquats, golden “cheddar” cauliflower, persimmon, ground cherries, Yellow – golden raspberries, “pineapple” tomatoes, Buddha’s Hand, star fruit, yellow wax beans Green – gooseberries, fiddlehead fern, seaweed, green eggplants, Romanesco, kohlrabi, okra, tomatillos Blue/Purple - purple and blue fleshed potatoes, purple cauliflower, purple carrots, purple kohlrabi, purple WWW.ORTODAY.COM

bell peppers, purple asparagus, black currants, figs, elderberries, purple sweet potato White – white cucumbers, Dragon fruit (white inside), jicama, coconut, garlic, white carrots, white tomatoes, white currants. 1. Bull, Matthew J, and Nigel T Plummer. “Part 1: The Human Gut Microbiome in Health and Disease.” Integrative Medicine (Encinitas, Calif.) 13, no. 6 (2014): 17–22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566439/#__ffn_sectitle.

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2. Jennings, Amy et al. “Microbial Diversity And Abundance Of Parabacteroides Mediate The Associations Between Higher Intake Of Flavonoid-Rich Foods And Lower Blood Pressure”. Hypertension, vol 78, no. 4, 2021, pp. 1016-1026. Ovid Technologies (Wolters Kluwer Health), doi:10.1161/hypertensionaha.121.17441. Accessed 12 Sept 2021.

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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November 2021 | OR TODAY

OUT OF THE OR recipe

Overnight Apple Cinnamon French Toast Casserole INGREDIENTS: • Nonstick cooking spray

Recipe

• 1 package (20 ounces) French bread, cubed, divided • 1 can (20 ounces) apple pie filling • 9 eggs • 1 cup half-and-half • 2 teaspoons ground cinnamon • 1 cup powdered sugar, plus additional (optional) • 2 tablespoons milk, plus additional (optional)

the

By Family Features

OR TODAY | November 2021

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OUT OF THE OR recipe

A Wonderful Breakfast Worth Waking Up For aking up, no matter how late,

W can be such a drag. You’re

moving slow and cuddled up warm under the blankets. However, your stomach is growling which means eventually you are going to have to arise. Prepared the day before and chilled overnight, this casserole is ready to throw in the oven once you’re up. It’s gooey on the inside and baked to a perfect crisp on the outside, plus it’s filled with mouthwatering apples and ground cinnamon, not to mention the sweet glaze drizzled on top at the end. It’s perfect for any breakfast or brunch occasion and the little ones will enjoy the sweet crunch, as well. To start, add cubed French bread to a glass baking dish. Add apple pie filling on top of the bread and smooth it out over the entire dish. Then add more cubed French bread on top.

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In a mixing bowl, whisk nine eggs, half-andhalf and cinnamon. Pour the egg mixture over the ingredients in the baking dish. Cover the dish with aluminum foil and chill overnight. Remove the foil and bake for about an hour. Let cool. In a small bowl, whisk together powdered sugar and milk to form a sweet glaze. Drizzle the glaze over your warm casserole and enjoy. Whether you are waking up on an early Monday morning or lounging around in your pajamas for an hour (or two) over the weekend, this breakfast casserole is worth the wait. Find more breakfast and brunch recipes at Culinary.net. If you made this recipe at home, use #MyCulinaryConnection on your favorite social network to share your work.

Overnight Apple Cinnamon French Toast Casserole Servings: 12

3. In medium bowl, whisk eggs, halfand-half and cinnamon. Pour evenly over bread.

1. Spray 8-by-8-inch glass baking dish with nonstick cooking spray.

4. Cover with aluminum foil and chill overnight.

2. In baking dish, add 10 ounces cubed French bread in bottom of dish. Pour apple filling over bread. Top with remaining cubed French bread. Set aside.

5. Heat oven to 325 F. 6. Remove foil and bake 50-60 minutes. 7. Let cool 10-15 minutes.

November 2021 | OR TODAY

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H QUOTE OF THE MONT

is hard work, It t. n e id c c a o n is ss e d most “Succ n a e c fi ri c sa , g in y d u g, st arning to do.” perseverance, learnyin le r o g in o d re a u o of all, love of what – Pelé

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The News and Photos

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that Caught Our Eye This Month

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ATTRACT MORE BIRDS

TO YOUR BACKYARD Basic tips for Feeding Wild Birds By FAMILY FEATURES

ith all the constraints people lived through in 2020, many turned to their own backyards – nature, in particular – for hope, solace, wonder and even entertainment. Despite the worldwide crisis, nature’s normalcy remained intact; flowers continued to bloom, bees continued to pollinate and birds continued to fly and forage food. Feeding birds can be enjoyable for any age group and provide stress relief for all who partake. A University of Exeter study, focused on nature’s impact on humans in suburban and urban areas, found lower levels of depression, anxiety and stress were associated with the number of birds people saw during afternoons at home. The benefits of birdwatching come from seeing lots of birds – quantity not “quality” – the study found. People “felt relaxed and connected to nature when they watched birds in their gardens,” researchers said. These feelings increased with the level of bird feeding in the yard. For millions working and schooling from home, this stress reduction was an unintended bonus. Data from 2020 shows sales of bird feed, feeders, nesting boxes and bird houses spiked as interest in backyard birds soared while people spent more time at home. Interest in birding isn’t slowing down. If you haven’t tried attracting birds to your backyard, now is a perfect opportunity to start. The experts at Cole’s Wild Bird Products Co. offer these bird feed and feeder basics to attract more birds to your backyard. FEEDERS A variety of bird feeder types placed at different heights attract more birds than one feeder featuring one seed type. Start with two feeder types that accommodate most feed options. Bowl feeders serve not only seeds but also dried mealworms, fruit and suet. An option like Cole’s Bountiful Bowl Feeder comes with an adjustable dome cover you can raise or lower to prevent larger birds and squirrels from getting to food and protect it from rain. Traditional tube feeders are all-purpose options for bird feeding, especially for small birds that cling. For example,

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the Terrific Tube Feeder is made with state-of-the-art materials to prevent warping and discoloration and includes a quick-clean, removable base to make cleaning fast and easy. Just push a button and the bottom of the feeder pops off for easy access to the inside. Rinse the feeder with soapy water, dunk it into a water-bleach solution at a concentration of 9-to-1, rinse, dry and reattach the bottom. Regular cleaning of feeders is essential for preventing mold, germs and disease. POPULAR FOODS Birdseed: Not all birdseed is created equal. Look for quality blends without cheap filler like red millet and oats. All-natural seed containing no chemicals or mineral oil is safe and more appealing to birds. Top seed picks include all-natural black oil sunflower and Cole’s “Hot Meats” (sunflower meats infused with habanero chili peppers that birds love and squirrels dislike). Or an option like Special Feeder blend, packed with favorites including black oil sunflower, sunflower meats and pecans, attracts the greatest number of wild birds. Offering a wide variety, Cole’s feed is researched and specifically formulated to attract certain bird species, the largest number of birds and the greatest variety of birds. Insects and Worms: A healthy, lush lawn is one of the best ways to feed birds that prefer insects and worms. You can supplement birds’ diets by serving dried mealworms in a packaged variety that’s easier to feed and less messy than live mealworms. Mealworms are packed with energy and contain essential nutrients, fat and protein. Fresh Fruit: Apples, orange halves and bananas are favored fruits. Suet: Perfect for insect-eating birds, suet is a high-fat food that provides abundant calories, rich nutrition and is a high-energy treat. Using the right feeders and high-quality feed can enhance your backyard and entice more birds, bringing stress relief and enjoyment. For more information, visit coleswildbird.com.

November 2021 | OR TODAY

INDEX

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ALPHABETICAL AIV Inc.………………………………………………………………… 4

Cygnus Medical………………………………………………… 64

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

ALCO Sales & Service Co.……………………………… 25

Healthmark Industries Company, Inc.……………19

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

AORN…………………………………………………………………… 8

Innovative Medical Products…………………… 40-43

SIPS Consults…………………………………………………… 25

ASCA………………………………………………………………… 23

Jet Medical Electronics Inc…………………………… 23

TBJ Incorporated………………………………………………… 5

C Change Surgical………………………………………………15

MD Technologies Inc.……………………………………… 39

TrackCore, Inc.…………………………………………………… 11

CS Medical………………………………………………………… 63

MedWrench……………………………………………………… 38

CATEGORICAL ASSOCIATION

INFECTION CONTROL

REPROCESSING STATIONS

AORN…………………………………………………………………… 8

ALCO Sales & Service Co.……………………………… 25

MD Technologies Inc.……………………………………… 39

ASCA………………………………………………………………… 23

CS Medical………………………………………………………… 63

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

CARDIAC PRODUCTS

Cygnus Medical………………………………………………… 64

TBJ Incorporated………………………………………………… 5

Healthmark Industries Company, Inc.……………19

SAFETY

C Change Surgical………………………………………………15 Jet Medical Electronics Inc…………………………… 23

CARTS/CABINETS ALCO Sales & Service Co.……………………………… 25 Cygnus Medical………………………………………………… 64 Healthmark Industries Company, Inc.……………19 TBJ Incorporated………………………………………………… 5

CS/SPD CS Medical………………………………………………………… 63 MD Technologies Inc.……………………………………… 39 Ruhof Corporation…………………………………………… 2-3

DISINFECTION CS Medical………………………………………………………… 63

MD Technologies Inc.……………………………………… 39 Ruhof Corporation…………………………………………… 2-3

Healthmark Industries Company, Inc.……………19

SIPS Consults…………………………………………………… 25

SINKS

TBJ Incorporated………………………………………………… 5

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

INSTRUMENT STORAGE/TRANSPORT

TBJ Incorporated………………………………………………… 5

Cygnus Medical………………………………………………… 64

SOFTWARE

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

TrackCore, Inc.…………………………………………………… 11

ONLINE RESOURCE

STERILIZATION

MedWrench……………………………………………………… 38

Cygnus Medical………………………………………………… 64

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

Healthmark Industries Company, Inc.……………19

OR TABLES/BOOMS/ACCESSORIES Action Products, Inc.……………………………………… 57

Innovative Medical Products…………………… 40-43 MD Technologies Inc.……………………………………… 39 TBJ Incorporated………………………………………………… 5

Cygnus Medical………………………………………………… 64

OTHER

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

AIV Inc.………………………………………………………………… 4

DISPOSABLES

PATIENT MONITORING

ALCO Sales & Service Co.……………………………… 25

AIV Inc.………………………………………………………………… 4

ENDOSCOPY

Jet Medical Electronics Inc…………………………… 23

Cygnus Medical………………………………………………… 64

POSITIONING PRODUCTS

Healthmark Industries Company, Inc.……………19

Action Products, Inc.……………………………………… 57

Cygnus Medical………………………………………………… 64

MD Technologies Inc.……………………………………… 39

Cygnus Medical………………………………………………… 64

Healthmark Industries Company, Inc.……………19

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

Innovative Medical Products…………………… 40-43

FALL PREVENTION ALCO Sales & Service Co.……………………………… 25

PRESSURE ULCER MANAGEMENT

FLUID MANAGEMENT

Action Products, Inc.……………………………………… 57

MD Technologies Inc.……………………………………… 39

REPAIR SERVICES

GENERAL

CS Medical………………………………………………………… 63

AIV Inc.………………………………………………………………… 4

HOSPITAL BEDS/PARTS

Cygnus Medical………………………………………………… 64 Jet Medical Electronics Inc…………………………… 23

SURGICAL Innovative Medical Products…………………… 40-43 MD Technologies Inc.……………………………………… 39 SIPS Consults…………………………………………………… 25

SURGICAL INSTRUMENT/ACCESSORIES C Change Surgical………………………………………………15

TELEMETRY AIV Inc.………………………………………………………………… 4

TEMPERATURE MANAGEMENT C Change Surgical………………………………………………15

WASTE MANAGEMENT MD Technologies Inc.……………………………………… 39 TBJ Incorporated………………………………………………… 5

ALCO Sales & Service Co.……………………………… 25

OR TODAY | November 2021