OR Today April 2022

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The Value of Volunteer Work

Surgical Market

Low Back Pain

Kathleen Singleton

CCI

MARKET ANALYSIS

CE ARTICLE

SPOTLIGHT ON

LIFE IN AND OUT OF THE OR

APRIL 2022

RETAINED

SURGICAL ITEMS PAGE 34

OR TODAY | April 2022

contents features

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RETAINED SURGICAL ITEMS Experts discuss one of the most frequent and costly surgical “never events” – retained surgical items.

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The global market for surgical instruments

The goal of this continuing education

When creating a goal, start by clarifying

is predicted to reach $15 billion by 2027.

module is to update nurses’ knowledge

three core factors: a specific action, a

about the evaluation, management and

specific measurement and a specific time

prevention of acute low-back pain.

that the goal must be accomplished.

MARKET ANALYSIS

CE ARTICLE

EQ FACTOR

OR Today (Vol. 22, Issue #4) April 2022 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290.

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EVENTS

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6 News & Notes 12 HSPA: Key Changes to ANSI/AAMI ST91: Impact on Endoscope Processing Practices 14 AAMI’s New President: A Career Built at Hospitals 16 TJC: Preventing Unintended Retained Foreign Object in Ambulatory Surgery Care 19 CCI: The Value of Volunteer Work

ACCOUNTING Diane Costea

WEBINARS Jennifer Godwin

EDITORIAL BOARD Hank Balch, President & Founder,

IN THE OR

Beyond Clean

21 M arket Analysis: Reports Predict Surgical Instrument Market Expansion 22 Product Focus: Surgical Instruments 24 CE Article: Low-Back Pain: The Nurse’s Nemesis

Vangie Dennis, MSN, RN, CNOR, CMLSO, Assistant Vice President, Perioperative Services with AnMed Health System Sharon A. McNamara, Perioperative Consultant,

OUT OF THE OR

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news & notes

ObservSMART Continues Rollout of Patient Safety Technology ObservSMART, a patient safety compliance solution, has announced that AltaPointe Health in Mobile, Alabama, has recently started using its technology to ensure patient safety while reducing risk, errors and costs. An easy-to-use observation tool, ObservSMART is an innovative product of InvisALERT Solutions, developed to improve patient safety and overall quality of care for high-risk patient populations.

AltaPointe Health has deployed the ObservSMART technology at BayPointe Hospital, which treats pediatric psychiatric patients, and at EastPointe Hospital, which cares for adults.

“BayPointe Hospital provides more than 100,000 hospital services to children each year, and safety is our top priority. Incorporating ObservSMART, the next generation of technology, into our daily patient observations helps us ensure patient safety while maintaining the highest quality of care,” said Jarrett Crum, chief hospital officer for AltaPointe Health.

ObservSMART is a proximity-based system that syncs a patented, tamper-resistant wristband with a tablet to validate required patient observations, specifically designed for higher acuity patient populations, or patients in need of frequent monitoring. The staff member needs to be within a certain proximity to the patient to validate their patient check. The ObservSMART App also provides real-time staff reminders to check on their patients. In addition, leadership and other supervisors receive alerts for missed observations and additional safety concerns, allowing them to intervene in real-time, mitigating the potential of risk.

For more information about ObservSMART, visit observsmart.com.

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CenTrak RTLS Ranked Best in KLAS for Fourth Year CenTrak, a provider of enterprise locating and sensing services for the health care industry, has been named 2022 Real-Time Location Systems (RTLS) Best in KLAS for the fourth time by KLAS Research, a healthcare IT data and insights company. The Best in KLAS report recognizes companies that excel in helping health care professionals improve patient care. All rankings are a direct result of feedback from thousands of providers over the past year.

CenTrak received the highest performance score of all ranked RTLS vendors.

CenTrak’s enterprise platform enables a variety of health care and senior living solutions including infection control applications such as automated temperature monitoring of treatments and vaccines, differential air pressure monitoring in isolation rooms, hand-hygiene compliance for staff, and contact tracing among patients, visitors, staff and equipment. The locating and sensing company also offers asset monitoring and management for medical equipment, and workflow and safety solutions for staff and patients via IoT-enabled badges and sensors.

As the health care industry strives to improve patient care and outcomes through the use of data and technology, CenTrak’s full suite of services provide the actionable analytics needed to optimize workflow and productivity, reduce operating costs and transform patient care.

“Each year, thousands of health care professionals across the globe take the time to share their voice with KLAS. They know that sharing their perspective helps vendors to improve and helps their peers make better decisions,” said Adam Gale, KLAS Research, CEO. “These conversations are a constant reminder to me of how necessary accurate, honest, and impartial reporting is in the health care industry. The Best in KLAS award serves as a signal to provider and payer organizations that they should expect excellence from the winning vendors.”

KLAS researchers collect feedback from more than 30,000 health systems and payers from the US and other countries to generate honest and impartial assessments on the performance of software, service and medical equipment vendors in the industry.

For more information, visit CenTrak.com.

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Exactech Planning App Earns 510(k) Clearance

INDUSTRY INSIGHTS

news & notes

Exactech recently announced 510(k) clearance of the Equinoxe Planning App (v. 2.0).

The latest version reveals many new features, including: • The ability to pre-operatively plan humeral implant options to model the best fit for each patient’s unique anatomy • Select from a range of humeral stem components • Adjust humeral head offset/position in anatomic procedures • Alter humeral trays and liners in reverse procedures • The ability to assess shoulder range of motion and impingement • Visual enhancements for clarity and ease of use “Exactech is driven to create new solutions that enhance our surgeons’ surgical experiences. The Equinoxe Planning App’s newest update helps surgeons plan and select various implant types and sizes for the scapula and humerus based on a patient’s specific boney morphology to facilitate planning of impingement-free movement,” Senior Vice President of Extremities Chris Roche said.

U.S. surgeons can expect availability in the second quarter of this year. International market clearance is targeted for the third quarter. The Equinoxe Planning App can be used with ExactechGPS Shoulder navigation and is available in more than a dozen countries around the globe.

For more information, visit AISurgeon.com.

Getinge Launches State-of-the-Art Experience Center Getinge recently opened the company’s new Experience Center in Wayne, New Jersey with a virtual event involving leaders from health care, technology, and government. The event featured demonstrations of the latest advances in technology to help hospitals drive efficiencies and improve outcomes for patients suffering health challenges including COVID-19, cardiovascular disease and other serious illnesses.

During a virtual inaugural event hosted via LinkedIn Live, executives from Getinge together with leaders from health care and government unveiled the Experience Center, which is designed to recreate hospital and other health care settings including operating rooms and intensive care units. During the livestreamed tour participants learned about the specific applications in technology from Getinge that deliver a range of advantages across sterile processing, digital health solutions, the intensive care unit and life science including: • advances in ventilator technology for COVID patients and others with pulmonary distress; • a heart-lung support system that processes blood outside the body for patients in cardiac or pulmonary distress; • a system to harvest veins for use in cardiac surgery; • state-of-the-art sterilization systems that seamlessly integrate into existing hospital infrastructures to speed up the processes and protect patients and workers from the spread of dangerous infection including COVID; and, • software systems and AI technologies that can help hospitals work more efficiently by managing services better so more patients can gain access to care as quickly as possible.

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“We are very excited and proud to launch our Experience Center, which will be a center for learning and demonstrations with our newest and most advanced technologies that improve the delivery of health care services,” said Eric Honroth, president of Getinge North America. “The center will provide health care leaders with a truly hands-on experience with our technologies, demonstrating how our solutions can increase efficiencies and enhance the patient experience.”

In addition to product demonstrations, the launch event also featured remarks highlighting Getinge’s commitment to investing in new strategies like the Experience Center, that create high quality jobs and boost the economy in New Jersey. In the years ahead, the Getinge Experience Center will be a facility where customers can explore new products and solutions in a real world setting to quickly assess the impact these options can have on their facilities.

April 2022 | OR TODAY

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INDUSTRY INSIGHTS

news & notes

Report: Reducing OR time for elective surgeries helps address staffing concerns Decreasing operating room (OR) availability by 15% helped a hospital address a 30% staff shortage caused by the COVID-19 pandemic, according to a study presented at the American Society of Anesthesiologists’ ADVANCE 2022, the Anesthesiology Business Event.

“The Great Resignation has disproportionately impacted health care to near-crisis levels and we were able to address ongoing staff shortages by methodically decreasing available surgical times,” said Kimberly Cantees, M.D., M.B.A., clinical director of anesthesiology and perioperative services, UPMC Presbyterian Hospital, Pittsburgh. “By using a phased approach, including daily meetings to address scheduling issues, we were able to prioritize essential surgeries and care for patients with the greatest need.”

UPMC is a comprehensive quaternary care regional and national referral center for many surgical specialties including trauma, transplantation, neurosurgery, cardiac surgery and surgical oncology. In the study, the hospital implemented a five-phased approach, which started in May 2021, to ensure that it could continue to provide essential surgical care when its surgical technologist and OR nurse vacancy rate reached 30%.

The phases included: • Phase I (May 2021): Restricted OR availability for surgeries that were less time-sensitive and moved some to other hospitals and surgery centers in the UPMC system; decreased OR availability for surgeons with highly elective cases (e.g., sports orthopedic procedures, select hand surgery cases, some plastic surgery) and moved a small amount of surgical work to the bedside in the intensive care unit.

• Phase II (July 2021): Formed a multidisciplinary surgical services capacity committee that met

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daily to ensure the staffing matched the surgical schedule for the subsequent two weeks. Values for surgical care were identified and cases such as transplant and cancer surgeries were prioritized.

• Phase III (Oct. 2021): Reduced OR time availability by 15% when surgeries could be scheduled and extended the deadline for standard scheduling guidelines from three days to five days before surgery.

• Phase IV (Nov. 2021): Instituted additional reduction of OR scheduling to meet continued staff shortages and reduced available OR time for all surgical services by an additional 10%. Surgeons with two ORs had their time reduced for all services, except for the care of trauma patients.

• Phase V (Jan. 2022): Implemented UPMC system-wide review of surgical case prioritization and opened more ORs for booking, which allowed greater flexibility for performing surgeries depending on staffing availability.

Over the course of the phased approach, the available ORs were decreased from 36 to 31 (15%). This has been adequate to address the 30% reduction in surgical services staff, said Cantees. The hospital has continued to use the approach to successfully address staffing challenges during the Omicron surge.

Cantees said the phased approach received minimal pushback from surgeons, mostly because of clear communication of both the staffing hurdles, as well as established surgical priorities. Communication occurs via regular meetings, e-mail, and personal communication between members of the multidisciplinary surgical services capacity committee and individual surgeons.

For more information, visit asahq.org.

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INDUSTRY INSIGHTS

news & notes

Zeus Launches PTFE Sub-Lite-Wall Multi-Lumen Tubing for Steerable Catheters Zeus has added PTFE Sub-Lite-Wall multi-lumen tubing to its product portfolio.

For many years, Zeus has manufactured multi-lumen tubing with unique profiles and multiple working channels that run the entire length of the tubing. Zeus has now extended those multi-lumen extrusion capabilities to include ultrathin walls.

Prior to Zeus’ innovations in multi-lumen tubing, steerable catheter manufacturers had to procure and bundle multiple individual liners into a single catheter assembly.

This delicate bundling process is time-consuming and prone to error in both development and manufacturing settings.

Zeus helps simplify the manufacturing process by providing a single, process-ready multi-lumen extrusion that eliminates multiple manufacturing steps and complex tooling. Zeus’ new PTFE Sub-Lite-Wall multi-

lumen tubing is available in numerous configurations.

Satellite lumens can be internal, external or embedded.

Zeus can produce PTFE Sub-Lite-Wall multi-lumens with average max wall thicknesses ranging from 0.002” to 0.005” (0.051 mm to 0.127 mm). In addition to ultra-thin walls, the new product features high structural integrity, improved planarity, high lubricity, and excellent dielectric strength. It is biocompatible (certified USP Class VI) and has a working temperature of 260 °C (500 °F).

All Sub-Lite-Wall multi-lumens are custom manufactured per a customer specification or drawing. Zeus can provide a design guide and will collaborate with customers on their multi-lumen designs.

For more information, visit zeusinc.com.

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April 2022 | OR TODAY

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INDUSTRY INSIGHTS

news & notes Reducing Opioid Use for Post-Surgical Pain Control in Children There is considerable variation in how doctors prescribe opioids to children and adolescents following removal of an appendix. A quality improvement project involving 10 pediatric hospitals in the Western United States and led by Children’s Hospital Los Angeles has succeeded in minimizing and standardizing opioid prescriptions while controlling patients’ pain and avoiding additional hospital visits. The study has been published online in the Journal of the American College of Surgeons.

“Our goal is to provide children with effective pain management following surgery without over-reliance on opioids, and we showed that goal is more than possible,” said lead author Lorraine KelleyQuon, MD, MSHS, FACS, FAAP, pediatric surgeon at Children’s Hospital Los Angeles. In 2020, Kelley-Quon was instrumental in crafting guidelines with the American Pediatric Surgical Association that identified laparoscopic appendectomy, a minimally invasive surgery, as an opportunity for an opioid-free recovery in children.

Appendectomy is the most common operation for children, with approximately 80,000 children undergoing this surgery at both pediatric and non-pediatric hospitals.

The study evaluated 1,524 children under 18 years of age who had an appendectomy during 2019 at 10 hospitals in the Western Pediatric Surgery Research Consortium.

Collectively, these hospitals perform approximately 3,500 appendectomies per year. Prior to this project, five hospitals, including Children’s Hospital Los Angeles, did not routinely prescribe opioids after appendectomies.

The remaining five followed no standard protocol, leaving opioid prescriptions up to individual surgeons.

In their effort to change prescribing practices, the participating hospitals used three interventions. Study surgeons educated other surgical faculty and advanced practice providers at each hospital about the risks associated with prescription opioids and on the importance of minimizing or eliminating opioid usage after an appendectomy. They also instructed patient families to use over the counter medications such as ibuprofen and acetaminophen when returning home from the hospital. Finally, the team surveyed parents after returning home on how effective post-surgical pain control was for their children.

The year-long project achieved a significant decrease

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in opioid prescriptions after appendectomies; overall prescribing dropped from 18.2% to 4.0%. In hospitals that were not using a prescribing protocol, opioid prescriptions declined from 37.9% to 8.8%, and in hospitals with protocols already in place, prescriptions also went down, from 2.7% to 0.8%.

In addition, participating hospitals closely tracked post-surgical emergency room (ER) visits and complicated appendicitis cases, where quality improvement measures also achieved lower rates of opioid usage.

“We successfully reduced opioid use while maintaining parents’ satisfaction with pain management and without increasing post-surgical emergency room visits,” said Kelley-Quon, who is also an assistant professor of surgery and population and public health sciences at the Keck School of Medicine of USC. The participating hospitals supplemented their project with data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIP-Pediatric). Quality improvement projects like this seek to standardize processes to systematically improve care.

According to Kelley-Quon, this was the first time multiple pediatric hospitals worked together using NSQIPPediatric to improve pediatric surgical care and opioid stewardship efforts. The next step, she added, is implementing more multi-institutional collaborations leveraging these quality improvement resources.

INDUSTRY INSIGHTS

news & notes

The Africa Mercy Returns to Dakar to Resume Surgery The President of the Republic of Senegal, His Excellency Macky Sall has announced that the Africa Mercy has returned as promised to continue the surgical operations and training that were interrupted in March 2020 by the onset of the COVID-19 pandemic. The ship’s presence is expected to last until November 2022.

The Minister of Health and Social Action presided over the arrival ceremony and welcomed the return of the hospital ship to contribute to the state’s efforts to strengthen the provision of surgical services.

“Human beings are at the heart of development, and it is imperative that they enjoy a better state of health for their full development and for their contribution to the development of our country. Therefore, the interventions of the Mercy Ships are an opportunity to achieve this goal, thus complementing the many efforts made by the state. To this end, I renew my confidence in all the members of the ship’s crew.

I am convinced that the quality of human resources involved in this cooperation will enable us to give back hope,” stated M. Abdoulaye Diouf Sarr, Minister of Health and Social Action.

Between October 2021 and January 2022, the Mercy Ships patient selection team visited all 14 regions of the country. With the participation of the chief medical officers of these regions, more than 900 patients have been selected for consultation with a surgeon with the hope to provide free surgery. Mercy

Ships wishes to honor its promises to the people of Senegal and priority has been given to patients already identified in 2019/20 by the chief medical officers of each region. The selection of patients is now closed. At the same time, nearly 750 health care providers will receive medical training in various specialties.

Mercy Ships has worked with the Ministry of Health and Social Action to develop protocols that ensure all activities are undertaken as safely as possible.

These protocols are aligned with those in place in Senegal and Mercy Ships emphasizes that the plans may require further modification in response to the global and local coronavirus situation and will be updated regularly.

“Although Mercy Ships has never really left Senegal, it is an honor and a blessing to return in 2022. This return would not be possible without the partnership of the Senegalese government, which has continued to walk closely with us through a difficult season. On behalf of Mercy Ships, I would like to extend a special thank you to President Macky Sall for his friendship and support, which has enabled us to once again bring hope and healing to Senegal,” said Gert van der Weerdhof, CEO of Mercy Ships.

Thanks to donations from partner organizations and individuals, shipboard consultations, surgery, training and mentoring are provided free of charge to local patients and professionals.

For more information, visit mercyships.org.

April 2022 | OR TODAY

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INDUSTRY INSIGHTS HSPA

Key Changes to ANSI/AAMI ST91 Impact on Endoscope Processing Practices

By Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS ultidrug-resistant organism (MDRO) infection outbreaks have been associated with flexible endoscopes, and review of processes and procedures used to reprocess these complex devices has revealed failures in reprocessing steps. Mitigating these risks requires proper care and handling – from point of use through all reprocessing steps to safe transport for patient use. .

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At the end of 2021, the Association for the Advancement of Medical Instrumentation (AAMI) released its updated ANSI/AAMI ST91:2021, Flexible and semi-rigid endoscope processing in health care facilities, which reflects current research and advancements in flexible endoscope processing. What follows is a brief summary of some of the key changes.

Point-of-use treatment, cleaning, inspection Point-of-use treatment now includes hand-off communication from point of use to the decontamination area (this should include, at minimum, the patient identifier, date of procedure, time pointof-use treatment was completed, and employee contact). It is recommended that endoscopes and their accessories be kept moist following patient use and before transport to the decontamination area by applying a detergent designed to retain moisture, placing a towel moistened with water over the items, or placing items inside a package designed to maintain humid conditions.

The revised ST91 states that three decontamination sinks are ideal (one sink used for leak testing, another for manual cleaning and the third for critical rinsing); at this time, however,

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two sinks or one sink with two separate basins may be used. Sink size and location(s), flushing accessories and ergonomics are important considerations to facilitate effective cleaning as well as employee safety. Ergonomic, heightadjustable sinks help prevent personnel from bending over to perform cleaning tasks (sinks positioned too high or low increase injury risks). If a delay in endoscope processing exceeds the manufacturer’s recommended time, the endoscope should be cleaned following the manufacturer’s written IFU for delayed processing. If no timeframe is given, manual cleaning should begin within one hour or as determined by the facility’s own risk assessment.

Cleaning verification (CV) used after endoscope cleaning and before disinfection or sterilization may detect residual organic soil and microbial contamination present on a surface, even if a device appears clean. The updated version recommends CV tests be performed after each use of high-risk endoscopes.

Additionally, the use of a borescope to visualize interior working channels is recommended in the revised ST91.

Training, competency, certification It is recommended that all who perform endoscope processing duties complete formal training and competency verification in all aspects of endoscope processing prior to their first solo assignment.

All personnel performing endoscope processing should also be certified in flexible endoscope processing within two years of employment.

Transitioning to sterilization High-level disinfection (HLD) may not reliably inactivate certain types of microorganisms (i.e., bacterial spores).

Evidence supports sterilization (instead of HLD) of all flexible endoscopes, including those used in both semi-critical and critical procedures. Sterilization offers a greater margin of safety in the overkill process and provides a sterile packaged endoscope. Transitioning from HLD to sterilization will take time in terms of the endoscope and sterilizer manufacturers implementing necessary technological advances and for health care facilities to provide the budgetary and site accommodations to implement this change. Health care facilities should begin taking steps toward sterilization for flexible endoscopes, when possible.

Environment, HVAC parameters, water quality It is recommended that heating, ventilation and air conditioning (HVAC) operating parameters in the endoscope processing area comply with the specifications of ANSI/ASHRAE/ ASHE Standard 170-2017, Ventilation of Health Care Facilities that were in effect when the HVAC system was first installed or last upgraded. The standard recommends that health care facilities establish processes to monitor HVAC performance parameters and identify, document and resolve variances within the rooms where processing occurs. If a variance in the HVAC parameters occurs, a risk assessment should be conducted.

A new section has been added to ST91 (Section 4.3.11, Water quality).

To ensure that the correct water quality is used in each stage of processing, the manufacturers’ written instructions for use (IFU) for all equipment and supplies should be used. The health care facility should monitor and control the water supply to endoscope processing

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sinks and processing equipment. Whenever major repairs occur or changes to the water utility system occur, equipment qualification testing should be performed before use. Note: More information on water quality can be found in AAMI TIR34:2014/(R)2021.

A multidisciplinary team should be established to select cleaning chemicals, materials, tools and equipment for use in the endoscope processing setting. Cleaning frequencies should be established for high-touch objects and surfaces as well as for storage shelves, endoscope storage cabinets and similar objects. Terminal cleaning frequency should also be established for endoscope processing areas (at a minimum daily and more often as needed).

Leak testing Significant revisions were made regarding leak testing, including having automated leak testers placed on a calibration schedule to verify that each leak tester is producing the correct pressure. Manual handheld leak testers and leak tester tubing should be inspected for damage, leakage and pressure output. Pressure verification should be performed for each type of leak tester in the facility each day endoscopes are used. Documentation of leak testing results should be recorded. Some AERs include mechanical leak testing, and the updated ST91 recommends that when using this type of AER, the endoscope and AER manufacturers’ written IFU must be followed (with the outcome of the leak test documented). Note: Conducting mechanical leak testing using an AER is not a substitute for the leak testing recommended in the endoscope manufacturer’s IFU.

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Drying It is recommended that endoscope channels be dried for a minimum of 10 minutes with pressure-regulated forced instrument air or, at minimum, HEPA-filtered air. If moisture remains, drying should be extended until no moisture is visible. The use of alcohol has historically been recommended in the drying process after disinfection is completed; however, some studies have shown that alcohol can be a fixative agent. ST91 now recommends that a multidisciplinary team conduct a risk assessment to determine whether endoscope lumens should be flushed with 70-90% ethyl or isopropyl alcohol.

Storage Two types of storage cabinets are being recommended for HLD- and liquid chemical sterilization-processed endoscopes: drying cabinets and conventional cabinets. There is no clear consensus at this time among professional organizations regarding which type of cabinet is best; drying cabinets, however, have been shown in scientific studies to reduce the risk of retained moisture and microbial contamination. Endoscopes hung in HEPA-filtered storage cabinets that do not have drying capabilities should be dried prior to storage.

Cabinets should be located in a secure location, such as in the clean workroom, and not within the endoscopy procedure room. Storage cabinet doors should be kept closed, and the cabinets should be located at least three feet from any sink to prevent endoscopes from becoming contaminated by water.

The updated ST91 is available at the AAMI store (www.aami. org); those with an electronic subscription have immediate access to the revised standard. The standard is also available to HSPA members at a reduced rate; visit www.myhspa.org.

– Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS, serves as a clinical educator for HSPA. WWW.ORTODAY.COM

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April 2022 | OR TODAY

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INDUSTRY INSIGHTS AAMI

AAMI’s New President: A Career Built at Hospitals ollowing an eight-month search, the AAMI Board of Directors has announced Pamela Arora, a respected health care leader, as its next president and CEO. Arora, who serves on the AAMI Board, most recently served as senior vice president of strategic technology at Children’s Health System of Texas, where she was chief information officer for 14 years.

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“I’m honored to be chosen to lead AAMI as its next president and CEO. I first moved into the health care technology field for several reasons, including the industry’s readiness to adopt technological transformation. But the most important reason is the mission of using technology to improve the health and livelihood of those around us. That’s the goal of AAMI’s many stakeholders, and it’s at the very heart of AAMI’s role as a trusted, neutral convener,” Arora said.

At Children’s Health, Arora was responsible for directing technology efforts to support capital

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projects planned and underway at the system. Before joining Children’s Health in 2007, Arora served as senior vice president and CIO at UMass Memorial Health Care in Worcester, MA, CEO of LiquidAgents Healthcare, and CIO of Perot Systems in Dallas, Texas.

She holds a bachelor’s degree in computer science from Wayne State University and an MBA from Southern Methodist University.

“As a leader, the most important lesson I’ve learned is that you can’t do it all by yourself – you must surround yourself with team members who work well together toward a common goal. I am very much looking forward to working with AAMI staff, volunteers and members in our shared mission,” Arora added.

An avid traveler and music enthusiast, Arora currently resides in Dallas, Texas, with her partner, Roy, and daughter, Madison, who will be attending medical school in the fall. Arora looks forward to returning to the Washington, D.C., area to be closer to AAMI’s offices as well as to family on the East Coast, including her father, William Kerr, and her sister in North Carolina.

Pamela Arora President & CEO of AAMI

“Over the past several years, AAMI has invested in the people and systems necessary to support the needs of our members as we continue to advance the field of health technology. With Pamela coming on board, we are poised to begin an era of greater growth and extraordinary possibility,” said Steve Yelton, chair of the AAMI Board of Directors and professor emeritus at Cincinnati State Technical and Community College. “I also want to extend our apprecia-

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tion and gratitude to Steve Campbell, who served as acting president and ensured that AAMI continued to dutifully fulfill its mission.”

In choosing Arora, the AAMI Executive Search Committee hired consulting firm Staffing Advisors, which evaluated more than 300 candidates. The search committee was led by Yelton and included Chair-Elect Janet Prust (3M Health Care), Walt Rosebrough (STERIS), Kurt Finke, Joyce Hansen (Johnson and Johnson), Jeff Eggleston (Medtronic), Donna Marie Dyer (GE Healthcare), and Larry Hertzler (The InterMed Group).

Arora’s history as a longtime supporter and active AAMI participant was a major benefit in her selection as AAMI’s next president, “as well as her impressive record of leading both health care and non-health care related technology organizations as an executive,” said Prust, global standards director with 3M Health Care. “I am excitedly looking forward to collaborating with her and the AAMI team to evolve the organization and lead the way for safe and effective use of healthcare technology.”

After more than a year serving as acting president, Steve Campbell plans to remain engaged with AAMI, where he

will work on the transition and his roles as AAMI’s COO and executive director of the AAMI Foundation.

“Despite the challenges that all organizations have faced the past year, AAMI is financially strong, our membership is growing, and our mission is as important as ever. I’m confident that this organization is on the right path and – with its new CEO – in good hands,” Campbell said.

Over the coming weeks, AAMI members can look for more ways to get to know the organization’s CEO, including a meet and greet at the AAMI eXchange in San Antonio this June.

– AAMI (www.aami.org) is a nonprofit organization founded in 1967. It is a diverse community of more than 10,000 healthcare technology professionals united by one important mission – supporting the health care community in the development, management, and use of safe and effective health technology. AAMI is the primary source of consensus standards, both national and international, for the medical device industry, as well as practical information, support, and guidance for health technology and sterilization professionals.

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April 2022 | OR TODAY

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INDUSTRY INSIGHTS

Joint Comission

Preventing Unintended Retained Foreign Object in Ambulatory Surgery Care

By Suzanne Gavigan and Raji Thomas nintended retention of foreign objects (URFOs) – also called retained surgical items (RSIs) – after invasive procedures are Sentinel Events reportable to The Joint Commission. Patients who experience a retained surgical item may sustain both physical and emotional harm, depending on the type of object retained and the length of time it is retained.

U

A review of the Sentinel Event (SE) database from 2010-2020 indicates that a total of 326 events were reported for health care organizations in the Ambulatory Health Care Program (AHC). Of those events, 40 were classified as URFOs, which was the second highest frequently reported event.

URFOS were second only to wrong site procedures. These preventable adverse events have been estimated to occur in 1 in every 5,500 surgeries.

Regardless of severity of harm, every incident of URFO results in three victims: the patient who was the recipient of care; the health care team that operationalized the care processes which broke down and allowed harm to reach the patient; and the health care organization that may suffer from loss of reputation or esteem in the community if individuals involved share the occurrence with friends and family, and/or post to social media. Developing reliable systems of care is incumbent for every health care organization that provides surgical services to maximize their patients’ outcomes and to avoid URFO. 16

OR TODAY | April 2022

Suzanne Gavigan, MSN, CRNP, CPPS

Defining and Reporting URFOS URFOs are Sentinel Events by Joint Commission definition. As outlined in the Comprehensive Accreditation Manual for Ambulatory Care (CAMAC), “Sentinel Events are a subcategory of adverse event, not primarily related to natural course of patient’s illness or underlying condition and results in death, severe harm, or permanent harm.” Some specific harm events that reach a patient are added to the definition as stand-alone items. Adding stand-alone line items to the definition allows review of events that may, or may not, result in death, permanent harm, or severe temporary harm, but are considered serious events where harm reached a patient because of system failures.

In addition, updated language specific for reporting a URFO as a sentinel event has been added to CAMAC section, “Unintended retention of a foreign object in a patient after an invasive procedure, including surgery.¹” To add further clarification, the footnote

defines: “The time after an invasive procedure encompasses any time after the completion of final skin closure, even if the patient is still in the procedural area or in the operating room under anesthesia. A failure to identify and correct an unintended retention of a foreign object prior to that point in the procedure represents a system failure, which requires analysis and redesign. It also places the patient at additional risk by extending the surgical procedure and time under anesthesia.”

Root Causes and Prevention Strategies What causes URFO cases? Leadership, human factors and communication were the most frequently identified root causes for URFO cases during 2010-2018.

Leadership breakdown is further defined as: failure to follow policy and procedures; failure to determine counts as expected; failure to complete established processes when count is identified as incorrect; hierarchy/intimidation issues; lacking relevant policy; and equipment not in place.

Strategies to Improve Leadership Sustainment of Safety Culture • Prioritize a culture of safety² • Conduct proactive risk assessment² • Respond to errors with focus on process improvement using human factors analysis regarding any identified URFO or near miss 3 • Allocate resource for education, training and audit² • Report events of retained fragWWW.ORTODAY.COM

INDUSTRY INSIGHTS

Joint Comission

Raji Thomas, DNP, MBA, CPHQ, CPPS

ments to manufacturer² • Implement policy and procedures based on current evidencebased literature and self-monitor that all team members are following the process • Determine process for counts when team undergoes break or shift change • Limit number of people in procedure room to help prevent distractions • Human factors that cause error include inadequate team training; anchoring bias; assumptions; lack of situational awareness; rushing; normalization of deviance around count process; and failure to follow established procedures.

STrategies to prevent human factor error • Provide team training such as TeamSTEPPS²,³ • Address disruptive behavior² • Minimize distractions, noise and interruptions²,³ • Educate risks for occurrence of URFO and mitigation strategies² • Assess competency of staff regarding count process and next steps if additional actions warranted at any time during or immediately following procedure • Establish uniform documenWWW.ORTODAY.COM

tation across all procedural areas³ • Reconcile the count so the entire team is involved³ • View counts concurrently by two individuals, including circulating nurse3 • Standardize layout of procedural areas to help staff locate equipment and supplies in comparable areas if working in new location • Adjust lighting to enhance visibility Communication breakdowns noted with inadequate communication of count process, inadequate team communication, staff not speaking up.

Strategies to improve communication • Use a whiteboard to communicate insertion of devices² • Call out when instrument placed in body cavity has not been immediately removed²,³ • Alert team when packing is placed and not immediately removed; discuss need for packing removal during handoff²,³ • Physician voices affirmation that the count is correct prior to completion of skin closure • Discuss removal of objects during debriefing at conclusion of case² • Verbal affirmation by the team that the patient meets criteria for an intraoperative X-ray to screen for URFOs • When ordering an X-ray for ruling out URFO, provide description of object² • Develop process with radiology colleagues for ordering X-ray for URFO and reporting results of study in a timely manner

gical procedures. ASCs should strive to maintain reliable systems that include layers of protection, to assist health care leadership complete complex tasks. Focus and accountability is required for all members of the ambulatory surgery team.

The best way to prevent URFOS is by addressing the most common vulnerabilities with consistent processes, rooted in evidence-based literature.

Following these processes will help maintain reliable systems for safe care and strengthen staff confidence in their ability to provide successful outcomes to all who seek their care and expertise.

For more information about URFOs contact The Joint Commission’s Office Quality and Patient at seu@jointcommission.org.

– Suzanne Gavigan, MSN, CRNP, CPPS, is the associate director of the Office of Quality and Patient Safety at The Joint Commission.

– Raji Thomas, DNP, MBA, CPHQ, CPPS, is the director of the Office of Quality and Patient Safety at The Joint Commission.

References • Comprehensive Accreditation Manual AC Update 2 January 1, 2022, release • Steelman VM, Shaw C, Shine L HardyFairbanks AJ. Unintentionally Retained Foreign Objects: A Descriptive Study of 308 Sentinel Events and Contributing Factors. Jt Comm J Qual Patient Saf 2019; 45:249-258.

• Wallace SC. Retained Surgical Items: Events and Guidelines Revisited. PA Patient Safety Advisory. 2017 March;14(1)27-35.

• The Joint Commission, Division of Healthcare Improvement. Strategies to prevent URFOs. Quick Safety 2016.

It is imperative that ambulatory surgery centers (ASCs) recognize the risk of human interaction during complicated and ever-changing technical processes, since URFOs continue to present risk to vulnerable patients undergoing sur-

Jan;(20):1-3.

April 2022 | OR TODAY

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INDUSTRY INSIGHTS CCI

The Value of Volunteer Work

By James X. Stobinski n these columns I have recently written on perioperative nursing competency. This month, I would like to change it up and speak to volunteer work for health care professionals. The Competency and Credentialing Institute (CCI) conducts periodic studies, called job analysis surveys, to reach consensus on the work of perioperative nurses. Reliably, and across multiple studies of diverse credentials, volunteer work is found in these studies.

Volunteer work seems to a small but important part of what we do as perioperative nurses.

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In my pre-licensure training, my diploma of nursing program had a tradition of volunteer service. This orientation to volunteer service continued and was strengthened when I re-joined activeduty military service in the late 1980s.

After working with many organizations over the years I now have two main foci for work in the community. The first organization is my local professional organization, Denver AORN Chapter 0601. I joined an AORN chapter almost four decades ago and I have continued to serve with local chapters and at times with national level committees.

The second organization which comprises the majority of my volunteer work is Project CURE (projectcure.

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org) which has its world headquarters in a Denver suburb near my home. This organization collects excess medical equipment and supplies from around the country and then re-distributes that material worldwide to medically underresourced sites. We are blessed in this country in which many have access to the highest quality and most advanced medical care in the world which accounts for a significant share of our gross domestic product. But we also have significant waste and not all our resources are well utilized. The work of Project CURE decreases the waste in American health care and markedly improves the life of those who receive our supplies.

At Project CURE, I work as a sort team leader and lead groups of volunteers to sort supplies, inventory materials and assemble overseas shipments. I do this once a week for 4 hours and it gives me a distinct break from the work of CCI. Sorting supplies and using hydraulic lifts to move pallets of inventory is much different than working in test development activities. I can honestly say that the benefit of this work is reciprocal for me and the organization. I connect to the community and other health care providers and meet a lot of new, but like-minded people.

Nurses have a lot to offer organizations such as Project CURE and perioperative nurses with supply chain experience are a valuable addition. I share my knowledge of supplies and I get to teach,

a distinct side benefit of the work. CCI encourages volunteer work and engagement in our local communities. In this, I try to lead by example. About two years ago we transitioned to an all-remote workforce; our team is dispersed all over the continental United States. Our volunteer work reaches many communities and organizations. My work at Project CURE is but one small example of the diverse volunteer work done by the CCI team. In very disruptive times it is very easy to become absorbed in our daily work. Consider giving back and volunteering in your community as part of your work-life balance. Perioperative nurses agree that is part of what we do, and it can have immense value on a personal level.

Next month, I have some exciting news to share about the professional development and credentialing work going on with the CCI team. There have been some recent advances in the larger world of credentialing which present great opportunities for the CCI staff. I will share the details next month.

– James X. Stobinski, Ph.D., RN, CNOR, CNAMB, CSSM(E), is CEO of the Competency and Credentialing Institute.

References: Project CURE (2022). Accessed January 27th, 2022 at: https:// projectcure.org/

April 2022 | OR TODAY

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IN THE OR

market analysis

Reports Predict Surgical Instrument Market Expansion Staff report he global market for surgical instruments is predicted to reach $15 billion by 2027, growing at a CAGR of 3.9% over the forecast period, according to a press release from iHealthcareAnalyst Inc. The release states that the market is driven by advanced technologies such as smart instruments with integrated sensors.

T

Other factors driving market growth include an increasing number of surgical procedures, growing elderly population and high demand for minimally invasive procedures globally.

Surgical instruments are specially designed tools or devices for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it.

Surgical instruments are essentially classified by the way the surgery is performed and its use in a particular surgical procedure. They are classified as cutting, incising or dissecting instruments; grasping, holding and clamping instruments; retracting and exposing instruments; suturing or stapling instruments; suctioning and aspirating instruments; dilating and probing

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instruments; and measuring instruments.

Bar code- or radio frequency identification (RFID)-based medical instrument management systems have gradually been introduced in the field of surgical medicine for the individual management and identification of instruments.

Based on products, the most commonly used surgical equipment such as surgical sutures and staples segment accounted for the largest share of the total market. The surgical staples segment is expected to grow at a relatively higher CAGR than the sutures segment during the coming years.

Staples are widely accepted wound closure products requiring less time during the stapling process and are also more consistent in size compared to sutures.

However, the electrosurgical devices market is anticipated to be the fastest growing segment, during the forecast period, mainly due to increased application of these devices in minimally invasive surgeries.

Electrosurgery is often used in surgery to control bleeding and to rapidly dissect soft tissue in surgery, such as dermatologic surgical procedures to provide superficial or deep coagulation or cutting of the skin, whether it be for removal of benign or malignant neoplasms or cosmetic indica-

tions such as acne keloidalis nuchae or dermatosis papulosa nigricans removal.

In terms of geography, the North America region held the largest revenue share of the global surgical instruments market, due to rising health care expenditure.

Increasing incidences of various chronic diseases such as cardiovascular disorders and obesity, are leading to a number of surgical procedures.

On the other hand, the rapidly aging population, growing GDP per capita, and increasing disposable income in emerging markets indicates that the fastest growth rate will happen in the Asia Pacific region.

Another research firm also issued a report predicting market growth.

The “Global Surgical Instruments Market - Forecasts from 2020 to 2025” report from ResearchAndMarkets.com states that the global surgical instruments market is estimated to increase with a CAGR of 5.78% from a market size of $53 billion in 2019. The global surgical instruments market is projected to surge at a significant growth rate in the forecast period owing to the high prevalence of cardiovascular diseases in the world. These include coronary heart diseases, and rheumatic heart diseases among other cardiac diseases driving the market demand in the forecast period, the report states.

April 2022 | OR TODAY

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IN THE OR

product focus

Boss Instruments

LightMat Retractor system Illuminate the surgical site with LightMat. The all new LightMat Retractor System features a variety of hand-held lightweight retractors and the ultra-thin LightMat. The single-use LightMat can be positioned anywhere on the retractor and easily moved from one to another. Because it’s cool to the touch, and remarkably bright, LightMat is safe and effective for any procedure where additional light may be necessary. It’s also one of the most cost-effective lighting accessories on the market.

For more information, visit bossinstruments.com/lightmat-retractor.

Chemence Medical Exofin Precision Pen

The Exofin Precision Pen is the only pen-style applicator on the market to feature an adjustable tip that allows the user to control the adhesive width by supporting three different application methods in a single device: a micro-bristle brush for wide coverage, an inverted brush for narrow lines, and an angle precision tip for micro lines. The Exofin Precision Pen also includes an ergonomic design with a grooved non-slip surface, a pressure-controlled variable adhesive flow rate, a see-through activation chamber for easily viewing the adhesive flow and contains up to 152% more usable adhesive than other products in the industry. The Exofin Precision Pen provides a 14-day microbial barrier to improve recovery and allow patients to resume normal activities faster, including showering without special coverings or dressings.

For more information, visit chemencemedical.com.

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OR TODAY | April 2022

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IN THE OR

product focus

Capital Medical Resources Reusable & Disposable Electrosurgery Cords

Capital Medical Resources’ high-frequency monopolar and bipolar electrosurgical cords are offered in many disposable and reusable styles and can accommodate a variety of instrument brands and generator combinations. Their quality and durability make them a cost-effective solution for laparoscopic use in hospitals and surgery centers, and we stock many common styles for immediate delivery.

For more information, visit https://capitalmedicalresources.com/online-store/ols/categories/monopolar-bipolar-cords

Stryker PROstep MICA SOLO Guide The all-in-one procedure guide is used during PROstep MICA minimally invasive bunion procedures and is designed for use by a solo surgeon, potentially eliminating the need for additional surgical assistance during the operation. The PROstep MICA SOLO is an all-in-one guide that acts as a third hand for the surgeon, providing automatic targeting of the screw, stabilization of the head fragment and a controlled, adjustable shift. The intuitive guide streamlines the procedure, allowing for reproducibility while minimizing the need for a surgical assistant.

For more information, visit www.stryker.com.

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April 2022 | OR TODAY

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CE570 CE283

IN THE OR

continuing education

Low-Back Pain: The Nurse’s Nemesis ealthcare workers consistently rank among professions with the most days away from work because of injuries with back sprains and strains. Understanding that low-back pain can be the result of multiple factors and knowing when to use conservative versus aggressive therapy are warranted. Stress reduction, assistive lift technologies, and exercise are valuable tools in the prevention of low-back pain.

H

The goal of this continuing education module is to update nurses’ knowledge about the evaluation, management, and prevention of acute low-back pain in nurses and their adult patients.

Severity of the Problem Bend. Lift. Push. Pull. Stoop.

Stand. Walk. Eight, 10, 12 hours in a row, day in and day out. No wonder nurses have the highest rate of workers’ compensation claims for back injuries. A review of 80 studies revealed an annual prevalence of 40% to 50% and a lifetime prevalence of 35% to 80% 24

OR TODAY | April 2022

for low-back pain (LBP) among nurses (Richardson, Gurung, Derrett, & Harcombe, 2019). Among the general population, LBP is the second most common reason for a visit to a primary care provider and the third most frequent reason for surgery. LBP affects 5.6% of adults each day in the U.S., while 18% reported having had back pain within the past month (Kinkade, 2007). About eight in 10 people in developed countries will experience back pain at some point in their lives. LBP is most common in people from 35 to 55 years of age and causes more disability in those younger than 45 than any other condition. (Hills, 2018).

Why Nurses?

To understand the cause of severe back injuries among nursing personnel, three factors must be considered: the anatomy and physiology of the back, risk factors for injury, and injury prevention. According to the American Nurses Association (ANA), patient-handling tasks, such as frequent manual lifting and transferring of patients, are the primary causes of the escalating rate of LBP in nurses. For example,

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

Goal and Objectives After taking this course, you should be able to: • Identify the main causes of acute low back pain.

• Describe critical factors to consider in the evaluation of low back pain.

• Understand the importance of stress reduction, assistive lift technologies, and exercise in the prevention of low back pain.

98% of the time, nurses lift patients by grasping them under the axillae and then heaving them to another location. This technique is banned in many institutions because it has been found to be harmful to nurses and is painful for patients (Hills, 2018). According to the Department of Labor, Bureau of WWW.ORTODAY.COM

IN THE OR

continuing education Labor Statistics, nursing assistants have the fifth highest incidence of musculoskeletal disorders (MSD), such as back and shoulder injuries, among private, state, and local government employees, and the highest incidence among private and local government workers.

They also have the highest incidence among all healthcare professions. In this population, there are approximately 565 cases of musculoskeletal injuries for every 10,000 workers per year (Bureau of Labor Statistics, 2016).

Environmental factors that increase a nurse’s risk of back injury by interfering with proper body mechanics include space limitations, medical equipment around the patient, transfer surfaces that are not flush, and nonadjustable beds, chairs, and commodes.

Examine the statistical impact of back injuries among nurses (American Nurses Association, 2004) • 52% of nurses complain of chronic back pain.

• 38% of nurses experienced a back injury severe enough to require that they take time off from work.

• 12% of nurses who leave the profession report back pain as a major contributing factor.

The estimated total direct and indirect costs for the treatment of LBP are in the billions of dollars annually (Institute for Clinical Systems Improvement, 2012).

“Oh, My Aching Back” Reviewing a few basics on the anatomy of the spine and surrounding area can help nurses understand the causes of LBP. The spine consists of 24 mobile and five immobile vertebrae separated by disks.

During normal activity, the disks absorb the high compressive forces sustained by the lumbar spine. This is significant because there’s an WWW.ORTODAY.COM

inherent structural weakness in the lumbar area, where the longitudinal ligament begins to narrow. Twisting and bending puts the greatest stress on the disk. For instance, bending over leads to compression of the disk and may cause it to bulge backward toward the spinal canal and nerves. The position most likely to cause LBP is forward flexion of the lumbar spine (trunk twisted) while attempting to lift a heavy object with outstretched hands (Hills, 2018).

A common cause of LBP is pressure or irritation on the nerve roots of the lumbar spine. The nerves of the lower lumbar spine join to form the sciatic nerve, which is responsible for providing the legs with sensation and movement.

Irritation of this nerve results in numbness, pain, weakness, and diminished reflexes to the innervated areas.

Muscles that surround the spine also play a key role in LBP. The large muscles in the lower back (erector spinae) help hold up the spine. Inflammation of the muscles leads to painful spasms and marked limitation in motion. An episode of LBP lasting more than two weeks can result in disuse atrophy and subsequent muscle weakening. In turn, weakened muscles cannot support the spine properly, and the cycle of pain intensifies.

Pain, muscle tension, or stiffness localized below the lumbar or lumbosacral region, with or without leg pain, fit the definition of LBP. Research indicates only one-third of cases are related to a single, specific event that caused the back pain; studies suggest that back pain is a symptom that is related to multiple factors (Institute for Clinical Systems Improvement, 2012).

Risk factors include strenuous or repetitive work; frequent bending, twisting, lifting, pulling, or push-

ing; a lack of physical activity; and obesity.

The causes of LBP may elude even the most thorough healthcare professionals. Assessment must include a basic history and physical; subjective pain rating and functional status; and questions about the onset, location, duration, and description of symptoms, previous therapies used, and the patient’s response. Nevertheless, despite a complete history, clinicians discover the cause of LBP in less than 15% of patients with this complaint (Institute for Clinical Systems Improvement, 2012).

Mechanical disorders of the lumbosacral spine related to overuse injuries or abnormal structural anatomy are the most common cause of LBP. Common examples include muscle strain, intervertebral disk herniation, and lumbar spinal stenosis (Casazza, 2012).

It’s a Mechanical Thing Physical injuries of the lumbosacral spine lead to muscle strain (Institute for Clinical Systems Improvement, 2012). For example, lifting heavy patients or objects or twisting the upper body without moving the feet cause excessive muscle strain. This type of injury is the culprit of most acute low-back problems. It is typically characterized by pain with sudden onset that radiates up and across the spinal muscles (Casazza, 2012).

The pain spreads to the buttocks, upper back, and thighs but not to other areas. It tends to worsen with movement and improves during rest. Range of motion in the lumbar area is limited and muscles contact, but neurological findings are normal (Casazza, 2012).

Herniated disks, like muscle strains, result in sudden back pain from an acute injury. There are from five to 20 cases for every April 2022 | OR TODAY

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IN THE OR

continuing education

1,000 adults in the U.S. annually.

They generally occur more often in adults from 30 to 50 years of age. Males have twice as many herniated disc injuries than females (Dulebohn, Massa, & Mesfin, 2019). Inflammation, neurologic deficits, and sciatica, known as radicular pain, characterize herniated disks (Casazza, 2012). Sudden pain radiating to the buttock and down the back of the leg occurs with disk herniation syndromes.

Muscle strain and disk herniation (which typically last less than 12 weeks) are differentiated from spinal stenosis in that spinal stenosis is chronic. Osteoarthritis and protruding discs are examples of mechanical disorders that result in spinal stenosis. These types of conditions can cause the spinal canal to narrow and apply pressure to nerve roots (Hargis, 2001). This is characterized by pain radiating down both legs and neurologic deficits. Patients typically report that pain in the legs worsens with walking or standing, and bending and sitting tend to relieve pain (Institute for Clinical Systems Improvement, 2012).

Underlying Conditions Although mechanical disorders cause most LBP episodes, clinicians must rule out underlying serious organic causes. Asking several key questions about the characteristics of the pain will help this process. The most serious underlying conditions related to LBP include the following (National Institute of Neurological Disorders and Stroke, 2019): • Infections. Although not common, infections of the vertebrae (osteomyelitis), intervertebral discs (discitis), and sacroiliac joints that connect the lower spine to the pelvis

26

OR TODAY | April 2022

(sacroiliitis) are serious conditions that require immediate medical attention. Fever, fatigue, recent spinal surgery, immunosuppression IV drug use, history of urinary or other infections, and pain increased by rest or not relieved by positional changes may suggest infection.

• Tumors. LBP directly caused by a tumor is relatively rare but may occur due to cancer originating in the back or from metastases to an area impacting the back. A history of cancer and unexplained weight loss may suggest a tumor.

• Cauda equina syndrome. This condition results from a centrally herniated disk, fracture, spinal stenosis, or an epidural hematoma/abscess that compresses lumbar and sacral nerve roots that innervate the legs, bladder, and rectum. Thus, the characteristic symptoms are bowel or bladder dysfunction, bilateral sciatica, bilateral lower extremity motor weakness, and saddle anesthesia (around the anus, genitals, or perineum) or paralysis (Institute for Clinical Systems Improvement, 2012).

• Abdominal aortic aneurysm (AAA). AAAs occur when the abdominal aorta becomes abnormally enlarged. Back pain may be a sign that an aneurysm is becoming larger and could rupture. AAAs are most common in patients older than 50 with a history of circulatory problems, such as claudication.

Patients with this life-threatening condition complain of a sudden, severe tearing back pain and may be hemodynamically unstable (Casazza, 2012). These patients may not have a history of back injury before the pain.

• Nephrolithiasis (kidney stones).

Pain is the most common symptom of a kidney stone and occurs most often when a stone causes urinary obstruction from the kidney to the bladder (Preminger & Curhan, 2019). Pain typically fluctuates (or goes in waves called renal colic) and lasts from 20 to 60 minutes.

• Some common less serious underlying diseases that cause back pain include the following (National Institute of Neurological Disorders and Stroke, 2019): • Age. Back pain becomes more common with advancing age due to loss of bone strength and muscle elasticity and tone.

Intervertebral discs lose fluid and flexibility with age, which reduces cushioning between vertebrae. The possibility of vertebral fracture should be considered in older patients at risk for osteoporosis or one who complains of acute LBP after an acute injury, such as a fall (American Nurses Association, 2004). Other red flags that suggest fracture are a direct blow to the back of a young adult, a motor vehicle accident, or the prolonged use of steroids (Institute for Clinical Systems Improvement, 2012).

• Weight gain. Overweight, obesity, and quickly gaining a significant amount of weight puts additional stress on the back.

• Genetic factors. Genetic conditions, such as ankylosing spondylitis, can lead to LBP. This condition is a chronic, progressive illness that involves inflammatory changes and new bone formation in the sacroiliac joint and spine that result in hardening of the soft tissue around the joints. The bones of

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IN THE OR

continuing education

the spine may grow together, causing the spine to become rigid and inflexible (Medline Plus, n.d.). Other joints, such as the hips, shoulders, knees, or ankles, may also become involved. This condition usually occurs in men younger than 40 and is characterized by morning back stiffness that improves with activity (Kinkade, 2007).

While the majority of people with ankylosing spondylitis live normal, productive lives, some will become severely disabled.

Early detection is important because the effects of the disease can be significantly reduced with proper body posture and daily exercises.

If there are no red flags, routine spinal images are not recommended during the first month of symptoms, because structural abnormalities can be found in only 20% to 30% of patients who do not have low-back problems (Institute for Clinical Systems Improvement, 2012). After four to six weeks of symptoms, imaging is appropriate if surgery is an option or if symptoms progress despite treatment. In general, uncomplicated LBP with or without radiculopathy does not require imaging and is considered benign and self-limited (Patel, et al., 2016).

Bed Rest Versus Exercise Pain relief and reasonably comfortable physical activity are the goals of therapy as the patient waits for spontaneous recovery. Research has shown that most patients who seek medical attention for their back pain will improve and return to work in two to four weeks, but it is estimated that the probability of recurrence within the first year ranges from 30% to 60% (Institute

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for Clinical Systems Improvement, 2012). In most cases, clinicians do not need to refer patients to a specialist unless they suspect structural abnormalities. The conservative management of acute LBP includes exercise, medications, and spinal manipulation.

In the past, bed rest was the treatment of choice for LBP, based on the rationale that rest reduced pressure on the disks and stopped the mechanical stresses causing the pain. Now, however, bed rest on a limited basis is recommended in conjunction with stretching exercises and resuming normal daily activities as soon as possible while avoiding movements that aggravate pain. Some studies have shown that bed rest alone may make back pain worse and lead to other complications, such as depression, decreased muscle tone, and deep vein thrombosis (National Institute of Neurological Disorders and Stroke, 2019).

Theoretically, abdominal and back exercises reduce the risk of injury by strengthening and stabilizing the abdominal muscles and back extensors and flexors (DeBeeck & Hermans, 2004). Some clinicians believe that exercising these muscles can support the back and protect it from strains, but others question the overall benefit of these exercises. Exercise therapy appears to be slightly effective at decreasing pain and improving function in chronic back pain but does not provide better relief than no treatment in acute back pain (Hayden, van Tulder, Malmivaara, & Koes, 2005).

Mechanical Low Back Pain Medication, 2018). Numerous studies have shown NSAIDs to be an effective treatment for relief of short-term mechanical LBP (Hills, Mechanical Low Back Pain Medication, 2018).

They reduce inflammation and promote healing during the first week of therapy.

Acetaminophen (Tylenol) is a reasonable alternative for patients at risk for adverse events or who do not tolerate NSAIDs. Patients need to be made aware that all medications have potential benefits and risks, and that the risks associated with these medications may be decreased if the medications are prescribed for short periods of time (Institute for Clinical Systems Improvement, 2012).

Often prescribed for LBP, muscle relaxants reduce pain by relieving muscle spasms. NSAIDs are often prescribed with muscle relaxants. Taken together, these medications should be prescribed on a scheduled basis instead of as needed. Studies show that patients taking NSAIDs and muscle relaxants together report greater reduction in symptoms at 1 week when compared to either drug alone (Hills, Mechanical Low Back Pain Medication, 2018).

Growing evidence suggests that opioids are no better than nonopioid treatment strategies for relieving LBP (Waljee & Brummett, 2018). Prolonged use of opioids and muscle relaxants is not recommended because of the potential adverse effects.

Medications

Lumbar bracing (supportive braces) was initially used in medical settings to provide additional support during rehabilitation and for the prevention of back injuries (Nelson

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed pain medication for mechanical LBP (Hills,

Physical Therapies

April 2022 | OR TODAY

27

IN THE OR

continuing education & Baptiste, 2004). They are indicated for simple lumbosacral pain and instability (Schott, Zirke, Schmelzle, Kaiser, & Fernandez, 2018). Use of these devices may increase intraabdominal pressure, counter the forces on the spine, and stiffen the spine so that the effect of the force is balanced. Back belts also remind the person to lift properly.

Stabilizing braces limit extension, flexion, lateral tilt, and rotation due to a stronger construction consisting of rods or a plastic frame. According to a recent study, prescription lumbar orthoses provides significant improvement in functional capacity and pain, and also improves patient adherence (Schott, Zirke, Schmelzle, Kaiser, & Fernandez, 2018).

Spinal manipulation. In spinal manipulation, an osteopathic physician or chiropractor applies manual pressure to specific areas along the spine to help increase range of motion and reduce pain.

Studies indicate that for chronic or subacute low-back pain, there is fair evidence to suggest that spinal manipulation has small to moderate benefits (Chou & Huffman, 2007).

Before beginning manipulation therapy, healthcare professionals must rule out serious medical conditions since spinal manipulation is contraindicated in people with cauda equina syndrome, herniated disks, bleeding disorders, malignancy, severe osteoporosis/osteopenia, and progressive neurologic deficits.

Physical therapy. In a patient with acute back pain, the main goals of physical therapy are to help the patient achieve adequate pain control, reduce the inflammatory process, restore joint range of motion, improve spine stability, and improve the patient’s general cardiovascular condition. The goal is not to increase strength (Hills,

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OR TODAY | April 2022

Mechanical low back pain, 2018).

No scientific evidence exists to suggest that people with acute back pain benefit from strengthening exercises (Hills, Mechanical low back pain, 2018). Pain and inflammation are controlled with ice, transcutaneous electrical nerve stimulation, ultrasound therapy, and relative rest (Hills, Mechanical low back pain, 2018). After being discharged from physical therapy, a home exercise program is developed for the patient to continue with maintenance exercises (Hills, Mechanical low back pain, 2018).

Ergonomics and Exercise While most people with back pain recover quickly and without loss of function, up to 60% have one or more relapses (Institute for Clinical Systems Improvement, 2012).

Poor workplace ergonomics may predispose people to additional degenerative disk changes. Also, many people will have a relapse of pain because they tend to revert to previous habits if the appropriate training is not reinforced.

In emergencies, a sudden quick movement of weight increase may overly strain the body, and behavior modification cannot eliminate the inherent risk in physically stressful jobs (DeBeeck & Hermans, 2004).

Some ergonomic principles that can prevent future occurrences of LBP are proper posture, exercising, reducing emotional stress, and sitting properly (DeBeeck & Hermans, 2004).

Proper posture One study found that during a typical eight-hour shift, the cumulative weight lifted by a nurse is equivalent to 1.8 tons (Nelson & Baptiste, 2004). Awkward posture over a period of time can strain the structures of the back. Unfortunately,

many people, especially nurses, work in awkward positions (Nelson & Baptiste, 2004). Maintaining these positions or any prolonged static posture results in excessive stress to the ligaments and muscles, leading to fatigue, strain, and pain.

Proper posture, therefore, is crucial for the prevention of future episodes of LBP because it minimizes the stress placed on the spinal muscles. Chronic LBP may be a result of poor posture and a sedentary lifestyle (DeBeeck & Hermans, 2004). Slouching also places a significant amount of mechanical stress on the joints, ligaments, disks, and muscles of the back. Over time, these structures weaken and are more susceptible to injury.

Body mechanics training Body mechanics training implies that by lifting with the large, strong leg muscles instead of the small muscles of the back, it is possible to prevent back injuries and reduce LBP. The early body mechanics studies were based on lifting static loads (such as boxes) and were primarily conducted on men. Based on those studies, nurses are commonly taught that proper lifting techniques and body mechanics will help prevent back injuries; however, no scientific evidence suggests that these techniques reduce occupational back pain in nurses.

Proper body mechanics training in nursing is ineffective in the prevention of back injury during lifting tasks (American Nurses Association, 2004). Some lifting tasks are so stressful to the body that even when proper body mechanics are used, back injuries can occur. The problem of lifting a patient extends far beyond managing the heavy weight. The nurse must also take into account the patient’s size, balance, physical condition, coordina-

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tion, and cognitive functioning, as some patients may resist or become combative. Any unpredictable movement, such as a patient falling, may disrupt the nurse’s balance, resulting in injury.

The ANA recommends that the healthcare industry focus on other injury prevention programs, including the use of assistive lift technologies (Nelson & Baptiste, 2004).

Examples of assistive devices include full-body sling lifts, standassists lifts, lateral transfer devices, and friction-reducing devices. The use of assistive equipment limits the amount of manual patient lifting that is required of the caregiver.

According to the ANA, injuries among nursing personnel have decreased within healthcare facilities using assistive devices (American Nurses Association, 2004). However, there are situations in which manual patient lifting cannot be avoided. These cases include the care of the pediatric or small patient, or during a life-threatening situation that prohibits the use of an assistive device.

Sitting properly People who sit for prolonged periods of time are at risk for developing low-back problems. The back pain is a result of sitting upright with the hips flexed at a 90-degree

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angle, sitting forward in a slouching position, or sitting too long without changing positions (DeBeeck & Hermans, 2004). Sitting in a supported reclined posture is better than sitting upright because the muscles are relaxed. Sitting for prolonged periods of time causes the muscles to tense up and spasm (DeBeeck & Hermans, 2004). Getting up and moving around will help the muscles relax.

Exercise. People who exercise regularly have a lower incidence of LBP. A daily active strengthening and stretching program for the lumbar spine builds up strength and muscle mass and stabilizes the back muscles.

Strong spinal muscles help the body to better cope with sudden forces placed on the back. This reduces the frequency and severity of episodes of sprain and strain injuries when the back is subjected to an abnormal force. Maintaining ideal body weight also diminishes the strain on the spine. Excessive abdominal weight puts a strain on the spine, which can cause chronic spasms in the low back region. When the back muscles contract to hold the abdomen up, abnormal forces on the spine result in disk degeneration and arthritis in the spine. The best exercises for those with LBP are low-impact activities, such as swimming, walking, and bicycling. These exercises provide an excellent workout without causing

further injury, unlike high-impact exercises, such as jogging.

Stress Reduction Stress and anxiety place people at greater risk for LBP because they cause muscles to tighten, which can result in muscle spasm (DeBeeck & Hermans, 2004). Researchers have found that social and psychological work factors such as night-shift work, perceived lack of support from superiors, or perceived lack of a relaxing or supportive work environment are associated with an increased risk of intense back pain and low back-related sick leave in nurse aides (Eriksen, Bruusgaard, & Knardahl, 2004). Examples of stress-reducing techniques include relaxation methods and meditation. Meditation has been shown to reduce pain and improve mood in chronic pain sufferers Just the words “low-back pain” cause nurses and other workers to groan and reach for their ibuprofen. Nonetheless, those who spend hours on their feet every day, lifting and bending, pulling and pushing, should not accept work-related back pain as an inevitable part of the job. Prevention of back disorders lies in implementation of innovative lifting programs, ergonomics, back care, and prompt attention to the early signs of strain.

April 2022 | OR TODAY

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IN THE OR

continuing education

The content for this course was created or revised by Rebecca Smallwood, MBA, RN. Rebecca has over 25 years of experience across a wide spectrum of healthcare settings including: rural and urban acute care hospitals, public health, ambulatory surgery, higher education, and commercial organizations. Her roles have included: medical/surgical, ED, and OR staff and charge nurse; director of school health services/ school nurse for PK-12th grades; public health epidemiology and bioterrorism preparedness; Infection control practitioner; quality management specialist; organizational development specialist; and educator. Prior to joining Relias as a SME and writer for acute care, she provided healthcare learning and development consultation to Swank Healthcare and was the Director of Education Services for Health.edu, a division of Texas Tech University Health Sciences Center. Rebecca earned a diploma in nursing from Methodist Hospital School of Nursing in Lubbock, Texas in 1989 and an MBA in Healthcare Administration from Wayland Baptist University in 2010.

Editor’s note: Lina M Lackey, MSN, RN, FNP, the original author of this educational activity has not had the opportunity to influence the content of this version.

Clinical Vignette Sam is a 42-year-old nurse. He first experienced low-back pain while transferring a patient from a gurney to a bed in October. The pain was mild to moderate in severity and lasted for six weeks. During that time, he received metaxalone (Skelaxin®) and acetaminophen/tramadol (Ultracet®), which provided some relief. The following May, while at work, he once again developed pain in his low back and left buttock. This time, however, the pain had become so intense that it interfered with work, driving, and recreational activities. On his history form, Sam reported that has become very stressed and smokes a pack of cigarettes per day. On physical examination, Sam is obese and has mild left-lower extremity weakness.

His straight-leg raise was positive, with pain radiating into the left posterior calf. Sam opted to undergo a sixweek trial of medical management and entered into a physical therapy program. The program involved 12 therapy sessions over a four-week period. Sam improved with each session.

After the 12th session, he reported that the physical therapy program had returned him to his pre-exacerbation level of pain and activity. He was discharged from the program and given a home exercise program.

2. What medication combination is most likely to provide the best pain relief?

A. Acetaminophen and NSAIDs B. NSAIDs and muscle relaxants C. Opioids and Acetaminophen D. Corticosteroids and muscle relaxants Feedback [Studies show that NSAIDs are an effective treatment for relief of shortterm mechanical LBP and opioids are no better than non-opioid treatment strategies. They reduce inflammation and promote healing. Patients taking NSAIDs and muscle relaxants together report greater reduction in symptoms at 1 week when compared to either drug alone.]

3. The most appropriate injury prevention recommendations for this patient would be: A. Complete bed rest for one week B. Limiting manual patient lifting by using an assistive device C. Sitting upright with the hips flexed at a 90-degree angle several hours per day D. Abdominal and back exercises to strengthen and stabilize the abdominal muscles and back extensors and flexors Feedback [The ANA recommends injury prevention programs, including the use of assistive lift technologies. Examples of assistive devices include full-body sling lifts, stand-assists lifts, lateral transfer devices, and friction-reducing devices. The use of assistive equipment limits the amount of

1. LBP risk factors for Sam are:

manual patient lifting that is required of

A. B. C. D.

the caregiver.]

Obesity and strenuous work Family history and gender Age and family history Gender and age

4. Radiographic imaging is NOT recommended at this time.

strenuous or repetitive work; frequent bending,

A. True B. False

twisting, lifting, pulling, or pushing; a lack of

Feedback [After four to six weeks of symptoms,

physical activity; and obesity.

imaging is appropriate if surgery is an option or

Feedback [Risk factors for low back pain include

if symptoms progress despite treatment.]

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References 1.

American Nurses Association. (2004). Handle with care: The American Nurses Association’s Campaign to Address Work-Related Musculoskeletal Disorders. Online Journal of Issues in Nursing, 9(3). Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/ HandleWithCare.aspx

2.

Bureau of Labor Statistics. (2016). Nonfatal occupational injuries and illnesses requiring days away from work. Retrieved from U.S. Department of Labor: http://www.bls.gov/ news.release/osh2.nr0.htm

3.

Casazza, B. (2012). Diagnosis and treatment of acute low back pain. American Family Physician, 85(4), 343-350.

4.

Chou, R., & Huffman, L. (2007). Nonpharmacologic therapies for actue and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical pratice guideline. Annals of Internal Medicine, 147(7), 492-504.

5.

DeBeeck, R., & Hermans, V. (2004). Research on work-related low back disorders. Retrieved from European Agency for Safety and Health at Work: https://osha.europa.eu/en/ publications/reports/204

6.

Dulebohn, S., Massa, R., & Mesfin, F. (2019). Disc Herniation. Retrieved from StatPearls: https://www.ncbi.nlm.nih.gov/books/NBK441822/#:~:targetText=The%20incidence%20 of%20herniated%20disc,2%3A1%5B6%5D.

7.

Eriksen, W., Bruusgaard, D., & Knardahl, S. (2004). Work factors as predictors of intesne or disabling low back pain: a prospective study in nurses’ aides. Occupational and Environmental Medicine, 61(5), 398-404.

8.

Hargis, C. (2001). Hospital Physician: Emergency Medicine Board Review Manual: Acute Back Pain. Turner White Communications.

9.

Hayden, J., van Tulder, M., Malmivaara, A., & Koes, B. (2005). Excercise therapy for treatment of non-specific low-back pain. doi:10.1002/14651858.CD000335.pub2

10.

Hills, E. (2018). Mechanical Low Back Pain. Medscape.com. Retrieved from https://emedicine.medscape.com/article/310353-overview

11.

Hills, E. (2018). Mechanical Low Back Pain Medication. Retrieved from Medscape: https:// emedicine.medscape.com/article/310353-medication

12.

Institute for Clinical Systems Improvement. (2012). Health Care Guideline: Acult Acute and Subacute Low Back Pain. Retrieved from https://www.healthpartners.com/ucm/groups/ public/@hp/@public/documents/documents/cntrb_035022.pdf

13.

Kinkade, S. (2007). Evaluation and treatment of acute low back pain. American Family Physician, 75(8), 1181-1188.

14.

Medline Plus. (n.d.). Ankylosing Spondylitis. Retrieved from https://medlineplus.gov/ ankylosingspondylitis.html

15.

National Institute of Neurological Disorders and Stroke. (2019). Low Back Pain Fact Sheet.

Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/FactSheets/Low-Back-Pain-Fact-Sheet#3102_3

16.

Nelson, A., & Baptiste, A. (2004). Evidence-based practices for safe patient handling and movement. Online Journal of Issues in Nursing, 9(3). Retrieved from www.nursingworld. org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/ Volume92004/No3Sept04/EvidenceBasedPractices.aspx

17.

Patel, N., Broderick, D., Burns, J., Deshmukh, T., Fries, I., Harvey, H., Corey, A. (2016). ACR Appropriateness Criteria Low Back Pain. Jounral of the American College of Radiology, 13(9), 1069-1078.

18.

Preminger, G., & Curhan, G. (2019). Patient education: Kidney stones in adults . In UpToDate. Waltham, MA: Wolters Kluwer. Retrieved from www.uptodate.com

19.

Richardson, A., Gurung, G., Derrett, S., & Harcombe, H. (2019). Perspectives on preventing musculoskeletal injuries in nurses: A qualitative study. Nursing Open, 915-929. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1002/nop2.272

20.

Schott, C., Zirke, S., Schmelzle, J., Kaiser, C., & Fernandez, L. (2018). Effectiveness of lumbar orthoses in low back pain: Review of the literature and out results. Orthopedic Reviews, 10(4). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315306/

21.

Waljee, J., & Brummett, C. (2018). Opioid prescribing for low back pain: What is the Role of Payers? JAMA, 1(2). Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2685622

Clinical VignettE ANSWERS by using an assistive device. 4. Answer: B, false.

1. Answer: A, obesity and strenuous work. 2. Answer: B, NSAIDs and muscle relaxants. 3. Answer: B, limiting manual patient lifting WWW.ORTODAY.COM

CE283

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 3/31/2023 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.

ONLINE

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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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COVER STORY

RETAINED

SURGICAL ITEMS

By DON sadler

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OR TODAY | Month April 2022 2017

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espite all the amazing surgical advancements D that have occurred in recent years, retained surgical items, or RSIs, remain a rare but potentially

catastrophic event. These occur in approximately one out of every 10,000 surgical procedures, according to the Association of periOperative Registered Nurses (AORN) Guidelines for Perioperative Practice. RSIs are one of the most frequent and costly surgical “never events.” They have been either the number one or number two Sentinel Event reported to the Joint Commission each of the past four years. The estimated cost of an RSI is approximately $525,000. This includes readmission and reoperation for RSI removal, legal costs, costs related to internal investigation and administrative time, public reporting fees and state penalties.

Negative Patient Outcomes from RSIs RSIs can lead to a number of negative patient outcomes including infection, bowel perforation, adhesions, fistula, obstruction, abscess, pain, reoperation and even death.

“There is also emotional harm to patients and their families that is hard to quantify,” says Julie Cahn, DNP, RN, CNOR, RN-BC, ACNS-BC, CNS-CP, senior perioperative practice specialist with AORN. “The reputation of clinicians and the institution may also be affected,” Cahn adds. “And perioperative team members in these events may experience a phenomenon known as ‘second victim’ where they feel disbelief, anxiety or fear about the event and potential future events.”

“RSIs are Sentinel Events that must be reported to the regulatory agencies,” says Sharon McNamara, BSN, MS, RN, CNOR. “But most important, they are avoidable errors that require astute attention to the administrative, practitioner and technology aspects of the prevention strategies implemented and sustained to protect patients from harm.”

Amanda Heitman, BSN, RN, CNOR, is a perioperative educational consultant who says she has had personal experience with retained surgical items. “Fortunately, with due diligence, good communication and standardization, we resolved it,” she says.

“However, I have had times where the surgeon is adamant that items are not in the patient,” Heitman adds. “They refused to stop to look until it was insisted upon by the team – and low and behold, the item was still in the patient. This is why I remind my team that we should do counts consistently in order to keep our patients safe.”

Tom Rawlings, COL (Ret.) USA, RN, MSN, CNS-CP(E), CNOR, lead clinical specialist for DinamicOR, says he was also involved in an RSI incident. “I notified the surgeon that a count was incorrect and he replied, ‘I don’t believe you.’ ” “Before the case was complete, the surgical incision had to be reopened due to an unforeseen complication,” Rawlings continues. “I asked the surgeon to explore for a missing lap sponge and he did find a retained sponge. This is why it’s so important for all perioperative team members to feel empowered to speak up for patient safety.”

Most hospitals rely on strict counting protocols as the main safeguard to prevent RSIs. “Other methods of accounting for items used in the patient in-

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Month April 2017 2022 | OR TODAY

35

clude methodical wound exploration, verbal and visual feedback about what is placed in and removed from the patient, and visual inspection of guidewires and instruments before and after use in the patient,” says Cahn.

“Unfortunately, none of these methods are foolproof and they’re all subject to human error,” Cahn adds.

Using Adjunct Technology to Reduce RSIs AMANDA HEITMAN, BSN, RN, CNOR, is a Perioperative Educational Consultant Periop Anew

SHARON MCNAMARA,

BSN, MS, RN, CNOR

TOM RAWLINGS,

COL (Ret.) USA, RN, MSN, CNS-CP(E), CNOR, lead clinical specialist for DinamicOR

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OR TODAY | April 2022

One way that some hospitals are reducing incidences of RSIs is by using adjunct technology designed to detect items that have been left inside of patients following surgery. The AORN Guideline for the Prevention of Unintentionally Retained Surgical Items now recommends the use of adjunct technology devices that are FDA-cleared or deemed exempt from pre-market notification.

“Studies on specific adjunct technology devices show that when used according to the manufacturer’s instructions for use, they can increase the chance of identifying a count discrepancy for surgical soft goods with the imbedded technology,” says Cahn.

In an online FAQ, AORN describes these adjunct technology devices as follows: “Adjunct technology devices use different processes to identify or locate items. The technologies include datamatrix codes, radiofrequency (RF) detection and radio-frequency identification (RFID). The data-matrix-coded sponge system identifies soft goods, the RF system locates soft goods and the RFID systems identify and locate soft goods.”

The FAQ stresses reviewing the manufacturer’s instructions for use for detailed information on a specific device. “The application of these devices in clinical practice may vary because of the differences between the technology used,” states the FAQ. “Manual counting is still performed when adjunct technology devices are used.”

Among the adjunct technology devices on the market today are Stryker SurgiCount (data-matrix) and SurgiCount+ (RFID), Haldor ORLocate (RFID) and Medtronic Situate (RF).

According to Cahn, AORN recom-

mends the use of adjunct technology with soft goods. When it comes to using adjunct technology with instruments, AORN recommends that each facility perform its own evaluation.

“The evidence on use of adjunct technology with instruments in two recent studies with limited sample sizes shows that there may be some barriers to implementation of these technologies that need to be addressed before use in practice,” says Cahn.

“This is why it’s so important for all perioperative team members to feel empowered to speak up for patient safety.”

- Tom Rawlings The AORN Guideline for the Prevention of Unintentionally Retained Surgical Items recommends that an interdisciplinary team evaluate adjunct technologies before they’re implemented. Specifically, the team should evaluate: • Manufacturer’s instructions for feasibility in practice • The process for cleaning, disinfection and sterilization of reusable devices • The process for cleaning and disinfection of equipment • The preferences of perioperative personnel • Associated costs • Potential interference of devices using RF and RFID with pacemakers, implantable cardioverter defibrillators (ICDs) or other electronic medical devices should also be evaluated before adjunct technology is implemented, since these devices have the potential to cause electromagnetic interference.

Cahn says that incidences of this type

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of interference have been published in children having congenital cardiac surgery with a temporary pacemaker. “The pacemaker stopped sending an electrical signal to the heart and the heart stopped beating for several seconds when an adjunct technology device with RF was used,” says Cahn.

“Therefore, adjunct technology devices with RF or RFID should be used with caution in patients with pacemakers, ICDs or other electronic medical devices,” says Cahn. “We recommend setting pacemakers to asynchronous mode before using these types of devices, when possible.”

Keys to Reducing RSI events Heitman believes that consistency is the key to reducing RSI incidences. “We need to do the same process every single time,” she says. “Standardization, good communication and teamwork are critical”.

“It’s not difficult to count to 10, but you would not believe how many things can make it harder,” says Heitman. “Rushing, distractions and human error are all potential factors.”

Rawlings points to communication as a key factor in reducing RSIs, along with strict adherence to policies and procedures.

“One of the biggest failure points in RSI incidents is staff not following policies on surgical counts, especially during handoffs for shift changes and breaks,” says Rawlings. “Clear communication among the perioperative team members during these times and throughout the case is crucial to preventing RSIs.” Concurrently verifying and having proper visualization from both the circulator and the scrub is another important step in reducing RSIs. “Neither should just assume that the count is correct when they may physically not be able to see it,” says Heitman.

One area of uncertainty Heitman points out is deciding what specific items absolutely must be counted. “There are the usual items like sponges, sharps and instruments,” she says. “But with new technology and surgical methods, non-traditional items like guidewires and wound therapy foam may need to be added to the list.”

For example, Heitman says she once

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worked with a new staff member who told her that where she came from previously, the policy stated that they had to count trocars, the cap to their inject needle and marker and even the paper ruler. “I feel that this constant adding of miscellaneous items can cause further issues with inconsistency and errors,” she says.

For McNamara, the best way to reduce RSIs is for health care organizations to embody the premise that “patient safety is number one.”

McNamara encourages health care organizations to devise a risk management plan. “This plan should include a safe, anonymous reporting mechanism practitioners can use to report RSIs and inappropriate behavior that may impact the ability to properly carry out patient safety initiatives such as sponge, sharp and instrument counts,” she says.

It’s critical that any risk management system provide safety for a whistleblower.

“The risk management department should have an organized system to do root cause analysis on actual RSIs and near misses with transparency for patients and practitioners,” says McNamara.

“If staff don’t know that the facility has had an RSI, the common belief is that ‘we do not have that problem.’ ” “Practitioners never plan to deviate from best practices,” McNamara points out. “But the human condition can cause slips, lapses and drift that may cause deviation from the planned intention.”

When it comes to using adjunct technology to help reduce RSIs, McNamara is a believer in the technology. “However, it does not replace the manual counting processes,” she stresses.

“It merely assists in identifying counting discrepancies.”

Rawlings says that he has worked in facilities that used adjunct technology to help reduce RSIs. “This technology can be beneficial in assisting surgical teams with the count process,” he says.

“But you have to remember that it does not replace any aspect of the surgical count; rather, it is used in addition to the surgical count to ensure that no RSIs are present.”

Not surprisingly, there are obstacles to the widespread use of adjunct technology to help reduce RSIs. Two of

the biggest are cost and the need for a change in perioperative practices.

“In an ever-increasing cost-conscience environment, adjunct technology might not be considered necessary, especially if a facility has never had an issue with RSIs,” says Rawlings. “Of course, a change in practice must be adopted to incorporate this technology in the surgical count process.”

McNamara concurs.

“Change is a difficult concept for surgical teams, especially if they don’t perceive RSIs as an issue in their facility,” she says. “Implementing new technology requires a learning curve for all practitioners and is frequently seen as requiring additional time, which appears to cause inefficiencies or disruption in the procedure flow.”

To offset cost objections, McNamara recommends developing a strong business plan that considers cost savings due to less time spent resolving counting discrepancies, fewer reoperations, less additional hospital care and savings in legal settlement fees. “This could reveal savings for the organization, especially if they have had a history with RSIs,” she says.

Cahn points to research on specific adjunct technology devices showing that a facility could save as much as $417,000 by preventing one RSI per every 10,000 procedures.

Providing a Safe Environment McNamara believes there are three victims when an RSI occurs: the patient, the practitioners and the organization. “Eliminating RSIs provides a safe environment in which practitioners can practice and give safe care to their patients,” she says.

“The goal of every hospital should be zero preventable harm,” adds Rawlings.

“A multidisciplinary team using professional guidelines and evidence-based practices should work together to create the right policies for preventing RSIs.” AORN offers a free Center of Excellence in Surgical Safety: Prevention of RSI program aimed at helping facilities evaluate their processes and provide education to personnel about RSIs. Visit https://www.aorn.org/education/facilitysolutions/rsi to learn more.

April 2022 | OR TODAY

37

SPOTLIGHT ON:

Kathleen Singleton MSN, APRN-CNS, CMSRN t the end of a 50-year nursing career, it would have been easy for Kathleen Singleton, MSN, APRN-CNS, CMSRN, to reflect upon the circumstances that brought her into health care as the culmination of a lifelong interest. But at the beginning, Singleton describes her pursuit of a nursing career with words like “serendipitous,” “fortuitous” and “happenstance.”

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From a young age, Singleton had learned to be self-sufficient: she lost her father at 14, and her mother battled chronic conditions that required the young woman to become resilient and resourceful as well as caregiving. But in school, she said her advisors believed college would be out of reach, and career options for women who didn’t attain an advanced degree were limited. It wasn’t until her high school best friend decided to pursue a nursing career – and dragged Singleton along with her – that she discovered an unanticipated aptitude for it.

“Suddenly, I was getting high scores, and the rest was history,” Singleton said. “My friend went on to be a very good executive secretary, and I ended up being the nurse.”

She completed her LPN education at the nearby Lakewood School of Practical Nursing in Ohio, and right out of training was hired into an intensive care unit at St. John’s Hospital. For the remainder of her career, Singleton split time between ICU and medical-surgical nursing at the Cleveland Clinic (20 years) and Cleveland Fairview Hospital (27 years) in Cleveland, Ohio.

“It’s been meaningful work that I am very grateful for,” Singleton said. “It matters

when you’re there, and it matters when you’re not. I use the words ‘serendipitous’ and ‘fortuitous’ and ‘happenstance,’ and I certainly stand on the shoulders of giants and many other people who’ve paved the way for me. I also had excellent mentors and leaders throughout my entire career.”

Singleton credits a knack for fusing humor and compassion as something that fueled her career longevity. She described those lifelong character traits as useful tools in a caregiving circumstance and a way of forming connections that helped her lead teams, support coworkers and get patients on the path to recovery. She also cites her own interest in others and curiosity about their perspectives on life as having been instrumental to her success as a nurse.

“My patients, peers, pupils and other professionals of the health care team have always given me more than I’ve ever brought to them,” Singleton said.

“I’ve always worked with colleagues who said, ‘Try this, do that,’ and I’ve always gotten a kick in the pants when I needed one.”

By embracing the type of guidance and mentoring that Singleton said pushed her out of her comfort zone and into opportunities for growth, she realized the way to bring others to the WWW.ORTODAY.COM

“Med-surg nurses collaborate to initiate advanced care until a bed or a transport is ready, and they still retain full responsibility for delegating care of the other patients within their nursing unit.”

intellect, technical skills and emotional intelligence.

“One of the most important things they do is they possess clinical skill sets to detect both subtle and acute changes in a patient’s condition,” Singleton said. “That can be towards recovery – they could require just a little support – or those changes could mean there’s a need for urgent or - Singleton emergent care. Med-surg nurses collaborate to initiate advanced care until a bed or a transport is ready, and they still retain full responsibility for delegating care of the other patients within their nursing unit.”

Med-surg nurses leverage strong diagnostic skills to optimize their patients’ functionality, to help visitors make the best of a difficult circumstance and, more than anything, to treat everyone they encounter with dignity and respect, Singleton said.

“No matter what technology or pharmacology, you don’t lose track of the person in the bed,” she said. “They’re still people at the end of the day. I never wanted to lose sight of that.”

To help ensure that future generations of nurses similarly don’t lose sight of their patients’ humanity, AMSN made former president, Singleton, the namesake of a new award, given annually to a facility that recognizes medical-surgical nurses as clinical leaders who function as a team within a nursing unit, and not just as workers on a hospital floor. It’s perhaps unsurprising that the inaugural recipient was the Cleveland Kathleen Singleton’s Clinic. same point was by identifying their “The idea of a continued expectation passions, their preferences and their career spanned 50 years. of excellence – you’re always looking potential. She boiled it down to AMSN recently named an to see what could be better, what could learning what people are interested be improved – and that expectation of award after her. in, what they’re good at (and whethevolving and improving and being a dyer those are the same things), and namic healthy workplace, that’s what this helping them to marry each with something that’s way bigger than youraward recognizes,” Singleton said. consistent effort. Those guideposts self. I thought it was important for me to As she’s now retired, Singleton spends served her well in a lengthy volunbe able to impart that knowledge back, much of her time with friends and teer career with the Academy of and one committee led to another.” members of her large extended family as Medical-Surgical Nurses (AMSN), Med-surg nurses are the largest group Aunt, Great-aunt, Godmother and “Aunt with which she volunteered for of acute-care nurses in the nursing field, Kathy” to many. She attends events from more than 26 years – longer than and part of a specialty that routinely T-ball through dance recitals. She enjoys half her professional nursing career. provides simultaneous care consistently all sports, especially baseball games; live “I always believe that you should acto multiple patients and their visitors. music; chiefly the Cleveland Orchestra; tively belong to the specialty organization Their dual roles in meeting the diverse and reading works by humorous authors. that represents your practice and to keep needs of patients, many of whom have up with their literature,” Singleton said. multiple complex diagnoses or acute ex“If you’re going to represent that, you acerbations of a chronic illness, as well have to model those behaviors and not as large complement of visitors who join just talk the talk. Belonging to a profesthem in the hospital, means med-surg sional organization, you get a picture of nursing involves a composition of a keen WWW.ORTODAY.COM

April 2022 | OR TODAY

39

OUT OF THE OR health

Dance & Music Aim to Improve Blood Pressure By family features early half of adult Americans have high blood pressure, and many do not know it.

To help Americans reduce their risk of heart attack and stroke, the American Heart Association (AHA), American Medical Association (AMA), HHS Office of Minority Health (OMH), Health Resources & Services Administration (HRSA) and the Ad Council released public service announcements (PSAs) encouraging people to take control of their health by self-monitoring their blood pressure and speaking with a health care professional about their numbers.

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The “Get Down With Your Blood Pressure” PSAs feature a catchy and danceable song to get people moving and help empower them to manage their health beginning with high blood pressure, the leading cause of heart attack and stroke and the most significant controllable risk factor. The creative aims to reach historically underserved communities – particularly Black, Hispanic/Latino, and Native Americans – who are at increased risk of developing high blood pressure due to longstanding health inequities.

The “Get Down With Your Blood Pressure” campaign reminds Americans that high blood pressure management may be as simple as four easy steps: “Get It, Slip It, Cuff It, Check It.” Self-monitoring and working with a health care professional to create a treatment plan can be an effective way to manage blood pressure. Healthy lifestyle changes such as eating a healthy diet focused on fresh vegetables and fruit, consuming less salt and processed foods, exercising daily, reducing alcohol intake, losing weight if overweight, and taking medication if needed are all effective ways to help control your blood pressure.

The campaign is also paired with step-by-step

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OR TODAY | April 2022

instructional videos in English and Spanish providing a step-by-step overview of how to self-monitor one’s blood pressure. More information and blood pressure monitoring resources can be found in English at ManageYourBP.org or in Spanish at BajaTuPresion.org.

“This new campaign is a fun way to get people engaged in monitoring their blood pressure and keeping it under control – which can often feel daunting to many patients – and is more timely than ever given that high blood pressure puts patients at higher risk of severe complications of COVID-19,” said AMA President Gerald E. Harmon, MD. “We are committed to eliminating structural drivers of health inequities that place Black and Brown communities at increasing risk of heart disease. And, with the percentage of U.S. adults who have their blood pressure under control significantly declining in recent years, we believe this new awareness campaign can help more people get their blood pressure under control and save more lives.

We encourage anyone with high blood pressure to speak with their physician or health care professional to collaborate on and commit to a treatment plan that will help them prevent the life-altering consequences of high blood pressure – heart attack, stroke and death.”

“Being champions for health equity is one of our core values at the American Heart Association to help support healthier, fuller lives for all communities,” said Donald M. Lloyd-Jones, MD., Sc.M., FAHA, president of the American Heart Association and Eileen M. Foell Professor of Heart Research, professor of preventive medicine, medicine, and pediatrics, and chair of the department of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

“The Get Down With Your Blood Pressure campaign aims to address health inequities in historically underresourced communities. This campaign is a part of the

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OUT OF THE OR health

American Heart Association’s National Hypertension Control Initiative. The initiative encompasses direct education and training on blood pressure measurement and management with health care professionals in community health centers and community-based organizations. We are meeting people where they are with access to blood pressure education and resources in trusted community settings.”

Developed pro bono by Uniworld Group (UWG), the longest-standing, full-service multicultural advertising and marketing agency in the nation, the PSAs encourage viewers to “get down” and get moving to help reduce the impact of high blood pressure. The work provides an encouraging message that those living with high blood pressure can lower their risk of stroke and heart disease by self-monitoring and talking to their health care professional about a treatment plan that works for them. Through collaboration with UWG, the PSAs leverage cultural insights to reach audiences, specifically Black, Hispanic/Latino, and Native Americans whose health has been adversely affected by disparities in health care, in a meaningful and motivational way.

“The goal of this campaign is to reach more people in the U.S. living with uncontrolled high blood pressure,” said Heidi Arthur, chief campaign development officer at the Ad Council. “However, it’s my hope that this work encourages everyone to speak to their doctors about how to best self-monitor their blood pressure for better overall heart health.”

The American Heart Association and American Medical Association are also working with their local offices, affiliates and other collaborators to promote and activate the campaign in their communities, with evidence-based materials to aid physicians and other health care professionals in the plan-building process.

This project is supported by a cooperative agreement with the Office of Minority Health (OMH) of the U.S. Department of Health and Human Services (HHS), as part of a financial assistance award totaling $12.2 million in partnership with the Health Resources and Services Administration (HRSA). The contents do not necessarily represent the official views of, nor an endorsement by OMH/OASH/HHS or the U.S. Government.

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April 2022 | OR TODAY

41

OUT OF THE OR fitness

Get Up and Challenge Yourself

By Miguel J. Ortiz here are many exercises that people have used to challenge the body in various ways. Some are simple, fun and used in everyday exercise.

Some others push the body to its highest limits.

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By challenging the body, we can observe and feel how we move through space and, by doing so, we start to understand our physical limits and the threshold of our own will. It’s sad to say, but we tend to feel old because of inactivity.

One’s inactivity decreases one’s exposure to different experiences within the spectrum of movement.

People tend to steer away because of a lack of confidence in their physical body. Let’s change that by implementing a movement that will have a drastic effect on one’s mobility, body strength and coordination. This is a movement that everyone can attempt without pushing their body over the limit. I give you the Turkish Get Up. The goal of the movement is to efficiently move weight in an overhead position from a prone position to a standing position. This total body movement is complex in its neuromuscular efficiency, but simple when broken down appropriately. First, we want to start with a light weight as this exercise requires proper shoulder stability throughout different 42

OR TODAY | April 2022

phases of the movement. Your core will be challenged the entire time so maintaining proper breathing is necessary – especially when doing more reps or heavier weight.

The first step is to complete a full sit up, to stabilize the weight appropriately rely on your opposite arm to transition from elbow to hand.

Once in the seated position, we move to the second step. The single leg glute bridge. Keep in mind that you are pressing a weight to the ceiling the entire time. This requires a quality base to ensure that your core is stable enough to continue forward. Once stabilized, some mobility is required to sweep the back leg underneath the body, returning to three points of contact on the ground – foot, knee and hand. It’s important to note that for a good neutral spine we want to be looking at the weight we are carrying the entire time as this will help stabilize the shoulder.

Our third step may seem simple, but it’s an important transition for the shoulder carrying the weight.

Your hips as we need to come off your hand and come to a kneeling position. This also can be known as a kneeling windmill. You want your knee and foot stable as you use your core to lift yourself up into the full kneeling position.

For the fourth and final step, we have the lunge or kneeling to

standing position. Make sure your core is braced and that you feel comfortable being in a completely kneeling position – especially while carrying weight overhead. Once you get to the standing position reverse the movements and make your way back to laying down to complete a rep. To do so, literally complete everything in reverse.

Reverse lunge, smooth transition to place hand down on ground for three-point stance, transition back leg to front of body coming to bridge, and seated position to lay down and reverse crunch.

Whether you want to challenge your strength to see how much you can lift or just do some good reps with a moderate or light weight to push your strength and endurance, have fun with this movement.

Continue to push yourself and discover what your body can do.

Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a Master Trainer for Pain-Free Performance and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz. You can find his YouTube channel at tinyurl.com/ORTfitness.

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OUT OF THE OR EQ Factor

The Nuts & Bolts of Goalsetting

By Daniel Bobinski uch power exists in the ability to set goals.

However, without a purposeful framework, many goals are simply dreams. A solid goal should have at least five aspects to consider, and those five items can be remembered by using the acronym SMART. Here are the five aspects

M

S = Specific M = Measurable A = Action R = Realistic T = Time of completion When creating a goal, start by clarifying three core factors: a specific action, a specific measurement and a specific time that the goal must be accomplished. Then, do a gut-check and decide if the goal is realistic.

In dissecting this, let’s start by talking about action. In many places, people say the “A” stands for achievable. I say this is a duplication, because achievable and realistic are synonyms. The A should be a clearly defined action because a SMART goal should have a specific behavior that must be done, and we must know what it is. The more specific, the better.

A goal of making more money does not have a specific action.

Better would be to save, earn or invest.

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The next word is measurable.

This aspect is necessary because it’s how we know success has been reached. The phrase “I want to make more money” does not qualify as a goal because it has no measurability. “More” is not measurable. There will always be more money, so even if someone earned $6 billion, more could be earned.

Pick a specific number and make sure it’s realistic.

Measurability does not have to be a spelled-out number. The phrase “read Covey’s Seven Habits book” includes both a specific action (read) and a specific measurability (the book).

Following measurability, we need a specific time of completion.

Many goals are written that have a specific action and measurability, but they don’t get completed because no time of completion was identified. It’s amazing how much more gets done when we can answer the question, “by when?”

Know that it’s a best practice to assign a specific date, not a number of weeks, months or years.

Finally, we need to look at our goals and decide if they are realistic.

If someone has been earning $60,000 a year for the past five years and wants to make more money, it is not realistic to make a goal to earn $600,000. Unrealistic goals usually lead people to give up because they know the goals are unattainable.

That said, sometimes we should set goals that help us stretch. Setting easily achievable goals all the time may give us the ability to check off boxes, but there’s not a lot of satisfaction in accomplishing easy goals. Much of what’s been written about goalsetting says that if we want to stretch ourselves so we can accomplish more in life and develop a strong sense of achievement and satisfaction, we should consider creating some goals that have only an 80% chance of getting accomplished. Doing this leads us to work harder and do more than we may have originally believed possible.

Daniel Bobinski, M.Ed. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing.

Reach Daniel by email at DanielBobinski@protonmail.com or his office: (208) 375-7606.

April 2022 | OR TODAY

43

OUT OF THE OR nutrition

An Abundance of Riches

By Kirsten serrano

wear a lot of hats in the food world and one of those is being a restaurateur.

My husband and I have owned an Italian restaurant for 22 years. I know how the restaurant world works and what foodservice suppliers offer. I know the slim profit margins and the corners that typically get cut in order to make a profit.

I

When you outsource the sourcing and cooking of your food, it’s a lot less likely you will maximize nutrition and quality. I see dining out as a compromise, and compromises are a part of life. It’s so nice to be served, enjoy a meal with family and friends, and try something you don’t normally eat.

The key to better nutrition when dining out is to look for whole foods and avoid the highly processed ones, that means finding restaurants that are really cooking. Sadly, that can be a tall order! I find that many Americans buy into the illusion that most

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OR TODAY | April 2022

restaurants are cooking from scratch.

The whole industry is built upon keeping food prices and wages down.

To do so, there is a lot of “warm cutlet A” and “top it with sauce B” happening in restaurant kitchens.

The emphasis is on cheap ingredients that can be combined in addicting ways by low-wage labor.

I encourage you to make your dining out dollars count. For many, that means dining out less but spending more when you do. The larger your community, the easier it will be to find restaurants that really earn your dining dollar, but there are gems to find everywhere. Here are some tips for identifying restaurants that make more nutrient-dense foods with lower toxins: • Farm-to-Table. Restaurants advertising farm-to-table eating are sourcing part of their food from local farmers. Sourcing locally means that someone inside is cooking from scratch.

• Paleo, Vegetarian, Vegan, etc.

Restaurants advertising meals to meet these special diets may be

•

•

•

•

cooking from scratch. As special diets like these become more mainstream, the food processing industry is keeping up by supplying restaurants with processed foods that meet these needs.

Independent and/or ChefOwned. There are a million restaurants you can automatically weed out because they are chains. Look for privately owned and chef-run restaurants. Generally, these folks are passionate about their craft.

Price Point. Expect to pay more.

You get what you pay for (hopefully).

Integrity. They can tell you what’s in their food because they made it. Try asking a fast-food place what’s in the food.

Special Orders and/or Allergen Flexibility. The more willing they are to meet your needs/ tastes tells you how much cooking is going on. No substitutions across the board is a red flag for a place serving you premade factory food.

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OUT OF THE OR

nutrition

How careful you are when you eat out is obviously a personal decision that depends on your health, the parameters of your diet and how often you eat out. You can embrace occasional meals out and still safeguard your health if you follow some guidelines.

Here are my tips for smart ordering when eating out: • Start with vegetables and fruits. Add some great protein and build from there.

• Avoid fried foods. It’s not that they are fried. It’s that they will be fried in highly inflammatory omega-6 fats, like canola, soy and/or corn.

• Ask if your food can be prepared with olive oil.

• Beware of sauces, dressings and marinades. Just like at the grocery store, they are often full of inflammatory fats, added sugars, too much sodium and non-food ingredients. At chains, they are mostly unavoidable.

• If the proteins served are conventionally raised, look for lower-fat options. If you are lucky to be

dining at a place with well raised protein, fattier cuts are fine for most.

• If you are following a special diet with serious consequences, be extremely careful. The risk of cross contamination and a less-than-prepared staff is significant. For some, the risk is just not worth it.

Regardless of where and what you eat, enjoy your meal.

Food is about more than nutrients, calories and fuel. It is also about flavor, experience and celebration. Dine well.

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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April 2022 | OR TODAY

45

OUT OF THE OR recipe

Lemon Chicken with Roasted Red Onions and Potatoes LEMON CHICKEN:

Recipe

• 1 whole chicken, cut into eight pieces

the

• 1 ounce minced garlic • 1/4 teaspoon granulated garlic • 1/4 teaspoon paprika • 1/4 teaspoon smoked paprika • 1/4 teaspoon ground fennel seed • 1/4 teaspoon dried oregano • 1/4 teaspoon ground coriander • 1 tablespoon kosher salt

POTATOES: • 2 1/2 pounds Yukon gold potatoes • salted water • oil

CAULIFLOWER: • 1 head cauliflower • salted water • ice • 2 tablespoons mayonnaise • 1 teaspoon tamari or soy sauce • 1 tablespoon chopped parsley

ROASTED ONIONS: • 1 red onion • salt • oil

FOR SERVING: • 3 ounces pitted Castelvetrano or green olives, cut into quarters • 5 ounces wild arugula • 1 lemon, quartered

By Family Features

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OR TODAY | April 2022

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Recipe to Boost Iron Levels

OUT OF THE OR recipe

hef Nate Appleman knows how important it is to serve healthy meals to your family – ones they actually want to eat. Before having his first child, he transformed his eating and exercise habits and lost 85 pounds to get on a healthier path.

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Now, he’s cooking meals for his family, including 14-year-old Oliver who was diagnosed with Kawasaki Disease as a toddler – an inflammation of the blood vessels that can cause damage to coronary arteries – as a healthy lifestyle is important to help manage the disease. Since Oliver’s diagnosis, Appleman made it his personal mission to create awareness of Kawasaki Disease and for the critical need for plasma donations that many people with the disease rely on for treatment, which is why he partnered with Abbott to bring attention to the need for plasma donations.

Plasma is a powerful part of your blood that supports essential bodily functions. It’s a lifeline for thousands of people who are immune-compromised and live with a variety of chronic and complex diseases. In fact, more than 125,000 Ameri-

Lemon Chicken with Roasted Red Onions and Potatoes

cans rely on medication made from plasma every day, according to the Plasma Protein Therapeutics Association (PPTA).

The COVID-19 pandemic led to a serious shortage of plasma donors – average donations per center in the United States were down approximately 11% during the first few months of 2021 compared to the previous year, further deepening the nearly 20% decline in donations in 2020 compared to 2019, according to the PPTA. Donating plasma is a safe and relatively easy process. Since plasma is replaced in the body within about 24 hours, it can be donated up to twice per week. With a donation that typically takes between 1-3 hours, you can make a lasting impact by providing lifesaving medicine for patients like Oliver.

It’s a good idea to fuel up with iron-rich foods before and after donating, so Appleman created fresh, nutritious recipes he loves to serve his family. One of those recipes is Lemon Chicken with Roasted Red Onions and Potatoes..

Learn where you can donate at bethe1donor.abbott.

4.

To make roasted onions: Preheat oven to 450 F. Peel onion and slice into 1-inch rings. Toss with salt and oil; roast until slightly caramelized with texture. Chill and reserve.

5.

Preheat oven to 450 F.

6.

Bake chicken on sheet pan approximately 15 minutes. Add potatoes and cauliflower.

Bake approximately 15 minutes then switch oven to broil approximately 10 minutes.

7.

Squeeze lemon over reserved onion.

8.

When chicken is crispy and reaches internal temperature of 165 F, remove from oven and add onions and olives.

Plate chicken, potatoes, onions, olives and cauliflower on top of arugula and garnish with lemon.

Recipe courtesy of chef Nate Appleman on behalf of Abbott

1.

2.

3.

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To make lemon chicken: Marinate chicken in mixture of minced garlic, granulated garlic, paprika, smoked paprika, fennel pollen, dried oregano, coriander and salt; let sit overnight.

To make potatoes: Boil potatoes in heavily salted water until tender. Cool, peel and cut into 1 1/2-inch chunks. Toss with oil to coat; reserve.

To make cauliflower: Cut cauliflower into florets and blanch in salted water 1 minute; shock in ice bath. Remove from ice and dry. Toss with mayonnaise, tamari and parsley; reserve.

April 2022 | OR TODAY

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C Change Surgical……………………………………………… 9

Jac-Cell Medical……………………………………………… 32

Soma Technology………………………………………………15

Ecolab………………………………………………………………… BC

Kapp Surgical Instrument Inc………………………… 33

CATEGORICAL ANESTHESIA

HOSPITAL BEDS/PARTS

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

Soma Technology………………………………………………15

ALCO Sales & Service Co.……………………………… 33

RESPIRATORY

C-ARM

INFECTION CONTROL

Soma Technology………………………………………………15

Soma Technology………………………………………………15

ALCO Sales & Service Co.……………………………… 33

SAFETY

CARDIAC PRODUCTS

ASP…………………………………………………………………………51

Healthmark Industries Company, Inc.……………18

C Change Surgical……………………………………………… 9 Kapp Surgical Instrument Inc………………………… 33

CARTS/CABINETS ALCO Sales & Service Co.……………………………… 33 Healthmark Industries Company, Inc.……………18

CS/SPD Ecolab………………………………………………………………… BC MD Technologies Inc.…………………………………………41 Ruhof Corporation…………………………………………… 2-3

DISINFECTION ASP…………………………………………………………………………51

Ecolab………………………………………………………………… BC Encompass Group………………………………………………13 Healthmark Industries Company, Inc.……………18

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

MD Technologies Inc.…………………………………………41

SMOKE EVACUATION

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

I.C. Medical, INC.……………………………………………… 20

INSTRUMENT STORAGE/TRANSPORT

STERILIZATION

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

ASP…………………………………………………………………………51

LAPAROSCOPY

Ecolab………………………………………………………………… BC

Jac-Cell Medical……………………………………………… 32

MONITORS Soma Technology………………………………………………15

Healthmark Industries Company, Inc.……………18 MD Technologies Inc.…………………………………………41

SURGICAL Ecolab………………………………………………………………… BC

Ecolab………………………………………………………………… BC

ONLINE RESOURCE

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

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

Soma Technology………………………………………………15

DISPOSABLES

OR TABLES/BOOMS/ACCESSORIES

SURGICAL INSTRUMENT/ACCESSORIES

ALCO Sales & Service Co.……………………………… 33

Soma Technology………………………………………………15

C Change Surgical……………………………………………… 9

Ecolab………………………………………………………………… BC

OTHER

Ecolab………………………………………………………………… BC

ENDOSCOPY

AIV Inc.……………………………………………………………… 45

Healthmark Industries Company, Inc.……………18

Healthmark Industries Company, Inc.……………18

PATIENT MONITORING

MD Technologies Inc.…………………………………………41 Ruhof Corporation…………………………………………… 2-3

FALL PREVENTION ALCO Sales & Service Co.……………………………… 33 Encompass Group………………………………………………13

FLUID MANAGEMENT Ecolab………………………………………………………………… BC MD Technologies Inc.…………………………………………41

GENERAL AIV Inc.……………………………………………………………… 45 Ecolab………………………………………………………………… BC

MD Technologies Inc.…………………………………………41

Kapp Surgical Instrument Inc………………………… 33

AIV Inc.……………………………………………………………… 45

TELEMETRY

Ecolab………………………………………………………………… BC

AIV Inc.……………………………………………………………… 45

PATIENT WARMING

TEMPERATURE MANAGEMENT

Ecolab………………………………………………………………… BC

C Change Surgical……………………………………………… 9

Encompass Group………………………………………………13

Ecolab………………………………………………………………… BC

POSITIONING PRODUCTS Kapp Surgical Instrument Inc………………………… 33

REPAIR SERVICES Soma Technology………………………………………………15

REPROCESSING STATIONS

Encompass Group………………………………………………13

TEST EQUIPMENT Jac-Cell Medical……………………………………………… 32

WASTE MANAGEMENT MD Technologies Inc.…………………………………………41

MD Technologies Inc.…………………………………………41

50

OR TODAY | April 2022

WWW.ORTODAY.COM

BETTER TOGETHER.

Engineered to work together, the suite of products from ASP provides seamless integration and intelligent software to simplify your department’s processes and help you achieve peace of mind. Rest easier knowing that you can rely on built-in safeguards, step-by-step on-screen instructions, automated documentation, and reconciliation of sterilizer and BI records.

COMPLIANCE MADE SIMPLE. STERRAD® Systems with ALLClear® Technology • ALLClear® Technology reduces workflow interruptions • System notifications help ensure compliance • On-screen instructional guides help reduce human-error

STERRAD VELOCITY® System

ASP ACCESS® Technology

• Results in 15 Minutes1

• Automates reconciliation and storage of sterilizer cycle and BI Records in audit-ready format

• Built-in safeguards help ensure compliance and error free operation • Step-by-step instructions make STERRAD VELOCITY® Reader simple to operate • Designed to work optimally with STERRAD® Sterilizers

• Synchronizes STERRAD® Sterilizers and STERRAD VELOCITY® Systems to simplify workflow

Contact your ASP Representative or call 888-783-7723 for more information.

15 or 30 minutes to results dependent on software version. Refer to the IFU for actual time to results.

1

Capitalized product names and ALLClear® are trademarks of ASP Global Manufacturing, GmbH. Important Information: Prior to use, refer to the complete instructions for use (IFU) supplied with the device(s) for proper use, indications, contraindications, warnings and precautions.

©ASP 2022. All rights reserved.

33 Technology Dr, Irvine, CA 92618 AP-2200009-1

SURGICAL SOLUTIONS PATIENT TEMPERATURE MANAGEMENT

!

W NE

ECOLAB HUSH SLUSH 2.0 ™

Upgrade your equipment to Ecolab’s latest automated surgical slush system.

OVER 25 YEARS of trusted surgical slush solutions

Engineered to make soft slush that may aid in minimizing damage to sensitive organs or tissues.

• Quietly produces smooth slush — reducing the likelihood of damaging tissue due to large or sharp ice particles

Enhanced capabilities improve user experience and promote safety over Ecolab’s previous ORS Hush Slush™ System.

• Streamlined design: built-in warmer and new drape-to-basin connection design • Auto-off safety switch prevents accidental heating

Removes need to leave Operating Room for surgical slush.

• AORN recommends keeping movement of personnel to a minimum to maintain sterile environment1 • Studies show movement in and out of OR (as well as movement within the OR) can negatively impact surgical outcomes2-8

Microtek Medical, Inc. 1 Ecolab Place St Paul, MN 55102 U.S.A www.microtekmed.com © 2022 Ecolab USA Inc. All rights reserved. ELIT013504 Rev New

Upgrade your equipment today: 2X faster

enhanced

warming

safety features

*

sleek **

modern design

TO LEARN MORE about our surgical solutions, contact your Ecolab representative.

Call: 800 824 3027 | Visit: ecolab.com/offerings/surgical-slush * 2L from room temperature to 98°F compared to previous ORS Fluid Warmer. ** compared to previous ORS equipment.