OR Today July 2023 by MD Publishing

Pros and Cons of Certification

2023 Awards Honoring Researchers & Clinicians

Natasha Granado, RN, BSN

Combatting Burnout

CCI

AAMI

SPOTLIGHT ON

LIFE IN AND OUT OF THE OR

EQ FACTOR

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OR TODAY | July 2023

contents

features

READY, SET GO! FACILITIES RACE TO PREP NEW HIRES The challenges of onboarding perioperative staff aren’t new, but they’ve been ramped up over the past few years.

Drug diversion is a known risk in health

The global patient temperature

Excessive workload because of employee

care but one that is difficult to quantify

management industry is anticipated to

shortages plus new and changing

because it so often is unreported.

generate $6 billion by 2031.

workplace rules are growing issues.

ACHC

MARKET ANALYSIS

EQ FACTOR

OR Today (Vol. 23, Issue #7) July 2023 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: See address changes to OR Today at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2023

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July 2023 | OR TODAY

contents

PUBLISHER

features

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INDUSTRY INSIGHTS

10 News & Notes 16 ACHC: Medication Waste in the Operating Room 18 NIFA: Surgical Demands Impact Staffing 20 Joint Commission: Developing Infection Prevention and Control Processes, Policies and Procedures 22 HSPA: TJC Names Top 5 2022 Infection Prevention Challenges; 3 Impact SPD 24 CCI: The Pros & Cons of Certification 26 AAMI: AAMI Honors Researchers & Clinicians with 2023 Awards 28 ASCA: Advocates for Protecting and Expanding Patient Access to ASCs

Kennedy Krieg

EVENTS Kristin Leavoy

ACCOUNTING Diane Costea

WEBINARS Linda Hasluem

EDITORIAL BOARD

IN THE OR

Justin Fontenot, DNP, RN, NEA-BC, FAADN

31 M arket Analysis: Temperature Management Market on the Rise 32 Product Focus: Temperature Management

Assistant Professor of Nursing at UL Lafayette Natalie Lind,

OUT OF THE OR

38 Spotlight On: Natasha Granado, RN, BSN 40 Health 42 Fitness 45 EQ Factor 46 Nutrition 48 Recipe 51 Pinboard 50 Index 8

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INDUSTRY INSIGHTS

news & notes

Healthmark Industries Promotes Cheron Rojo Healthmark Industries recently announced the promotion of Cheron Rojo to senior clinical affairs specialist. “Cheron has been a key part of our success and we are excited to promote him to this important position,” Director of Clinical Affairs Mary Ann Drosnock said. “I am honored to accept this position and together with my clinical affairs team, I look forward to continuing my passion by helping our sales team and our customers with our product solutions. Making a difference in better patient outcomes is what has always driven me,” Rojo said. “My goals will remain the same in my new role by continuing to help our Healthmark team and customers, but I will continue to expand our education even more on our YouTube channel with tutorials that help customers have continuous education on how to use our product solutions, as well as collaborating with our amazing and experienced clinical affairs team to provide innovative education.” Rojo joined Healthmark in 2018 as the clinical education coordinator SPD. Previous to joining Healthmark, he has 30 years in the sterile processing arena as a sterile processing technician, SPD educator, an instrument coordinator and a surgical technologist.

Cheron Rojo Senior Clinical Affairs Specialist

IMP Unveils New Look Innovative Medical Products (IMP) revealed its newly designed brand at the American Academy of Orthopedic Surgeons meeting (AAOS), held in Las Vegas from March 7-11. The brand’s updated booth featured a bold, modern design and refreshed color pallet, along with an updated tagline, all carefully crafted to closely reflect the brand’s primary focus of surgical patient positioning. The new branding illustrates that IMP is the market leader in knee positioning and owns the unique trademarked green boot prominently featured in its newly designed logo.

OR TODAY | July 2023

The brand refresh will be carried across all brand platforms and channels. Their website is being redesigned with new and improved features for an optimized customer experience. As the orthopedic health care industry continues to evolve, IMP aims to reflect these advancements internally and externally. Michael Reilly, IMP’s vice president of sales and marketing, notes, “The reason behind the brand refresh is to improve recognition of the company, as well as a better reflection of what it is we do.”

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INDUSTRY INSIGHTS

news & notes

AORN Among Top Online Learning Providers The Association of periOperative Registered Nurses (AORN) has been named to Newsweek magazine’s list of Top Online Learning Providers 2023. The ranking is based on a survey of 9,000 online learners and research by global data firm Statista. They looked at organizations that offer certificate and non-certificate courses supporting the professional or personal development of learners in the U.S. The listing is intended to support learners who are “looking for quality online education,” according to Newsweek Global Editor in Chief Nancy Cooper. AORN is the only professional nursing organization on this top-50 list, alongside other notable national companies known exclusively for providing online education. AORN provides a large learning library for new and advanced perioperative nurses and nurse leaders, including “Periop

101: A Core Curriculum” that is used by thousands of hospitals and ambulatory surgery centers to train nurses first entering the surgical nursing specialty. The association also provides a wealth of accredited, evidence-based continuing education, resources and tools that support experienced perioperative nurses who are advancing their careers and refreshing their skills in pre-, intra-, and postoperative surgical patient care. “This recognizes AORN’s predominant role in helping the entire community of perioperative professionals stay current in their clinical practice and management as healthcare technologies and techniques rapidly advance,” says AORN CEO and Executive Director Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN. “Nurses, especially, are ‘lifelong learners’ because of the need to understand and reflect evolving evidence of how to provide the safest patient care.”

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July 2023 | OR TODAY

INDUSTRY INSIGHTS

news & notes

AAAHC Relocates to Newly Designed Facility On April 25, the Accreditation Association for Ambulatory Health Care (AAAHC) announced its move to a new corporate office in Deerfield, Illinois. The bright, welcoming space, located at 3 Parkway North, unifies the organization through a thoughtfully designed location to maximize engagement opportunities and build upon the AAAHC 1095 Strong philosophy, according to a press release. “Our new corporate office builds upon our connection to people and elevates that theme throughout the site to bring our entire AAAHC community together,” said Noel Adachi, MBA, president and CEO of AAAHC. “The vitality afforded by this venue with the latest technology, sunlit collaboration areas, more staff amenities and a dedicated learning center enables us to present and deliver on the value of 1095 Strong. Our environmental branding represents the diversity of our accredited facilities, the patients they serve and our employees and surveyors. More than anything, this move represents our continued ironclad commitment to serving our clients and helping them

deliver quality patient care in a safe environment.” With the Deerfield location conveniently accessible through expressways and public transportation, AAAHC said it aims to further strengthen its team of health care and administrative professionals as the transition takes place in early May. “Our state-of-the-art, strategically located facility elevates our workplace and workforce capabilities to further deliver upon our mission. We are excited to welcome our dedicated professionals to an innovative environment providing space for daily collaboration as well as special events and education opportunities,” said Kathleen Fagan Dale, senior vice president, CFO and IT administration at AAAHC. “We carefully designed our enhanced environment to support both current operations and future growth. As our needs evolve, this space and its infrastructure are designed to evolve with us.” For information, visit AAAHC.org.

InfuSystem Announces Distribution Agreement InfuSystem Holdings Inc. has announced a national distribution agreement with Genadyne Biotechnologies Inc. for its negative pressure wound therapy (NPWT) systems and supplies. InfuSystem will offer Genadyne’s complete line of wound care products, including its most advanced XLR8 Plus NPWT Pump, which delivers advanced variable pressure capabilities with a gradual wave, in conjunction with Genadyne’s proprietary XLR8 Dressing Kit with Silver, an antimicrobial contact layer to protect the wound. Richard DiIorio, chief executive officer of InfuSystem, said, “We

OR TODAY | July 2023

are pleased to partner with Genadyne in providing our customers with access to their advanced negative pressure wound therapy systems and supplies. These products are manufactured in the U.S. This agreement represents a second NPWT device offering that will help to mitigate supply chain issues and provide our customers with multiple options. Our goal through our SI Wound Care partnership is to provide our patients and partners with a seamless offering of unique wound care products to promote healing, improve patient outcomes, and lower the cost of care. We look forward to a long and mutually beneficial relationship.”

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INDUSTRY INSIGHTS

news & notes

Eden Park Introduces TrofferShield222 Continuous Disinfection Eden Park, manufacturer of Far-UVC technology for continuous disinfection of air and surfaces, recently introduced TrofferShield222, the first dual-purpose recessed lighting solution dedicated to continuous disinfection of well-populated spaces. Manufactured in the United States, TrofferShield222 features thin-panel Far-UVC technology integrated into standard LED “troffer” lighting fixtures that fit seamlessly into most 2’x2’ and 2’x4’ tiled drop ceilings. Used extensively in schools and health care institutions, each TrofferShield222 recessed fixture emits a focused band of Far-UVC 222nm to inactivate up to 99.9% of harmful

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viruses, bacteria, and pathogens, including SARS-CoV-2, Avian influenza, E. coli, MRSA, Norovirus, Staph, Candida, Swine Flu, Hepatitis, and Legionella, among others. TrofferShield222 provides safe and effective continuous disinfection for a 10’x10’ space with ceilings up to 12’ in height. The built-in LED lighting is designed for adjustable CCT (3500 K, 4000 K, 5000 K). It is perfect for sensitive, critical or high-traffic areas where the harmful effects of airborne disease threaten the health and wellness of at-risk populations. Additional applications include spaces requiring office lighting, general illumination, hallway lighting, bathroom lighting and more.

July 2023 | OR TODAY

INDUSTRY INSIGHTS

news & notes

RAD Technology Medical Systems, Belimed Provide Portable SPD Solutions RAD Technology Medical Systems (RAD Technology) and Belimed Inc. (Belimed) have announced a partnership in portable sterilization services. RAD Technology, a provider of design-built modular facilities, will combine its health care construction expertise with Belimed’s medical and surgical instrument sterilization, disinfection and cleaning product services. Together, the companies will provide fully equipped portable sterile processing department (SPD) solutions to a burgeoning U.S. surgical market, according to a press release. “The FlexSPD is a portable sterile processing facility. The 888-square-foot modular building comes fully equipped with all the necessary sterile processing equipment for any hospital or surgical center,” the release states. The mobile facility, known as FlexSPD, is designed to meet the sterilization demands of new and growing hospitals and surgery centers. The FlexSPD can be located on an existing campus or at an offsite location. It can be used to decrease the demand on an existing SPD, serve as the primary sterilization solution for new practices

OR TODAY | July 2023

or satellite facilities, or provide interim services during renovations or large construction projects. The 24’x37’ temporary unit arrives fully built out with large capacity washer-disinfectors and sterilizers, a triple basin processing sink, an ultrasonic washer, and prep and pack workstations to fully meet the daily needs of an SPD in an efficient modular package. The building’s small footprint allows it to be easily and quickly installed on nearly any site. In addition, the facility is portable, allowing health care providers to relocate it to a variety of locations as needed. “We are pleased to be able to combine our modular technology and health care construction knowledge with Belimed’s equipment and sterile workflow solutions,” said Kenneth Wright, RAD Technology vice president of sales and business development. “We believe the FlexSPD will be the perfect back of house solution for hospitals and surgery centers trying to meet the growing demand for their services.” The FlexSPD is expected to be available for lease starting Q4 of 2023.

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INDUSTRY INSIGHTS ACHC

Medication Waste in the Operating Room By Julie Vandenbark, MLS, BSN rug diversion is a known risk

D in health care but one that is

difficult to quantify because it so often is unreported. It has been decades since the AMA first termed addiction as a disease in the 1980s1 and yet there is still a widespread tendency to demonize or disdain the dependent individual leading to guilt, shame and secrecy. This contributes to the difficulty in documenting the scope of the problem. As a complex issue that presents multiple patient safety risks, one of the best means of preemptively addressing the problem is through careful attention to every process gap. For surgical settings, appropriate wasting of unused medication is an important step in preventing drug diversion. Propofol is an excellent example of a widely-used medication that represents a risk, especially in surgical settings.

Why focus on propofol? Propofol, also known as Diprovan, is a

OR TODAY | July 2023

short-acting, non-barbiturate medication primarily used by anesthesia providers for procedural sedation, monitored anesthesia care, or as an induction agent for general anesthesia sedation in operating rooms. It is also used for long-term sedation in intensive care units (ICUs), such as for critically ill patients who require a breathing tube connected to a ventilator. Although its status has been debated ever since the drug was identified as an important contributing agent in the 2009 death of pop star Michael Jackson, propofol is not scheduled under the Controlled Substances Act (CSA), making it more likely to be overlooked if security protocols are focused on scheduled drugs. According to the Institute for Safe Medication Practices, propofol is listed among the most commonly diverted medications.2 It accounts for 41% of reported substance abuse cases among anesthesia providers.3 Ease of access by health care workers is a likely contributing factor. Single use vials may not be emptied and in the absence of a witness to validate the remaining volume to be wasted, this creates opportunity.

Accreditation standards offer a framework for appropriate drug handlinwwg In addition to the consequences for a patient whose pain is not managed or who is at risk of a medication error, drug diversion can have serious, longterm, life-changing impacts for the diverter, ranging from license suspension or revocation to legal action, to potential overdose, or even death. Due to the extent of these risks to employees, patients, and health care organizations as a whole, medication security and disposal are critical areas of focus during an accreditation survey. ACHC Surveyors focus on medication safety, looking for evidence that drugs and biologicals are secured, administered and disposed of properly to prevent unauthorized access. For hospitals and ASCs, the relevant standards are under Pharmaceutical Services (Chapters 25 and 12, respectively). Drug diversion is focused on scheduled drugs in the hospital standards, but the intent extends to all medications and biologicals. The goal of accreditation with regard to this issue is that through policy, procedure, education, practice, data collection, evaluation, and corrective action, each

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INDUSTRY INSIGHTS ACHC

organization adopts a continuous cycle of measurement and documentation to ensure the delivery of effective, high-quality care in a safe environment.

Diversion Risk Reduction Strategies for Propofol Multiple diversion risk points exist in any organization and for a non-controlled drug like propofol, Surveyors see evidence of these on many surveys. Unlocked medication cabinets or carts, override features built into automatic dispensing cabinets, and unwasted, leftover vials in trashcans are just a few frequently observed examples. Each of these should be addressed through a drug diversion prevention policy that covers procurement, storage, distribution, preparation, dispensing, administration, wasting and documentation. The big picture ideas for risk reduction: 1. Promote a culture of patient safety, transparency and high-quality care for employees and patients through campaigns for safe medication goals that include oversight and accountability. 2. Engage pharmacy leadership, anesthesia and surgical service providers as collaborative partners for input on an effective disposal process. 3. Review accreditation and other regulatory requirements. Action steps for your organization: 1. Conduct a risk assessment. • Evaluate current medication waste policies and procedures against evidence-based practice guidelines and industry standards. • Identify high-risk areas in your organization (ORs, procedural areas, ICUs, etc.) • Identify current practice for medication movement from point of entry through waste, destruction or return to manufacturer. • Identify gaps in procedure that may create opportunities for unauthorized access (e.g., automatic dispensing cabinet override capability, packaging issues). 2. Consider designating nonscheduled medication, such as propofol, as a locally controlled item based on risk determination. 3. Use designated waste containers or carbon pouches that deactivate the drug on contact to ensure it cannot be retrieved once disposed. 4. Require preparation, dispensing and wasting be performed in teams of two. And rotate the pairs.

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5. Establish a diversion monitoring program to incorporate a check and balance system and implement routine surveillance. 6. Provide staff education upon initial orientation and at routine intervals about proper disposal policies and procedures as well as your drug diversion policy (including indicators of impairment and protections for whistleblowers). 7. Ensure prompt review of improper disposal or suspected diversion and implement corrective action plans and control measures as applicable. An interdisciplinary approach will be necessary to address complex system issues. Tailored interventions may be required to reduce unauthorized or illicit propofol access. Assessment of risk, strong medication waste and security policies and procedures, and active surveillance can help prevent diversion activities and safeguard your employees and patients. Julie Vandenbark, MLS, BSN, RN, is a Standards Interpretation Specialist for acute care and critical access hospitals. Before joining ACHC, she served as director of corporate integrity for a health care system in Ohio and has many years of accreditation program management and coordination experience. Some lucky organizations may meet Julie as an ACHC Surveyor, an aspect of her current role that keeps her keenly aware of on-the-ground challenges. 1 National Council of State Boards of Nursing. Retrieved April 20, 2023, from https://www.ncsbn.org/public-files/Understanding_the_Disease_of_Addiction.pdf 2 Institute for Safe Medication Practices. (2023, February 23). Controlled Substance Drug Diversion by Healthcare Workers as a Threat to Patient Safety – Part I. Retrieved March 28, 2023, from https://www.ismp.org/resources/controlled-substance-drug-diversion-healthcare-workers-threatpatient-safety-part-i 3 Schneider, D., Ponto, J., Martin, E. (2017, December). Propofol Disposal in the Anesthesia Setting: Overcoming Barriers. American Association of Nurse Anesthesiology. Retrieved March 28, 2023 from https://www.aana.com/publications/ aana-journal/journal-issue-detail/december-2017

July 2023 | OR TODAY

INDUSTRY INSIGHTS NIFA

Surgical Demands Impact Staffing By James X. Stobinski n this column, I would like to speak about another factor central to surgical care – the demand for surgery. Changes in demand have a direct impact on our continued issues with surgical staffing. I recently attended the Association of Anesthesia Clinical Directors (AACD) meeting in Orlando and the demand for surgery and our continued staffing issues were frequent topics of conversation at that meeting. In a future column, I will speak to the takeaway messages from that AACD meeting. But, for now, let’s return to the issue of demand.

My employer, NIFA, recently purchased the Life Science International (LSI) dataset detailing the volume of surgery from 2018-2021 and projections of surgical volume to 2026. The LSI data is well detailed with information on the overall U.S. population and surgery caseload broken down by surgical service and the site of care; inpatient versus outpatient. The LSI reveals that, “Surgical procedure volumes in the U.S. experienced a significant decline as a result of the COVID-19 pandemic, due to postponement or cancellation of elective procedures and, to a lesser degree, elimination of procedures that would have been performed on patients who die as a result of contracting COVID-19 disease.” (LSI, 2022). 18

OR TODAY | July 2023

Surgery volume rebounded sharply in 2021, which exacerbated our staffing issues. Beginning in 2022, we returned to a pattern of slow, steady growth in surgical volume in part due to an increase in the total U.S. population. However, in the LSI data we also see that the number of Americans 65 and older will increase more rapidly than the overall population and will reach 19.3% of the total population by 2026. These population shifts will increase our surgical workload. The LSI data projects that the demand for surgery will continue to increase and that orthopedic surgical volume will rise at a rate exceeding the overall increase in surgical volume. Predictably enough with a rise in the numbers of older patients, the numbers of revision knee arthroplasties, hip arthroplasties and a diversity of spinal surgeries will also continue to increase. The LSI data also contains considerable information about the sites where surgical care will be done. Notably, more orthopedic surgery will shift to the outpatient setting to include total knee and hip procedures continuing a trend which accelerated during the pandemic. Perioperative and perianesthesia nursing must shift their focus and skill set as more surgery transfers to the ambulatory setting. As more complex cases move out of the inpatient setting our workforce must change. In example, when total knee procedures are done in an ambulato-

ry setting less nurses are needed for the episode of care as an inpatient, post-surgical unit is not needed. However, a broader nursing skill set is required in the ambulatory setting as nurses need pre-surgical and post-surgical care skills in addition to their intraoperative expertise. These changes in the methods and sites of surgical care compel nurses to engage in lifelong learning as the skill set used in surgery 2 or 3 decades ago may no longer suffice. A predictable pattern in surgical care is underway. The data from LSI clearly points this out. There must now be a transformation in the education and training of the surgical care team as the practice of surgery evolves. With these shifts the work of perioperative nurse educators and preceptors becomes increasingly important. Just as NIFA adapted our training to accommodate technology such as robotic surgery we will need to re-evaluate other education and training programs in surgery. I look forward to these challenges as I begin my work at NIFA. – James X. Stobinski, Ph.D., RN, CNOR, CNAMB(E), CSSM(E), is the director of education at the National Institute of First Assisting.

References Life Science Intelligence (2022) LSI-PV-US2144SU: Surgical Procedure Volumes in the U.S. from 2018-2026: Executive Summary. [Technical report].

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INDUSTRY INSIGHTS

Joint Comission

Developing Infection Prevention and Control Processes, Policies and Procedures:

Use of Evidence-Based Guidelines By Sylvia Garcia-Houchins hen developing infection

W control processes, policies

and procedures (PPP), health care organizations should use a structured approach to ensure they are meeting requirements. Requirements vary based on applicable regulations, including from the Centers for Medicare and Medicaid Services (CMS), if deemed, manufacturer instructions for medical devices and supplies used by the organization, and accreditation requirements. Once organizations ensure they are meeting requirements, they may also consider incorporating recommendations from chosen evidence-based guidelines (EBGs), consensus documents, position statements and other sources of guidance on best practices. The goal is to create an infection prevention and control (IPC) program that adheres to local requirements and supplements those requirements with practices that can improve the safety and quality of the organization’s patient population, staff and visitors. In order to meet this goal, infection preventionists (IPs) and others responsi20

OR TODAY | July 2023

ble for PPP should identify which EBGs and consensus documents are required versus those that are optional. The below Q&A can help prepare them to do so.

Which EBGs are required by The Joint Commission and/or CMS? The Joint Commission requires compliance with: • The Centers for Disease Control and Prevention (CDC) and/or World Health Organization (WHO) 1A, 1B and 1C hand hygiene guidelines (NPSG.07.01.01, EP1) • Standard and transmission-based precautions (IC.02.01.01, EP 2 and 3) Joint Commission standards and CMS requirements are not prescriptive regarding other EBGs or consensus documents that organizations must consider or implement. Joint Commission standards contain general wording that specifies an organization should “measure and monitor its infection prevention processes, outcomes and compliance using EBGs or best practices, and consider EBGs when implementing evidence-based practices.”

Are there other requirements for EBGs? Joint Commission standards require compliance with state law and regulation and manufacturer instructions for use (IFUs) as part of a hierarchical method to address infection control (IC)-related requirements.1 Several states have adopted specific EBGs or consensus documents by incorporating them into health care code requirements. It is important for organizations to access their specific state requirements as they vary from state to state. Additionally, manufacturer IFUs may refer users to EBGs and consensus documents for further information. Organizations need to confirm that manufacturer-required EBGs are used to clarify additional requirements but do not supersede an IFU. When an IFU is unclear or in conflict with an EBG (for example, the EBG states an instrument should be in a closed container for immediate use steam sterilization (IUSS), but the chosen EBG states all items undergoing IUSS should be placed in a closed container), the organization must resolve the conflict by contacting the device manufacturer’s technical services for clarification. WWW.ORTODAY.COM

INDUSTRY INSIGHTS

Joint Comission

If an EBG is not required, how can IPs assess whether it should be incorporated into their IPC program? IPs need to pay careful attention to sources and processes used to develop recommended IC practices. They should know the difference between an EBG, guidance, consensus document, position statement and policy, as well as the processes used to develop these documents. Misinterpreting certain documents as requirements and adopting policies of other organizations with differing requirements, especially across state lines, may lead to significant misunderstandings regarding Joint Commission and CMS requirements – resulting in regulatory, financial and resource implications. • EBG: Answers questions via a literature search protocol which identifies relevant articles. The evidence in the articles is abstracted and summarized before a group assesses and formulates recommendations based on consensus. EBGs should provide references that the user can use to evaluate relevance and context for their organization. • Guidance: Provides instruction on how to address a situation and may include relevant literature. However, guidance documents may not consider unique aspects of an individual organization and must be carefully evaluated to determine risk and benefits. • Consensus document: Created by WWW.ORTODAY.COM

a group and represents individuals’ collective opinions, which may or may not be supported by scientific literature. If a consensus group follows the American National Standards Institute (ANSI) and agrees to its oversight, procedures, approval process and more, the resulting consensus document becomes an American National Standard. Users may need to review literature to ensure recommendations are supported by evidence. • Position statement: Includes viewpoints of a professional organization on a particular topic, as well as background and rationale to support that viewpoint. IPs may need to do their own literature review to determine if the viewpoint is sound or could be negated by additional information. • Policy: Represents how an organization interprets and implements relevant requirements.

Which part of an EBG is required by The Joint Commission? Unless required by Joint Commission standards, regulation, CMS or manufacturer IFUs, organizations may choose which segments of EBGs and consensus documents to incorporate into their practices. For example, AORN uses “should” to indicate a recommended action, “must” to designate requirements mandated by regulation, “may” to

demonstrate action is permissible within the limits of the guidelines, and “can” to indicate possibility and capability. If an EBG is not required, organizations may follow a specific AORN guideline and follow some or all of “should” recommendations based on applicability and impact to the organization, staff and patients. IPs and other policy writers should clearly understand when, which and what part of EBGs are required before selecting a particular EBG or another document to incorporate into their IC policies, protocols or processes. They should add recommendations that are above the basic requirements only if they are based on compelling evidence for the improvement of safety or quality and are feasible and cost effective. Optional EBGs should not be incorporated if they conflict with routine organizational practices. Staying engaged in your organization’s development of policy, protocols and processes including incorporation of required EBGs and active selection of optional EBGs and consensus documents, is critical to regulatory compliance and providing quality care that supports staff and patient safety. - Sylvia Garcia-Houchins, MBA, RN, CIC, is the Director, Infection Prevention and Control, The Joint Commission. 1 The Joint Commission. Clarifying Infection Control Policy Requirements. Perspectives. April 2019.

July 2023 | OR TODAY

INDUSTRY INSIGHTS HSPA

TJC Names Top 5 2022 Infection Prevention Challenges; 3 Impact SPD By Susan Klacik he Joint Commission (TJC) published its top

T five challenging requirements for 2022, and

three of them pertain to the sterile processing department (SPD). Ambulatory care facilities, office-based surgery, critical access hospitals and general hospitals have a low comliance score for IC.02.02.01, EP 2: The organization implements infection prevention and control activities when doing the following: Performing intermediate and high-level disinfection and sterilization of medical equipment, devices, and supplies. Most of these processes are performed in the SPD. It is vital that all processes for sterilization and disinfection are performed, monitored and documented according to the most current standards and guidelines. As the experts in disinfection and sterilization, SP professionals are often consulted about how to perform these tasks. SP professionals should set an example of best practices in their health care facilities and share their distinctive expertise with the rest of the organization. Environmental management is another frequent area of noncompliance, according to TJC. Critical access hospitals and hospitals had an overall low score for the environment of care requirement, EC.02.05.01, EP 15: In critical care areas designed to control airborne contaminants (such as biological agents, gases, fumes, dust), the ventilation system provides appropriate pressure relationships, air-exchange rates, filtration efficiencies, temperature, and humidity. For new and existing health care facilities or altered, renovated or modernized portions of existing systems or individual components (constructed or plans approved on or after July 5, 2016), heating, cooling and ventilation are in accordance with NFPA 99-2012. This includes 2008 ASHRAE 170 (or state design requirements if more stringent). Ambulatory care settings scored low in EC.02.05.01, EP 7: In areas assigned to control airborne contaminants (such as biological agents, gases, fumes, dust), the ventilation systems provide appropriate pressure relationships, air-

OR TODAY | July 2023

exchange rates, filtration efficiencies, relative humidity, and temperature. The Environment of Care is a facility-wide requirement, and there are specific humidity, temperature and airflow requirements for each area of the SPD. While SP leadership is responsible for assuring these requirements are in place and monitored, all SP staff must be diligent in keeping doors and windows that control airflow closed when not in use. Staff safety must always be a priority; however, TJC identified the use of personal protective equipment (PPE) as another area of low compliance, especially in ambulatory care and office-based surgery settings (IC.02.01.01, EP 2: The organization uses standard precautions, including the use of personal protective equipment, to reduce the risk of infection). Wearing PPE in the decontamination room is a requirement, not an option. One of the chief complaints regarding PPE is it becomes hot and uncomfortable to wear. There are products available to keep staff cool when wearing PPE, and work practices – such as rotating staff more often throughout the shift – can also help prevent overheating and discomfort. Note: The March/April 2022 and January/February 2023 issues of HSPA’s PROCESS magazine featured updates on the Ofstead & Associates American Journal of Infection Control (AJIC) studies on decontamination splashes and aerosolization. The study results provided evidence of the critical importance of proper PPE use, among other vital requirements. Also, HSPA’s Process This! podcast (Episode 83: Keeping Cool with Decontamination PPE) features an SP team from Lebanon VA Medical Center that shared about their unique and creative methods for maintaining comfortable decontamination PPE. To read more about TJC’s infection prevention and control resources and the organization’s approach to standards compliance, visit www.jointcommission.org/resources/ patient-safety-topics/infection-prevention-and-control/. - Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS, is a clinical educator with HSPA.

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July 2023 | OR TODAY

INDUSTRY INSIGHTS CCI

The Pros & Cons of Certification By Cambria J. Nwosu, DNP, RN, CNOR, CSSM(E) hile finishing nursing school, a very wise

W mentor and professor instructed the entire

class that there were two things that every nurse should obtain after completing their boards. Those two things were obtaining nursing liability insurance and securing nursing certification in the specialty that you would call your own. As a student, the nursing certification mention intrigued me the most since this is not a normal subject taught within nursing curriculums. The who, what and why of it all hasn’t been a topic or something to strive for which could lead to why other disciplines including some nurses themselves don’t see the true value of nursing certification. But to be fair, there are both pros and cons of nursing certification which will be explored here. Certification, as defined by the American Board of Nursing Specialties (ABNS), is “the formal recognition of the specialized knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal health outcomes.” (ABNS, 2005). Hence, this is very different than passing the NCLEX national nursing board exam, which is mandated in the United States to practice as a registered nurse, as that displays competency as a nurse in the beginning stages of their practice. Certification in a specific specialty is a testimony of a nurse’s commitment to their expertise and excellence in patient care within that specialty. However, every certification and its requirements for obtaining and maintaining that certification vary on multiple factors; requirements, years of service, continuing education, etc. Due to the extraordinary work that it does take to not only obtain nursing certification, but also to maintain it, the benefits of that certification can extend beyond having the earned display of initials behind one’s RN licensure. The outside world, including current or potential employers, colleagues and patients can be educated on the value of nursing certification. Education on what a certified nurse and their objective measure of knowledge in relation to improving health outcomes is imperative. The pros or advantages of certification can be vast. The validation of knowledge that lies within the specific certification can benefit the certificate holder in more ways than one. The most recent edition of the Institute of Medicine Report, The Future of Nursing: Leading Change, Advancing Health (Institute of Medicine, 2011) advises nurses to develop and enrich a deep commitment to lifelong learning. This continuous process of learning goes far beyond initial didactic education learning embedded in historical institu24

OR TODAY | July 2023

tional settings such as colleges and universities. Most nurses are trained initially to model their current nursing practice on behalf of their teachings as novice nursing students. As a certified nurse, one is committed to professional growth and lifelong learning. In doing so, the nurse stays ahead as nursing and medicine continually evolve. Certification is a large part of recognizing the continuous learning of the practitioner in an official capacity. As a certificant myself the benefits of certification for me include personal growth, recognition, heightened levels of competence and self-confidence in daily clinical practice. Employers, especially those involved in the Magnet Recognition Program, prefer that nurses are certified, and even through various recruitment methods, will offer financial incentives. Certification often is associated with increased employer and peer recognition, marketability in the workforce and increased salary. Specifically for the surgical specialty of nursing, research has described the benefits and promotion of improved surgical outcomes. The cons of certification, regardless of nursing specialty, include the various barriers that nurses face to dedicate themselves to achieving certification or even maintaining it after certification. Most practitioners have heavy work and life schedules that prevent the dedication and time commitment to focus on studying for the required exams to successfully pass. Most certifications have a perception that the associated costs in preparation are expensive for the actual certification exam including any additional fees associated with recertification efforts. Depending on the location of the nurse and/or hospital system they work with, the ability to afford a certification exam (or recertification) in hospitals not offering any financial incentives for obtaining this achievement can be prohibitive. To expand even further, outside of financial incentives, some hospitals or care facilities don’t even recognize the excellence that comes with a certification, and this deters nurses from even obtaining the credential. Hospitals can assist with this perception by participating in annual national celebrations such as Certified Nurses Day and National Nurses Week with a real effort to recognize their certified nurses. Nurses have reported that they have a fear of failing standardized exams, which is another barrier. More hospital systems and administrators can assist with this global fear by offering resources and/or partnering with various organizations and certification bodies that can provide certification test prep assistance. Certification, in most instances, is often voluntary and nurses can feel that they are alone in their endeavor, which should not be the case. In my circumstance, due to my educational background, and in working with others who value nursing certification, I have WWW.ORTODAY.COM

INDUSTRY INSIGHTS CCI

been able to assist other nurses and organizations in the continued work of educating why certification matters. My journey as a perioperative nurse, and now as a nurse executive, has been further enriched by the choice I made to become a certified nurse. The network of certification and the quest for continued education have made a difference in how I care for my patients and also how I lead others. I am now always one step ahead of my practice. There are always two sides to a coin but with nursing certification, I believe that the good side will always outweigh the bad.

References American Board of Nursing Specialties Promoting Excellence in Nursing Certification A POSITION STATEMENT ON THE VALUE OF SPECIALTY NURSING CERTIFICATION (retrieved from: https:// www.aaacn.org/sites/default/files/images/ABNS-cert-stat.pdf) Dierkes, A. M., Schlak, A., French, R., McHugh, M. D., & Aiken, L. (2021). Why some nurses obtain specialty certification and others do not. The Journal of nursing administration, 51(5), 249. Fights, S. D. (2012). Reap the benefits of certification. Nursing2021, 42(1), 10-11. Fitzpatrick, J. J. (2017). The value of nursing certification: Revisited and reinforced. Journal of the Association for Vascular Access, 22(3), 131-134.

Garrison, E., Schulz, C., Nelson, C., & Lindquist, C. (2018). Specialty certification: Nurses’ perceived value and barriers. Nursing Management, 49(5), 42-47. Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press Kaplow, R. (2011). The value of certification. AACN Advanced Critical Care, 22(1), 25-32. Stucky, C. H., De Jong, M. J., & Wymer, J. A. (2020). Certified surgical services manager (CSSM): The new gold standard for perioperative nurse leaders. Journal of PeriAnesthesia Nursing, 35(6), 557-563.

Cambria Nwosu is currently serving as the Director of Practice Administration for Neurology at Access Telecare, a national telemedicine healthcare practice and as a Legal Nurse Consultant for SUN, Inc., a legal consultant business she coowns with her husband. She is the former Chair of the Certification Council for the Competency and Credentialing Institute (CCI) where she served for 8 years in various certified test development initiatives.

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INDUSTRY INSIGHTS AAMI

AAMI Honors Researchers & Clinicians with 2023 Awards AMI is proud to recognize deserving

A individuals with AAMI Awards for their

dedication and hard work on U.S. national and international standards development. These award recipients exemplify how standards development is enriched by the collaboration and leadership of volunteer experts. With each document created by working groups consisting of dozens of volunteers from across the health industry, academia, and regulation, AAMI standards could not have obtained the global recognition they have achieved if it were not for many individuals’ outstanding commitment to improving patient safety.

Introducing the 2023 Standards Development Awardees: Alan Hood, Ph.D., research toxicologist in the Division of Biology, Chemistry and Materials Science (DBCMS), Center for Devices and Radiological Health (CDRH) Dr. Alan Hood serves as CDRH Primary Liaison to AAMI BE-WG 11 – the working group which determines the U.S. input for ISO technical matter related to “Allowable Limits for Leachable Substances” – and co-chairs that same group. He also serves as the convenor of ISO/TC 194/WG 11. Hood has been lauded by his colleagues for championing a major revision to the influential ISO/FDIS standard ISO 10993-17, Biological evaluation of medical devices–Part 17: Toxicological risk assessment of medical device constituents. After nearly six years of accounting for modern best practices and scientific consensus, the highly anticipated revision is expected to publish within 2023. Leveraging Hood’s expertise, the working group has expressed hope that their revisions will facilitate recognition of the international standard by the U.S. FDA. 26

OR TODAY | July 2023

Amy Jo Karren, microbiologist at W. L. Gore and Associates After discovering a passion for improving health care through research, Amy Jo Karren has been contributing to her field for 30 years. A trained sterilization specialist and registered microbiologist, Karren has served on multiple working groups for Sterilization Standards and Biological Evaluation of Medical Devices technical committees for AAMI and ISO. She is celebrated for her work as the current convenor of ISO/TC 198/ WG8, Microbiological Methods, as well as the co-chair for AAMI’s microbiological methods working group (ST-WG08). Karren was lauded by her colleagues as not only an expert in her field, but as a diplomatic and levelheaded liaison for the people and organizations she works with. Debra R. Milamed, M.S., associate in anaesthesia, Harvard Medical School Debra R. Milamed has been an active member of the U.S. TAG to ISO/TC121, Anaesthetic and respiratory equipment(AAMI AR), since 1989. In 2018, Milamed was appointed Committee Manager of ISO/TC121/ SC4, Anaesthetic and respiratory equipment, vocabulary, and semantics, by ANSI. In this role she assured the publication of ISO 19223:2019 and ISO 4135:2022, two documents which establish a collection of common vocabulary and terms, as to avoid potentially disastrous mistakes in the development and labeling of medical devices. Notably, she was a key member of the AAMI COVID-19 Response Team, helping with the curation and development of publicly accessible emergency-use guidance during the world health crisis. A recognized leader for decades, Milamed is celebrated by her peers as a professional who has defined the shape of numerous standards projects. WWW.ORTODAY.COM

INDUSTRY INSIGHTS AAMI

James M. Anderson, M.D., Ph.D., Distinguished University Professor, Professor of Pathology, Biomedical Engineering, and Macromolecular Science, Case Western Reserve University Dr. James Anderson has worked in the area of biomaterials, medical devices and prostheses for the past 40 years, with activities ranging from the clinical pathology evaluation of retrieved implants from humans to fundamental studies of cellular interactions with biomaterials. He is a founding member of the Society for Biomaterials, the Controlled Release Society, and AIMBE. He currently serves as convenor of ISO/TC 194/WG 1, which is responsible for the development of the international standard ISO 10993-1, Biological evaluation of medical devices–Part 1: Evaluation and testing within a risk management process. He is lauded for his clinical and research activities, which have provided the foundation for revising this essential standard. In particular, he is celebrated as a mentor and voice of reason, leveraging his knowledge to find common ground between the working group’s many subject matter experts.

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Paul Matsumura, senior director of research and technology, SunTech Medical Once awed by the fantastical medical technologies featured in Star Trek, Matsumura now boast nearly 40 years of experience in the design of systems, hardware and software in several business areas including military and commercial telecom, industrial robotics and medical diagnostics. A Senior Member of the IEEE and a member of AAMI, he contributes to the development of ISO standards and other technical documents as a U.S. expert nominated by the respective U.S. technical advisory groups. He is currently serving as the Industry co-chair for AAMI’s Sphygmomanometer Committee (AAMI SP), establishing best practices for the development of blood pressure monitors, gauges and similar devices. Matsumura also serves as co-convenor for the ISO/TC 121/SC 3/JWG 7, which is responsible for developing standards applied by blood pressure device manufacturers in testing the accuracy of their products. Citing his expertise, calm leadership and respectful approach to complex deliberation, Matsumura’s peers have called him “the granite cornerstone” of the sphygmomanometer standards space. WWW.ORTODAY.COM

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INDUSTRY INSIGHTS ASCA

ASCA Advocates for Protecting and Expanding Patient Access to ASCs By Bill Prentice

SCA’s advocacy team is

A having a busy year.

In early February, working with Congressmen Brad Wenstrup, DPM (R-OH) and John Larson (D-CT) and Senators Richard Blumenthal (D-CT) and Bill Cassidy, MD (RLA), we supported the introduction of the Outpatient Surgery Quality and Access Act of 2023 (H.R. 972/S. 312). This was one of the first pieces of legislation to be introduced in the new Congress. If adopted, it would go a long way toward promoting patient access to the high-quality care ASCs provide while cutting costs for the Medicare program and its beneficiaries. To spread the word on Capitol Hill about the importance of this proposal, we then helped 70 ASCA members representing 31 states meet with 102 members of Congress during our first in-person National Advocacy Day Washington, D.C., fly-in since the public health emergency was declared. At the federal level, we also: • signed onto a letter encouraging the Centers for Medicare

OR TODAY | July 2023

& Medicaid Services (CMS) to facilitate the availability of nonopioid therapies to Medicare Part D patients; • opposed a Federal Trade Commission’s proposed non-compete rule since its inability to apply to health care facilities of all kinds would have unintentionally contributed to the power imbalance it was intended to eliminate; • provided comments prior to a House Committee on Energy & Commerce Health Subcommittee hearing encouraging adequate payments to health care providers and support for policies encouraging the migration of procedures into surgery centers; and • joined other health care organizations in urging Congress to take action that would help stabilize the Medicare Physician Fee Schedule. This year, we also reached out to Texas legislators to oppose the elimination of facility fees that were being proposed in the state and to United Healthcare, urging them not

to enact a prior authorization policy for GI endoscopies. As you read this message, we expect to be preparing our comments on Medicare’s proposed payment rule for surgery centers in 2024. Amid all that activity, we are placing a high priority on three Medicare policies that need to change to protect and enhance patient access to the many benefits ASCs provide. First, we are continuing to encourage Medicare to expand its ASC Covered Procedures List (ASC CPL). Ideally, we would like to see this list include all 370 procedures that CMS currently allows in HOPDs but not in ASCs, but as a top priority, we would like to see total shoulders on the ASC list. We continue to present clinical outcomes data to CMS that demonstrates that many procedures that are not currently on the ASC CPL can be performed safely in ASCs and continue to work with CMS to try to develop a meaningful process for adding new procedures to this list. Second, we continue to urge CMS or Congress to take action that

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INDUSTRY INSIGHTS ASCA

From left to right: Representative Neal Dunn, MD (R-FL); ASCA Chief Executive Officer Bill Prentice; Representative Brad Wenstrup (R-OH); ASCA Director of Government Affairs and Regulatory Counsel Kara Newbury; and ASCA Board President Mandy Hawkins during ASCA’s National Advocacy Day.

would eliminate the secondary scalar that CMS currently applies to ASC payments, but not to HOPD payments, each year when it updates its payment system. Applying this secondary scalar to ASC payments is exacerbating the growing disparity between ASC and HOPD payments and needlessly increasing the Medicare program’s costs by making it financially untenable for ASCs to perform procedures that are otherwise clinically appropriate for the surgery center setting. When those procedures are performed in HOPDs instead, Medicare, its beneficiaries and taxpayers pay more. Third, we are asking Congress to implement a patient copay cap in ASCs that would be identical to one it approved in HOPDs some time ago. A Medicare beneficiary typically has a coinsurance responsibility of 20 percent of a procedure’s cost in an ASC, but when they have that same procedure in an HOPD, the copay is capped at the inpatient deductible amount, which is $1,600 for 2023. Medicare then reimburses the hospital for the amount the patient would have paid above that cap as well as its share of the cost of the procedure. Since no comparable

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copay cap exists in ASCs, patients are incentivized to choose the HOPD setting where their costs are lower but Medicare’s costs are often twice as high or higher. Again, Medicare and taxpayers pay more for procedures that could be performed safely in ASCs. To make matters worse, this issue primarily impacts those without supplemental coverage – an area where a racial disparity in access has been observed, with only 40 percent of Black beneficiaries being covered by supplemental insurance in contrast to 72 percent of white beneficiaries. While it has already been a busy year, we have a lot of work left to do. We cannot do this work without our members and the companies that serve our members and support ASCA. If you work in a surgery center, please make sure your facility is an ASCA member. If you have questions about membership, please contact Mykal Cox. If you want to join us for our next D.C. fly-in, please contact Maia Kunkel. – Bill Prentice, ASCA Chief Executive Officer.

July 2023 | OR TODAY

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IN THE OR

market analysis

Temperature Management Market on the Rise Staff report n Allied Market Research

A report states that the

global patient temperature management industry generated $2.9 billion in 2021, and is anticipated to generate $6 billion by 2031, witnessing a compound annual growth rate (CAGR) of 7.7% from 2022 to 2031. Growth and innovations in medical devices is among the factors the report states is pushing the market higher. Other growth factors listed include a massive pool of chronic disease incidences, a surge in the geriatric population, the growth of the medical tourism sector in developed and developing countries, a growing awareness about health care and an increase in the number of hospitals, ambulatory care centers and emergency care centers. The outbreak of the COVID-19 pandemic, according to the report, had a negative impact on the global WWW.ORTODAY.COM

patient temperature management market, owing to severe disruptions in various medical device industries during the lockdown. Furthermore, the market players experienced constrained supply or curtailed customer demand because of customer loss of private health insurance coverage for the products, which in turn, adversely impacted the overall financial performance of the companies. Based on distribution channel, the operating room segment accounted for the largest share in 2021, contributing to around two-fifths of the global patient temperature management market, and is projected to maintain its lead position during the forecast period. This segment is expected to portray the largest CAGR of 8.4% from 2022 to 2031, as hospitals and diagnostic centers are the oldest and most conventional medium for using patient temperature management devices to manage

the temperature of patients in acute critical care or surgical care. Based on region, North America held the highest market share in terms of revenue in 2021, accounting for nearly half of the global patient temperature management market, and is likely to dominate the market during the forecast period. Grand View Research also predicts market growth in the coming years. The global patient temperature management market size was valued at $3.2 billion in 2021 and is expected to expand at CAGR of 8.8% from 2022 to 2030, according to a Grand View Research report. The firm Research and Markets also issued a report predicting continued growth of the patient temperature management market. “The global patient temperature management market size is expected to reach $6.9 billion by 2030, registering a CAGR of 8.8%,” the report states. July 2023 | OR TODAY

IN THE OR

product focus

Baxter

Patient Warming System Baxter products featured at AORN 2023 included the commercial launch of a new conductive Baxter Patient Warming System designed to help achieve and maintain patient normothermia (body temperature within standard limits). The system eliminates the need for disposables, as the warming technology is built into the table pad, which can reach temperatures up to 40 degrees Celsius. In addition, reusable conductive warming blankets can reach temperatures of 43 degrees Celsius and provide an increased surface warming area to help quickly warm from above and below. The system is also air-free, which may reduce risks associated with forced air systems1 – such as contamination of the surgical site – and operates quietly. This warming solution can also be combined with WaffleGrip, a positioning accessory that helps keep the patient warm and secure in the steep Trendelenburg position, in which a patient is tilted head-down at up to a 45-degree angle. The Baxter Patient Warming System is compatible with its TS7000, TS7000dV and PST 500 surgical tables. 1. Mehta V. Comparison of forced air and conductive heating systems during outpatient orthopedic surgeries. Journal of Anesthesia and Surgery. 2018. https://doi. org/10.15436/2377-1364.18.1771.

OR TODAY | July 2023

Encompass Nova

Encompass Group’s Nova is a new technology in patient warming features easy-to-operate technology without the risks or noise of forced air systems. Nova, when used in pre-op, banks a patient’s body heat before surgery with passive, or active, warming and supports maintaining normothermia throughout the surgical process without air movement, excess environmental noise or disruptive moving parts. Designed with both the caregiver and patient in mind, Nova provides a quiet and comfortable solution. The Nova blanket is easy to apply, stays in place, the control unit is intuitive and simple to operate, and because the Nova blanket doesn’t emit excess heat, patients stay warm while clinicians remain cool during surgery. For more information, visit encompassgroup.com.

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IN THE OR

CenTrak

product focus

Automated Environmental Monitoring Solution CenTrak’s Automated Environmental Monitoring solution offers a reliable, cost-effective system to monitor differential air pressure and temperatures of refrigerators and freezers (-200 C to +125 C) to ensure safe use of blood products, vaccines and other critical items. Real-time alerts and customizable escalation chains enable staff to take immediate action when conditions fall outside of safe parameters. Robust graphs and reports allow facilities to eliminate manual data collection and analyze data. The newest version of the system provides longer battery life and over-the-air configuration firmware upgrades. A single CenTrak customer saved 10,000 labor hours, valued at 970k/year, by automating temperature monitoring.

Attune Medical ensoETM

Attune Medical’s ensoETM modulates and controls patient temperature through a single-use silicone tube inserted into the esophagus, similar to a standard gastric tube, and connected to an external heat exchange unit. Positioned in the esophagus, next to the heart and great vessels, water circulates inside the closed-loop system to efficiently warm or cool a patient. Unlike surface devices, the ensoETM’s internal placement won’t impede patient access during procedures in the OR, ER, ICU, or electrophysiology lab for various temperature management applications. The ensoETM works with existing heat exchangers and is the only device cleared for use in the esophagus for patient temperature modulation.

MAC MEDICAL Blanket & Fluid Warming Cabinets MAC Medical’s Blanket & Fluid Warming Cabinets offer an unparalleled range of sizes and options ensuring the ideal customer solution. Available in single, dual, and triple chamber configurations accommodating blanket, intravenous fluids, and irrigation solution warming at different temperatures in each chamber. With our Easy Log data recording and USB Data management standard on all models, your documentation requirements are streamlined. Computer-controlled convection heating and fully insulated cabinetry supply consistent temperature management throughout. Manufactured in the USA, each MAC Medical Warming cabinet features our “Built to Last” Warranty. For more information, visit www.macmedical.com.

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July 2023 | OR TODAY

COVER STORY

READY, SET, GO! Facilities Race to Prep New Hires

By Don Sadler

he number and variety of professional, ancillary and support positions within perioperative services far exceeds any other department in the hospital. These range from surgical technologists, first assistants and perfusionists to radiology and instrument room techs, aides, orderlies, transporters and more. This presents challenges for health care facilities when it comes to onboarding perioperative personnel and ensuring their competency. The goal should be to provide creative, individualized education and training so each member of the perioperative team is equipped to provide safe, high-quality patient care.

OR TODAY | July 2023

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Challenges Ramped Up

director for the Nursing and Healthcare Administration Masters of Science in Nursing program at Loyola UniverThe challenges of onboarding perioperative staff aren’t new, sity of Chicago, identifies two main challenges to successful but they’ve been ramped up over the past few years, says perioperative staff onboarding. The first is the advancement of Amanda Heitman, BSN, RN, CNOR, perioperative educatechnology. tional consultant for Periop Anew. “Medical device manufacturers continue to develop new “There has been a tremendous amount of pressure to bring devices to improve care, but they are limited for use in specific in ‘capable’ staff as quickly as possible, especially since COspecialties,” says Duffy. “This means perioperative staff must VID-19,” says Heitman. “This pressure for fast-paced orientalearn the proper care, setup, use, decontamination and steriltion creates extra challenges for health care facilities.” ization for each device.” “New perioperative staff require and deserve the time to To put this into perspective, Duffy says there were 442 diffully orient and onboard,” says Dawn Whiteside, MSN-Ed, ferent pieces of equipment that his perioperative team needed CNOR, NPD-BC, RNFA, director of education at CCI. “Reto be familiar with. “To try and manage this, we would put our gardless of the specialty, the novice perioperative nurse must team members into specialties to give them the opportunity to first learn the foundations of perioperative nursing before they grow from novice to expert on their specialty’s equipment,” he are moved to the beginner or advanced beginner stages of Bensays. “However, this is only a partial fix.” ner’s model.” The second challenge is the drive for productivity. Colleen Becker, Ph.D., MSN, RN, CCRN-K, director of peri“Health care organizations are under immense pressure to operative education for the Associacontrol their expenses and almost every tion of periOperative Registered Nurses “There has been a nursing leader has been given productiv(AORN), agrees. ity targets to meet in their staffing pattremendous amount “The pandemic resulted in turnover terns,” says Duffy. and fatigue among veteran staff, which of pressure to bring “This puts enormous pressure on triggered the need to bring on more travelin ‘capable’ staff as the perioperative educator and the preers and new hires to fill gaps,” says Becker. ceptors who must get new staff funcquickly as possible, “At the same time, acuity of surgical tional in a specialty in just a few weeks,” procedures is on the rise, requiring higher especially since says Duffy. “But this often leads to folks nursing skills,” Becker adds. “But tightenCOVID-19. This teaching the ‘how to’ and not the ‘why’ ing budgets have reduced the ranks of behind the actions.” clinical educators and it’s difficult to fully pressure for fast-paced Of course, the financial side of the staff while also asking experienced nurses orientation creates equation also comes into play. to precept and train new team members.” extra challenges for “The finance department is always According to Jane Flowers, MAN, RN, concerned with the time it takes to onhealth care facilities.” CNOR(e), CRCST, a common onboardboard a new nurse,” says Duffy. “They ing challenge is when multiple practiAmanda Heitman generally understand the investment, tioners are all starting on the same day. but they are acutely aware that we are “This is great for things like tours paying double to have a nurse partnering with a preceptor.” through the department and giving employees a buddy to go According to Becker, health care facilities must pay new through orientation with,” says Flowers. “But it can be challengnurses and preceptors for up to a six-month orientation to ing if the folks being oriented are not all RNs. Many facilities are the OR, which is considered non-productive time in most lucky to have one educator, let alone a whole team to divide and budgets. “Many cannot provide incentives or additional pay orient different populations who all show up at the same time.” for staff nurses to be preceptors, so they tap experienced travel Even if you’re lucky enough to have only RNs as orientees, nurses,” she says. “They have clinical knowledge but may lack there are many other potential challenges. “Are your orientees facility policy or procedure knowledge.” all novices or is there a mix of skill levels and experience?” It can be difficult to get experienced contract and travel asks Flowers. “What previous experiences do the orientees nurses to adapt to facility procedures, says Patsy Davis, BA, have? And what types of learners are they?” RN (retired), CNORe. “They usually prefer to do things the way they have Impact of Technology and Productivity Drive always done them,” she says. “I did find that travel nurses Bill Duffy, RN, MJ, CNOR, FAAN, the former program could bring very good

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July 2023 | OR TODAY

COVER STORY suggestions and ideas for improving practice in my facility, and the exchange of ideas often helped obtain compliance.” Providing consistent preceptors is another onboarding challenge. “Retirements and resignations among experienced nurses and fatigue caused by the continual need to onboard new team members have created a shortage of experienced preceptors to provide clinical orientation and training in the OR,” says Becker. “With many senior staff leaving, precepting can be an added burden for the remaining staff,” adds Flowers. “It seems that the staff are always orienting someone.”

Periop 101 is a popular service utilized by many health care organizations across the country.” “The utilization of programs such as Periop 101 is an enormous help when orienting new RNs to the operating room,” adds Flowers. “This program is valuable as AORN constantly updates the content so that it’s current, which allows educators to focus on the needs of the orientee.” According to Becker, the reason Periop 101 has been adopted so widely is because AORN continually updates it to reflect current evidence-based practice. “And we surround Periop 101 RN learners with a support Innovative Onboarding Techniques system that includes peer networking, mentorship and clinical With all of these challenges hitting at once, Becker says that learning resources through their complimentary membership facilities are seeking innovative ways to onboard new periop- during the course, as well as while they transition through erative staff in more condensed and efficient ways. Nation- their first year of practice,” says Becker. ally, there’s a focus aimed at growing “AORN provides the largest catalogue the pipeline of perioperative nurses in of perioperative-specific resources and “Remember that undergraduate schools, which currently continuing education for all levels of you are developing provide students very little exposure to nursing through our eGuidelines Plus the next generation various nursing specialties. online platform, monthly webinars, “Facilities are actively encouraging regional in-person conferences, clinical of perioperative colleges to offer Introduction to Perioptool kits and our annual Global Surginurses. You have the cal Conference & Expo,” adds Becker. erative Nursing, which AORN provides opportunity to make to the schools for a nominal cost of just $20 per student,” says Becker. She points More Perioperative a difference in their to a study in the AORN Journal by one Onboarding Tips career development Heitman suggests developing a school of nursing that found that 38% and help them become nurse educator who is solely reof nursing school graduates who had participated in a perioperative elective the best they can be.” sponsible for initiating orientation between 2017 and 2021 entered periopand competency development. “De- Jane Flowers erative nursing practice. pending on your needs, he or she Another focus has been to provide could even continue to be partially emotional and wellbeing support to new nurses via mentorship involved in staffing and precepting,” she says. “The educator programs. “Orientees are matched with experienced nurses could eventually help develop a structured orientation profrom the time of hire through their first year or so,” says Becker. cess and a new-to-the-OR program to grow your own staff.” “This sets up a more connected relationship outside of educaAnother idea is to create a structured novice-to-expert tion and training.” orientation checklist that encompasses all details of the roles. “Periop 101: A Core Curriculum,” AORN’s evidence“There is usually a lot of crossover between circulating and based education program, is one of the most effective stratscrubbing,” says Heitman. egies used by many health care facilities to onboard new At the hospital where Davis worked before retiring, they perioperative staff. According to Becker, Periop 101 uses developed an onboarding competency checklist for each a structured format that includes a perioperative leader category of employee. “This allowed for ongoing evaluation in the program so nursing best practices are implemented by preceptors as the nurse progressed through orientation,” consistently from cohort to cohort. she says. Duffy hosted the first Periop 101 at his facility. “Periop “Periodically, the preceptor and educator would review 101 allows a large number of new hires to get educated by the list with the nurse and devise a plan for further educaone preceptor, which allows the clinical preceptors to focus tion if indicated,” adds Davis. “At completion of orientaon the ‘how to,’ ” he says. “Clearly, the idea is sound because tion the preceptor(s), educator and nurse would sign the

COVER STORY checklist, which then became a part of the nurse’s file.” Some nurses and preceptors were reluctant to complete the checklist, and checklists sometimes got lost as they followed nurses through the department. “You have to be firm and consistent in meeting with nurses to review their progress and adaptation to your facility, policies and procedures,” says Davis. Whiteside stresses the importance of executive leadership fully understanding how long it takes to orient the specialty of perioperative nursing. “It is essential that leadership support the educators and the required level of training for each individual,” she says. “I have found that many times, leadership is encouraging novice perioperative nurses to be counted as staff with the assurance that someone would be available to help if needed,” Whiteside adds. “This is a patient safety concern and ultimately sets the novice nurse up for failure.” Flowers points out that given staffing shortages, most facilities want to onboard new nurses as quickly and efficiently as possible. “At smaller facilities, orientation does not have the advantage of having sim labs, so hands-on practice sessions are done in the actual OR,” she says. “There are advantages as the orientee experiences the real OR, seeing and learning with the actual equipment that they will utilize in their practice once orientation is complete.” In her experience, Flowers discovered that if several orientees start at the same time, they automatically have an orientation buddy who frequently stays with them throughout their career. “They can compare notes and experiences and generational diversity can be exciting as the orientees learn from each other,” she says. At his facility, Duffy worked to allow nurses to periodically scrub in cases. “To be an effective circulator you need to know what it’s like to be at the surgical table,” he says. “Participating in the procedure allows the nurse to see what’s happening inside the patient and feel how the instruments work and where they are optimally placed.”

Build a Collaborative Practice Whiteside recommends building a truly collaborative practice with educators. “Build a united plan to support orientees in being successful in their profession and ultimately providing safe competent care to our patients,” she says. “Utilize resources both within and outside of your facility,” says Flowers. “One of the greatest benefits of being involved in AORN is that I have always known that I’m never alone. I’ve networked with other facility educators, with the Clinical Nurse Educators Specialty Assembly and with my colleagues all over the country in AORN.” Flowers stresses the importance of staying positive and showing excitement when onboarding new perioperative nurses. “Be present and attentive to the orientees,” she says. “Always be fair and clear in your expectations. Address issues promptly and always share all of your knowledge.” “Remember that you are developing the next generation of perioperative nurses,” Flowers adds. “You have the opportunity to make a difference in their career development and help them become the best they can be.”

MEDICAL EXPERTS

FEATURED: COLLEEN BECKER Ph.D., MSN, RN, CCRN-K, director of perioperative education for the Association of periOperative Registered Nurses (AORN)

JANE FLOWERS

MAN, RN, CNOR(e), CRCST

DAWN WHITESIDE MSN-Ed, CNOR, NPD-BC, RNFA, director of education

spotlight on:

NATASHA GRANADO, RN, BSN “ A s a little kid, I always loved

playing with my dolls and making them better, making them healthy,” recalled Natasha Granado. “I asked my mom about that, too. She said, ‘You’ve always had a big heart, and wanted to be in the service industry.’ ” After two decades in nursing, Granado still relies on a deeply rooted ability to care for her fellow humans, as well as the strong work ethic cultivated throughout her youth, in her daily routines at SCA Health Texas Health Surgery Center Arlington, in Arlington, Texas. She has always extended that attitude of caring, professionalism, and service to her nursing colleagues throughout that time as well. Of her 20 years in the nursing field, Granado has spent nearly 15 of them at the center, rising to become an OR circulating nurse and quality improvement study coordinator with Texas Health Surgery Center Arlington. In all that time, she’s seen her perspective shift from one of a nurse preceptor focused on helping the next generation of skilled professionals learn the ropes of the job,

OR TODAY | July 2023

to leading patient safety and workplace satisfaction initiatives. Out of high school, Granado completed her nursing prerequisites at Tarrant County College in Arlington, Texas, and continued on to the University of Texas at Arlington, from which she graduated in 2004. After a nursing school externship at Methodist Charlton Medical Center in Dallas, Granado remained at that facility, starting in a med-surg telemetry unit before rising to become a Level III charge nurse and nurse preceptor. “I had always heard in nursing school, ‘Go into med-surg, get that experience, and then get on to what you want to do,’ ” Granado said. “Med-surg in general back then was very short-staffed. I’ve always been a very hard worker, but it was overwhelming, and I was burning out because you couldn’t do so much.” Under-staffing at the facility was especially stressful to Granado because she never wanted to feel like she was abandoning a patient or leaving her colleagues without help that they might need. Amid demands to do more with less, she feared making a mistake without rest, help and the ability to delegate

to her peers. “To me, work is about teamwork, and our goal is that patient and making sure they’re being taken care of,” Granado said. “If we’re not working together, it’s not working.” After about three years, she left Methodist Charlton for a position as an orthopedic office nurse at the University of Texas Southwestern Medical Center in Dallas. The hours were much more reasonable, and Granado enjoyed the work, but she only lasted a year commuting from Arlington to Dallas five days a week. From there, Granado took a floor nurse role at Regency Hospital, a longterm, acute care center in Fort Worth. From wound care, she transitioned to the step-down ICU, but staffing levels at Regency were no better than they had been at her previous workplaces, and Granado threw her back out repeatedly while turning bed-ridden patients without any help. For the first time in her fledgling career, she began to wonder whether she had chosen the wrong profession. “I liked the unit, but the nursing shortage wears on you,” she said. “At that point, I was very depressed. I put myself WWW.ORTODAY.COM

through nursing school, took all these loans out, and I’m like, ‘What did I get myself into?’ I want to help people; I want to do something that matters, but not at the expense of my own health.” It wasn’t until Granado’s stepfather was having retina surgery at a multispecialty surgery center in Arlington that she found her opening into the position that would become the best fit for her. By chance, her mother ended up speaking with the facility’s director of nursing while they waited, and Granado’s name came up. At the time, the facility, Healthsouth, was staffed mostly by agency nurses. Granado joined as a med-surg nurse, received OR training onsite and dove into the work. Eventually, ophthalmology doctors invested in the facility as a privately owned concern, and it evolved into Texas Health Surgery Center Arlington after SCA purchased it in 2016. “I happened to stumble upon this, and I’ve been here 14-and-a-half years now, and I love it,” she said. “Transitioning to the OR was fast-paced at first; it was something brand new for me. I picked up every little thing I could learn from each person.” “I really enjoyed seeing people come back, and they say, ‘My gosh, I’ve been wearing glasses since I was nine and I’ve never seen colors like this,’ ” Granado

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said. “I wanted to be a part of that; part of helping restore a patient’s vision and their excitement.”

“I GET TO COME INTO WORK, AND DO WHAT I LIKE. WE WORK AS A TEAM; YOU WORK TOGETHER, YOU GET IT DONE FASTER. NOBODY FEELS LIKE THEY’RE BEING TAKEN FOR GRANTED. IF SOMETHING DOES HAPPEN, YOU TAKE ACCOUNTABILITY FOR THE MISTAKE, AND TEACH THE NEXT PERSON.” In every environment in which she’s worked, Granado believes she’s taken some aspect of learning that has served her throughout her career, whether it’s a leadership style, critical thinking approach or difference in perspective. But at Texas Health Surgery Center Arlington, Granado feels most like she’s where she’s supposed to be. As if in confirmation, a study Granado produced on teammate satisfaction for the facility was recently named

the Bernard A. Kershner Innovations in Quality Improvement Award winner and the People’s Choice Award winner by the Accreditation Association for Ambulatory Health Care (AAAHC) for 2022. Through a process of performance benchmarking, data collection and employee surveys, Texas Health Surgery Center Arlington was able to apply corrective actions that raised teammate satisfaction scores by nearly 25 percent over two years. In May 2022, the center was rated highest of any operated by SCA Health. “The doctors and the teammates here are amazing,” Granado said. “I get to come into work, and do what I like. We work as a team; you work together, you get it done faster. Nobody feels like they’re being taken for granted. If something does happen, you take accountability for the mistake, and teach the next person.” Granado’s life outside of work changed dramatically when she reconnected with her high-school sweetheart. After having spent some 20 years apart, the two were married in December 2022, and together they are raising a family of four children. In her free time, Granado enjoys singing – whether it’s karaoke or music in the operating room. She also likes crossword puzzles, dancing and anything to do with water.

July 2023 | OR TODAY

OUT OF THE OR health

Electricity Can Heal Wounds Three Times as Fast hronic wounds are a major health problem

C for diabetic patients and the elderly – in

extreme cases they can even lead to amputation. Using electric stimulation, researchers in a project at Chalmers University of Technology, Sweden, and the University of Freiburg, Germany, have developed a method that speeds up the healing process, making wounds heal three times faster. There is an old Swedish saying that one should never neglect a small wound or a friend in need. For most people, a small wound does not lead to any serious complications, but many common diagnoses make wound healing far more difficult. People with diabetes, spinal injuries or poor blood circulation have impaired wound healing ability. This means a greater risk of infection and chronic wounds – which in the long run can lead to such serious consequences as amputation. Now a group of researchers at Chalmers and the University of Freiburg have developed a method using electric stimulation to speed up the healing process. “Chronic wounds are a huge societal problem that we don’t hear a lot about. Our discovery of a method that may heal wounds up to three times faster can be a game changer for diabetic and elderly people, among others, who often suffer greatly from wounds that won’t heal,” says Maria Asplund, associate professor of bioelectronics at Chalmers University of Technology 40

OR TODAY | July 2023

and head of research on the project. The researchers worked from an old hypothesis that electric stimulation of damaged skin can be used to heal wounds. The idea is that skin cells are electrotactic, which means that they directionally “migrate” in electric fields. This means that if an electric field is placed in a petri dish with skin cells, the cells stop moving randomly and start moving in the same direction. The researchers investigated how this principle can be used to electrically guide the cells in order to make wounds heal faster. Using a tiny, engineered chip, the researchers were able to compare wound healing in artificial skin, stimulating one wound with electricity and letting one heal without electricity. The differences were striking. “We were able to show that the old hypothesis about electric stimulation can be used to make wounds heal significantly faster. In order to study exactly how this works for wounds, we developed a kind of biochip on which we cultured skin cells, which we then made tiny wounds in. Then we stimulated one wound with an electric field, which clearly led to it healing three times as fast as the wound that healed without electric stimulation,” Asplund says. In the study, the researchers also focused on wound healing in connection with diabetes, a growing health problem worldwide. One in 11 adults today has some form of diabetes according to the World Health Organization (WHO) and the International Diabetes Federation. WWW.ORTODAY.COM

OUT OF THE OR health

New research from Chalmers University of Technology and the University of Freiburg shows that wounds on cultured skin cells heal three times faster when stimulated with electric current. The project was recently granted more funding so the research can get one step closer to the market and the benefit of patients. (Illustration: Chalmers University of Technology | Science Brush | Hassan A. Tahini)

“We’ve looked at diabetes models of wounds and investigated whether our method could be effective even in those cases. We saw that when we mimic diabetes in the cells, the wounds on the chip heal very slowly. However, with electric stimulation we can increase the speed of healing so that the diabetes-affected cells almost correspond to healthy skin cells,” Asplund says. The Chalmers researchers recently received a large grant which will allow them to continue their research in the field, and in the long run enable the development of wound healing products for consumers on the market. Similar products have come out before, but more basic research is required to develop effective products that generate enough electric field strength and stimulate in the right way for each individual. This is where Asplund and her colleagues come into the picture: “We are now looking at how different skin cells interact during stimulation, to take a step closer to a realistic wound. We want to develop a concept to be able to ‘scan’ wounds and adapt the stimulation based on the individual wound. We are convinced that this is the key to effectively helping individuals with slow-healing wounds in the future,” Asplund says. WWW.ORTODAY.COM

July 2023 | OR TODAY

OUT OF THE OR fitness

How Well Are You Monitoring Rest During Exercise? By Miguel J. Ortiz hen it comes to training,

W many get obsessed with

sets, reps, tempo, weight and other variables. Yet, many people miss, or undervalue, rest. The rest you get between sets helps to maintain a high level of force production for the next set. It is one variable that can tremendously change how your workout feels. You’ll see people in a gym who will lift weights until it burns, put the weights down, and when they feel good they will go back to work. Sometimes people aren’t even that disciplined to how they feel as they are easily distracted on their phones or talking to friends, which again completely deviates from the workout. Studies have shown that typical rest periods for increasing strength are between 2 and 5 minutes for optimal strength development. If you do 2-3 exercises you could be resting for upwards of 10 minutes. And you may not have that much time. But, the better question is, are you even working hard enough to really need or earn that much rest? In this column, we’re going to simplify 42

OR TODAY | July 2023

how much time you should truly be resting depending on your goals. First, here is a quick rundown of how much rest you should be taking between sets to elicit the proper change in the body to support your fitness aspirations. • For muscular endurance development, you need 20-60 seconds of rest. • For muscular hypertrophy development, you need 30-90 seconds of rest. • For maximum strength and power, you need 2-5 minutes of rest. New to lifting weights? Try 1-2 minutes of rest. If your trying to perfect your form, rest for at least 1-2 minutes. By following the suggested rest variables above and applying them vigorously to your training routine, you will find that you might possibly need to drop weight, increase weight, slow down form and/or change your routine depending on what kind of feeling these new rest periods produce. I have found – when monitoring rest – that people actually start realizing they can lift more weight and they start seeing much better, progressive changes physically in their body. And isn’t that what we all ultimately want? Now, let’s take the three exercises

below and apply the rest principles above to see how the body feels. 1. Dumbbell neutral grip chest press 2. Dumbbell hinge and row 3. Dumbbell walking lunges Do these exercises two different ways. You can do them in a circuit 1,2, & 3 only resting when all 3 are completed, so very minimal rest between and focusing on the rest at the end of each round. Or, you can do them one at a time, exercise 1, then rest accordingly until 3 rounds are completed and then move to the next exercise and repeat. What you’ll notice is a completely different heart rate range and depending on how you do these exercises you’ll probably use different weights. Have fun with your movements, continue to stay active and be disciplined about monitoring rest. – 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 videos of the exercises mentioned in this column on his YouTube channel at tinyurl.com/ORTfitness. WWW.ORTODAY.COM

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OUT OF THE OR EQ Factor

Combatting Burnout By Daniel Bobinski ne of the most daunting O problems facing workers is

burnout. Excessive workload due to employee shortages plus new and changing workplace rules are growing issues. These conditions lead to frustration, cynicism and low levels of commitment, among others. Sometimes it can feel like a full-court press of tensions and turmoil around us, so what follows are some suggestions for maintaining sanity. To explore this topic, I contacted psychologist Dr. Lynn Laird of Meridian, Idaho, and asked what people could do to beat burnout. The first words out of her mouth were, “Maintain relationships.”

Maintaining Relationships More than just having people serve as sounding boards, Laird says relationships are important for taking our minds off of the things that are causing us stress or burnout. “Talk about things that have nothing to do with work,” she says. “Get out and do things that engage your creativity. Maybe it’s learning a new skill, maybe it’s playing sports.” She also says relationships provide a sense of belonging and being connected. “Not only do relationships help us to feel in touch with and supported by something bigger than ourselves, they can inject happiness that WWW.ORTODAY.COM

counteracts the weariness that comes with burnout,” Laird says. Also, don’t be afraid to ask others for help. The last thing we need is to come home from work and be faced with a project that feels burdensome. More often than not we can find someone in our circle of friends who will help us with that project, but they can’t help if we don’t ask.

Strive for Balance Something else Laird says that is helpful for beating burnout is striving for balance. “If people don’t have a system for working towards balance, it’s likely their lives will get out of balance,” she says. Recently in this space I wrote about the seventh habit in Stephen Covey’s book, “7 Habits of Highly Effective People.” That habit is called “sharpen the saw,” and it means paying attention to specific areas of life and doing things in those areas to keep a balance. If we’re more balanced, then we can work and live more effectively. The areas outlined by Covey are social, physical, mental and spiritual. Laird highlighted that the spiritual aspect of life often gets neglected when people start getting burned out. She says, “Sometimes when we hit a point of overwhelm or despair or get despondent, we forget about our spiritual lives. But staying tuned spiritually is important because it revives us from the inside out.”

Stay Principled Whereas striving for balance is associated with steadiness and moderation in the various aspects of life, being principled means being well-connected to your values. While reviewing our principles is certainly something that can be done on a regular basis so that we stay balanced in this aspect of our lives, regularly reminding ourselves of our chosen principles helps us act on our priorities. Laird says that reminding ourselves of our principles helps to root us to our foundation, which provides a sense of stability in the face of the emotional exhaustion or cynicism that accompanies burnout. Left unaddressed, burnout can cause serious problems. If you or someone you care about is experiencing burnout, perhaps the suggestions listed above can help in combatting it. Daniel Bobinski, who has a doctorate in theology, is a bestselling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach him by email at DanielBobinski@protonmail.com or 208-375-7606.

July 2023 | OR TODAY

OUT OF THE OR nutrition

Nutritional Exotic Fruits By Grace O rowing up in the Philippines, I came into contact with what the rest of the world considers exotic fruits. To me cherimoya, jackfruit, mangosteen and rambutan were perfectly common. When I moved to America and met people from all over the globe, I realized that these nutritional powerhouses were not so well-known worldwide. So, here is my primer on exotic fruits from Southeast Asia, Africa and South America with wonderful nutritional properties and delicious flavors. Find recipes using these superfruits on my website at FoodTrients.com and in my cookbooks.

Açaí Celebrated in Brazil for its life-sustaining power, açaí comes from the Amazon rainforest. The small round purple fruit grows around a large seed so it’s often eaten as pulp or fruit juice that tastes something like a plum or sour blueberry. The antioxidant capability of açaí has only recently been studied in the laboratory. According to LifeExtension.com,

OR TODAY | July 2023

“Açaí powerfully counteracts several of the most destructive free radicals. With the highest reported total ORAC score of any fruit or vegetable, açaí has also been identified recently as a potent COX-1 and COX-2 inhibitor, which may give it the ability to provide relief from pain and inflammation.”

mixing easily into any number of foods and beverages. It has a mildly tart taste that lends itself to boosting the nutritional value of fruit smoothies, yogurt, salsas, juices, soups, even pancakes, muffins and desserts. More than a dozen companies sell baobab powder on Amazon.

Cherimoya Baobab Baobab fruit looks almost like a velvetcovered yam dangling from the tree. Baobab is wild harvested and the inside of the fruit is dry and fibrous. According to the British Website, Aduna, “Baobab fruit contains 14 essential vitamins and minerals. It is almost 50% fiber and has one of the highest antioxidant capacities of any fruit in the world. This gives it an amazing range of benefits, helping with energy, stress, immunity, metabolism and skin health.” Besides being an excellent source of vitamin C, baobab fruit contains a healthy dose of B vitamins, calcium and potassium. It is a rich source of polyphenols, known to be beneficial in reducing the glycemic response, which is the rate at which sugar is released into the bloodstream. This superfood powder is organic and minimally processed by simply separating it from the seed. Baobab powder is highly versatile,

If you’ve never tried cherimoya, you are in for a real treat. Also known as a “custard apple,” the taste is a mix of mango, banana, papaya, and vanilla flavors, and the flesh is creamy smooth. Cherimoyas are native to South America, but can be purchased online from Amazon.com or melissas.com and need to be allowed to ripen until soft before use. The black seeds are poisonous when crushed, so be sure to discard them. Cherimoyas offer vitamin B6 – an antioxidant and an anti-inflammatory, vitamin C, iron and riboflavin for cell energy. Cherimoyas are rich in copper, magnesium, iron and manganese, and contain more of these minerals for their weight than many common fruits like apples. The potassium in cherimoya regulates heart rate and blood pressure, offering protection from strokes. I love to include cherimoyas in my Exotic Fruit Salad with Granola recipe whenever I can buy them fresh in the market.

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OUT OF THE OR

nutrition

Jackfruit

Rambutan

Jackfruit, one of the world’s largest tree fruits, is a nutritional staple in tropical countries. It can grow up to 100 pounds, but most of them are in the 10-20 pound range. It has spiky skin, a distinctive, musky smell, and a flavor that’s a lot better tasting than it smells – sort of like Juicy Fruit gum. Jackfruit is very high in antioxidants and has a mild tropical taste. Like all orange and yellow fruits, it is a rich source of carotenoids. Jackfruit is also high in protein, potassium and vitamin B. You can sometimes find jackfruit in Asian markets or order them fresh from melissas.com. I also buy canned jackfruit on Amazon. My Sweet Potato and Jackfruit Delight recipe helps build collagen and keep your skin young.

These Malaysian fruits which mean “hair” (rambut), look like small, red, hairy monsters. The somewhat rubbery brownish-red outer shell is peeled away to reveal a white, moist oval that is very similar to a lychee. It’s sweet, juicy and subtle in flavor. Rambutans contain vitamin C, iron and phosphorous. Sufficient iron intake ensures that your red blood cells are distributing enough oxygen to your tissues. Phosphorous helps muscles contract, builds protein and keeps nerves functioning properly. Rambutan are available at melissas.com.

Mangosteen These beautiful little fruits are about the size of a baseball. Dark purple in color, the top is crowned with small green leaves and the bottom is stamped

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with a flowerlike shape. They almost look manufactured, but this is how God makes them. You have to carefully cut a line around the tough outer pericarp – the fruit wall – with a sharp knife. The pericarp is about a quarter of an inch thick. Once you’ve made a line along its equator, you can pull the two halves of the mangosteen apart to reveal a soft, snowy white interior that is clearly segmented. The juicy flesh is like a pear or a peach, but with more floral tones. The flesh of the mangosteen has anti-inflammatory properties and is full of antioxidants, including the FoodTrient vitamin C. My fruit purveyor ships fresh mangosteens from Southeast Asia, but you can purchase them online at melissas.com. I like to eat the fresh fruit on its own, but I also use the pulp to concoct fun recipes. I created a drink with mangosteens called the Mangosteen Mood Lifter and I can’t resist making my Mangosteen Chutney when they are plentiful. – Grace O is the creator of FoodTrients, a unique program for optimizing wellness and longevity. She is the author of three awardwinning cookbooks. Her latest cookbook is “Anti-Aging Dishes from Around the World.” Recipes mentioned in this column can be found at FoodTrients.com.

July 2023 | OR TODAY

OUT OF THE OR recipe

SWEET POTATO POWER SALAD INGREDIENTS:

Recipe

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4-6 North Carolina SweetPotatoes, peeled and diced (6 cups) 2 teaspoons, plus 1 tablespoon, olive oil, divided 3/4 teaspoon salt, divided 1/4 teaspoon pepper 1 1/2 bunches curly kale, rinsed and chopped (7-8 cups) 1/2 large lemon, juice only 1 can (15 ounces) garbanzo beans, rinsed and drained 1 large avocado, pitted and diced 1/2 cup cranberries 1/2 cup coarsely chopped almonds 1/4 cup red onion, chopped 1/2-3/4 cup feta or goat cheese

Dressing: • 2 tablespoons pure maple syrup • 2 tablespoons olive oil • 1/4 cup balsamic or white vinegar

By Family features

OR TODAY | July 2023

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OUT OF THE OR recipe

Supercharge Spring Meals with a Powerful Salad right, beautiful days often

B call for fresh, delicious

meals that give you energy to enjoy the great outdoors. Whether you’re hitting the pavement for a run, powering up for an afternoon at the office or picnicking with loved ones, nutrition and flavor can go hand in hand with an easyto-make salad. For your next meal, lean on a versatile ingredient like sweet potatoes as a key

ingredient in this Sweet Potato Power Salad, a light yet filling solution that can feed the whole family. Easy to add to a variety of recipes to enhance flavor and nutrition content, sweet potatoes can be used in sweet, savory, simple or elevated recipes. Plus, they can be prepared on the stove, baked, microwaved, grilled or slow cooked to fit your favorite dishes as a natural sweetener without added sugar. Find more information and recipe inspiration at ncsweetpotatoes.com.

Sweet Potato Power Salad Recipe courtesy of Carol Brown on behalf of the North Carolina SweetPotato Commission Servings: 6

1. 2.

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Preheat oven to 375 F. Place sweet potatoes in large bowl. In small bowl, lightly whisk 2 teaspoons olive oil, 1/2 teaspoon salt and pepper. Toss on sweet potatoes and place potatoes on large sheet pan. Bake 35-40 minutes until tender, flipping once during baking. Place chopped kale in large bowl. In small bowl, lightly whisk remaining

olive oil, remaining salt and lemon juice. Pour over kale and massage with hands until mixed, about 1 minute. To make dressing: In bowl, whisk syrup, olive oil and vinegar. In bowl with kale, add garbanzo beans, avocado, cranberries, almonds, red onion, sweet potatoes and cheese. Toss with salad dressing and serve. Note: Sweet potatoes can be baked and refrigerated 1 day in advance.

July 2023 | OR TODAY

INDEX

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

I.C. Medical, INC.………………………………………………… 9

MD Technologies Inc.……………………………………… 44

ASCA………………………………………………………………… 23

Innovatus Imaging………………………………………………19

Milestone Medical……………………………………………… 6

CIVCO Medical Solutions……………………………… 30

Jet Medical Electronics Inc………………………………41

OR Today Webinar Series……………………………… 43

Cygnus Medical………………………………………………… 52

Key Surgical…………………………………………………………15

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

Encompass Group…………………………………………… 25

MAC Medical, Inc…………………………………………………13

SIPS Consults…………………………………………………… 23

Healthmark Industries Company, Inc.…………… 5

Matching Donors…………………………………………………41

Soma Technology……………………………………………… 11

Healthmark Industries Company, Inc.…………… 5 MD Technologies Inc.……………………………………… 44 Ruhof Corporation…………………………………………… 2-3 SIPS Consults…………………………………………………… 23

RESPIRATORY

CATEGORICAL ANESTHESIA

Soma Technology……………………………………………… 11

ASSOCIATION

ASCA………………………………………………………………… 23

C-ARM

Soma Technology……………………………………………… 11

CARDIAC PRODUCTS

CIVCO Medical Solutions……………………………… 30 Jet Medical Electronics Inc………………………………41

CARTS/CABINETS

CIVCO Medical Solutions……………………………… 30 Cygnus Medical………………………………………………… 52 Healthmark Industries Company, Inc.…………… 5 MAC Medical, Inc…………………………………………………13

CS/SPD

INSTRUMENT STORAGE/TRANSPORT

CIVCO Medical Solutions……………………………… 30 Cygnus Medical………………………………………………… 52 Key Surgical…………………………………………………………15 Milestone Medical……………………………………………… 6 Ruhof Corporation…………………………………………… 2-3

INVENTORY CONTROL

Key Surgical…………………………………………………………15

MONITORS

Soma Technology……………………………………………… 11

MRI

Innovatus Imaging………………………………………………19

CIVCO Medical Solutions……………………………… 30 MD Technologies Inc.……………………………………… 44 Ruhof Corporation…………………………………………… 2-3

ONLINE RESOURCE

DISINFECTION

OR TABLES/BOOMS/ACCESSORIES

CIVCO Medical Solutions……………………………… 30 Cygnus Medical………………………………………………… 52 Ruhof Corporation…………………………………………… 2-3

DISPOSABLES

CIVCO Medical Solutions……………………………… 30

ENDOSCOPY

CIVCO Medical Solutions……………………………… 30 Cygnus Medical………………………………………………… 52 Healthmark Industries Company, Inc.…………… 5 MD Technologies Inc.……………………………………… 44 Ruhof Corporation…………………………………………… 2-3

FALL PREVENTION

Encompass Group…………………………………………… 25

FLUID MANAGEMENT

MD Technologies Inc.……………………………………… 44

OR Today Webinar Series……………………………… 43 Soma Technology……………………………………………… 11

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

SMOKE EVACUATION

I.C. Medical, INC.………………………………………………… 9

STERILIZATION

Cygnus Medical………………………………………………… 52 Healthmark Industries Company, Inc.…………… 5 MD Technologies Inc.……………………………………… 44

SURGICAL

MD Technologies Inc.……………………………………… 44 Milestone Medical……………………………………………… 6 SIPS Consults…………………………………………………… 23 Soma Technology……………………………………………… 11

SURGICAL INSTRUMENT/ACCESSORIES

TELEMETRY

MAC Medical, Inc…………………………………………………13

PATIENT MONITORING

AIV Inc.………………………………………………………………… 4 Jet Medical Electronics Inc………………………………41

PATIENT WARMING

Encompass Group…………………………………………… 25

POSITIONING PRODUCTS

Cygnus Medical………………………………………………… 52

REPAIR SERVICES

REPROCESSING STATIONS

OR TODAY | July 2023

SINKS

PATIENT DATA MANAGEMENT

INFECTION CONTROL

Healthmark Industries Company, Inc.…………… 5 Key Surgical…………………………………………………………15 Milestone Medical……………………………………………… 6

AIV Inc.………………………………………………………………… 4 Matching Donors…………………………………………………41

AIV Inc.………………………………………………………………… 4 Milestone Medical……………………………………………… 6 CIVCO Medical Solutions……………………………… 30 Cygnus Medical………………………………………………… 52 Encompass Group…………………………………………… 25

SAFETY

Cygnus Medical………………………………………………… 52 Healthmark Industries Company, Inc.…………… 5 Key Surgical…………………………………………………………15 Milestone Medical……………………………………………… 6

OTHER

Cygnus Medical………………………………………………… 52 Jet Medical Electronics Inc………………………………41 Soma Technology……………………………………………… 11

GENERAL

Soma Technology……………………………………………… 11

AIV Inc.………………………………………………………………… 4

TEMPERATURE MANAGEMENT

Encompass Group…………………………………………… 25 MAC Medical, Inc…………………………………………………13

ULTRASOUND

Innovatus Imaging………………………………………………19

WARMERS

MAC Medical, Inc…………………………………………………13

WASTE MANAGEMENT

MD Technologies Inc.……………………………………… 44

X-RAY

Innovatus Imaging………………………………………………19

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July 2023 | OR TODAY