or today - may 2016

SPOTLIGHT ONMARY SALABOUNIS

PAGE 48

CESIMULATION BASICS

PAGE 32

RECIPETORTILLA SOUP

PAGE 66

TAKE GOOD CARE NURSES • SURGICAL TECHS • NURSE MANAGERS

CREATING THEULTIMATESURGICALENVIRONMENT

MAY 2016 www.ortoday.com

Copyright ©2013 Ruhof Corporation 033115 AD-008

FOCUS ORT final 12.3:Layout 1 12/3/15 6:42 AM Page 1

Copyright ©2016 Ruhof Corporation 032316 AD-25

• Begins cleaning on contact, preventing soil fromdrying on scope surfaces

• Removes gross contaminants, includingsynthetic lipids

• Solution is enhanced with BIO-CLEANTECHNOLOGY, allowing for the completeelimination of all Bioburden and Biofilm byhigh-level disinfectants or liquid chemicalsterilants

• Individually packaged for one time use• Pouch has wide, stable base to prevent

tipping

Each pouch contains

Endozime® SLR SpongeContoured sponge for cleaning outsidesheath of scope

Endozime® SLRPrediluted enzymatic detergent

For more information contact Ruhof at

1-800-537-8463 www.ruhof.com393 Sagamore Avenue, Mineola, New York 11501

The only Endoscopy Bedside Care Kit thatremoves synthetic lipids and gross contaminantsfrom scope surfaces and internal channels –now in a user friendly pouch

Available in250ml or 500ml

pouch sizes

CleanStart ort 3.25:Layout 1 3/25/16 9:38 AM Page 1

Did you know that Interpower® offers a simple solution if you need hospital-grade replacement cords? Our no minimum order requirement allows you to order just 1, 5, 100, or more.

Interpower’s North American hospital-grade power cords and cord sets are made in Iowa and approved to the appropriate UL and CSA medical standards. Replacement cords are available, as well as custom orders.

All Interpower manufactured cords are electrically tested for safety. Value-added options such as custom packaging and labeling are available upon request. We can provide special labeling for the use of custom identification.

We offer a variety of options with an extensive range of clear, black, and gray North American hospital-grade plugs on power cords, cord sets, and replacement cords.

• Made in Iowa

• No minimum order requirements

• Same day shipments available for in-stock products

• 1-week U.S. manufacturing lead-time on non-stock Interpower products

• Over 4 million parts in stock

• Free technical support

Contact our Customer Service Representatives today for pricing availability and technical aspects, such as application and/or approvals, help in obtaining required documentation, and for assistance in designing specialty products.

SIMPLE HOSPITAL-GRADESIMPLE HOSPITAL-GRADESIMPLE HOSPITAL-GRADEPOWER CORD SOLUTIONSPOWER CORD SOLUTIONSPOWER CORD SOLUTIONSPOWER CORD SOLUTIONSPOWER CORD SOLUTIONSPOWER CORD SOLUTIONS

®

®

Order Online! www.interpower.com INTERPOWER | P.O. Box 115 | 100 Interpower Ave | Oskaloosa, IA 52577 | Toll-Free Phone: (800) 662-2290 | Toll-Free Fax: (800) 645-5360 | [email protected]

Business Hours: 7 a.m.–6 p.m. Central Time | ORDER A FREE CATALOG TODAY! E-mail [email protected] or call toll-free.

QUICK PICK REPLACEMENT OPTIONS

P/N 86610400Rating: 10A/125VAC Conductor Size: 3 x 18AWG Length: 3.05m/10.0ft



011

OR TODAY | May 2016

CONTENTSfeatures

OR Today (Vol. 16, Issue #4) May 2016 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and adver-tisements 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. © 2016

42 48

53

CREATING THE ULTIMATE SURGICAL ENVIRONMENTHow does one create “the ultimate surgical environment.” To fi nd out, OR Today interviewed several perioperative veterans to get their thoughts on what it takes to create the ideal surgery center. Leadership is one key ingredient, but what else does it take to develop and maintain the perfect surgery center?

SPOTLIGHT ON:MARY SALABOUNISMary Salabounis decided on a career change, went back to college and is currently a charge nurse in Colorado. She loves her new career. “Even though it’s technically my job, I get to secretly know that I made somebody comfortable; that I kept them safe,” she says. “It’s very satisfying.”

PRESIDENTIAL RECOGNITIONA Recent OR Today article on Surgical Technician Edward McKay resulted in a letter from President Barack Obama. It also provides McKay additional motivation to reach out to today’s youth in an attempt to inspire.

May 2016 | OR TODAY 7WWW.ORTODAY.COM

PUBLISHERJohn M. Krieg | [email protected]

VICE PRESIDENTKristin Leavoy | [email protected]

EDITORJohn Wallace | [email protected]

ART DEPARTMENTJonathan Riley Jessica Laurain

Kara Pelley

ACCOUNT EXECUTIVESWarren Kaufman | [email protected] McKelvey | [email protected] Parker | [email protected]

ACCOUNTINGKim Callahan

WEB SERVICESBetsy Popinga Taylor Martin

Adam Pickney

CIRCULATIONLisa Cover

Laura Mullen

MD PUBLISHING | OR TODAY MAGAZINE18 Eastbrook Bend, Peachtree City, GA 30269

800.906.3373 | Fax: 770.632.9090Email: [email protected]

www.mdpublishing.com

PROUD SUPPORTERS OF

INDUSTRY INSIGHTS11 News & Notes18 AAAHC Update

IN THE OR20 Suite Talk23 Market Analysis24 Product Showroom 32 CE Article

OUT OF THE OR58 Health60 Fitness64 Nutrition66 Recipe 68 Pinboard

70 Index

11

24

58

CONTENTSdepartments

66

8 OR TODAY | May 2016 WWW.ORTODAY.COM

YOUR PATIENT IS PREPPED AND COMFORTABLE. ARE YOU?

Prepared To Endure

Contact us at 321-752-4130 to find out how you could receive a free 30-day trial

coolvest.com/OR

In an environment like an operating room where there’s no room for error, problems can easily become magnified. But the debilitating and distracting effects of heat stress no longer need be a factor, because Glacier Tek™ Cool Vests are designed to remain at a consistent 59°F, keeping your body cool in hot, stressful conditions. Fitting comfortably over or under scrubs or other garments, its reusable packs charge in just 20 minutes in ice and water. And with the threat of overheating minimized, you can then concentrate on the task at hand–your patient. Which is how it should be.

BLEED 8.5”

TRIM 8.25”

SAFETY 7.75”

BLEED 11”

TRIM 10.75”

SAFETY 10.25”

FULL PAGE

LOGO PHONE NUMBER WEBSITE ADDRESS SPELLING GRAMMAR

PROOF APPROVED CHANGES NEEDED

CLIENT SIGN–OFF:

AD SIZE

NOTES

PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT

PROOF SHEET

MEDICAL DEALER TECHNATION ORTODAY

BUYERS GUIDE OTHER

PUBLICATION

MONTH

J F M A M J J A S O N D

Gamechanger.

SLUSHSLUSHSurgiSLUSH TM

with

Intelli-SLUSH™ re-usable slush containers forever free your budget from the cost and risk of single-use slush drapes.

Contact us for evaluation at www.cchangesurgical.com (877) 989-3737Use code ORTMAY16 for free slush container with order.

Intelli-SLUSH TM

surgical slush

Say hello to the new kid in surgical

slush

No more torn drapes. No more high disposable costs.


Responding to the needs of health care facilities and growing interest in Indigo-Clean technology, Kenall Manufacturing has introduced a new line of Indigo-Clean light fi xtures specifi cally designed for operating rooms.

Like the original Indigo-Clean fi xture that installs easily into the ceiling of any room, the OR version uses safe, visible, light-emitting diodes (LEDs) to automatically, safely and continuously disinfect the air as well as hard and soft surfaces.

“Operating rooms represent one of the biggest challenges because of the procedures being performed, the frequent use of the facilities and the patients’ compromised immune systems,” said Cliff Yahnke, Ph.D., Kenall’s Director of Clinical Aff airs for Indigo-Clean.

Indigo-Clean OR light fi xtures provide bright, high-quality, white light to illuminate the surgical fi eld, while continuously disinfecting the environment. When the OR is not being used, the lights can be switched

to an Indigo-only mode, removing the white light and providing a higher degree of safe disinfection.

The Indigo-Clean technology was discovered in 2002 by researchers at Scotland’s University of Strathclyde and has been clinically proven to reduce harmful bacteria up to 70 percent beyond routine disinfection eff orts. It has been the subject of more than 30 peer-reviewed journals and conference presenta-tions. The university was granted the U.S. patent on the technology in 2013 and selected Kenall as the exclusive licensee to commercialize it for the North American health care market.

Earlier this year, the ECRI Institute included Indigo-Clean on its list of top 10 technologies that health care executives should watch in 2016.

Clinical evaluations of the tech-nology have been underway at several U.S. hospitals to document the eff ectiveness of Indigo-Clean. Froedtert and the Medical College

of Wisconsin, Froedtert Hospital in Milwaukee recently completed two evaluations of the technology in their gastroenterology (GI) clinic’s waiting room.

“During the fi rst phase of our study, where we initially validated the lighting, we saw approximately a 40 percent reduction in bioburden,” said Dr. Nathan Ledeboer, associate professor of pathoglogy at the Medical College. “However, in Phase 2 of the trial, where the lighting deployment was optimized across the room, we were able to improve the bioburden reduction to more than 70 percent.”

Indigo-Clean is available in three confi gurations, including a Mixed mode (white and 405nm LEDs), Indigo-Only and a Switchable White and Indigo LED, which allows users to conveniently optimize the level of disinfection based upon room occupancy. •

For additional information, visit www.Indigo-Clean.com.

INDUSTRY INSIGHTSNEWS & NOTES

NEW OR LIGHT FIXTURES KILL BACTERIA

STAFF REPORTS


The Association of periOperative Registered Nurses (AORN) has added PeriopSim, a new simulated learning module, to Periop 101 in a six-month pilot program that will evaluate whether simulation learning is effective as an additional educational approach. By using simulation learning activities in perioperative practice, nurse users, who are new or returning to the profession, can demonstrate their skills before entering the operating room. Periop 101 is an online education program based on the evidence-based Guide-lines for Perioperative Practice.

PeriopSim was created by Conquer Mobile as an iPad appli-cation with input and guidance from AORN. The piloted content includes instrumentation modules and procedure modules for both inguinal hernia and lap-chole. Instrumentation modules act like flashcards and procedural modules use real surgical video to guide learners step by step through a sur-gery, prompting for instruments at every stage.

“Our hope is, by adding simula-tion to this learning platform, our Periop 101 educators and adminis-

trators will observe enhanced performance and, potentially, a reduction in training time,” said Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, AORN’s Executive Director/CEO. “With this pilot, we want to determine if simulation is an effective education technique to move nurses safely from the classroom to their responsibilities as a perioperative nurse actively involved in patient care activities in the perioperative setting.” •

Find more information online at https://periopsim.com.

AORN PILOTS SIMULATION LEARNING TOOL

TRU-D SMARTUVC ROBOT GIVES PATIENT PEACE OF MIND

With his wife’s history of infections and a complicated surgery looming, Jack Gunter wanted to make sure her medical team took every measure available to reduce the chance of post-surgery complications or infections. After learning about Tru-D SmartUVC, Gunter inquired about utilizing the UV technology in the operating room prior to his wife’s leg amputation. As a Tru-D hospital, the staff made arrangements for the germ-eliminating robot to disinfect the room prior to the procedure. Gunter says his wife is now well on her way to recovery and is successfully using a prosthetic leg after her above-the-knee amputation.

“Having Tru-D was great for our mental framework,” said Gunter. “My wife’s two prior, major surgeries resulted in two different bacteria in her leg which was the reason for the amputation. We will

never know what caused those infections, but knowing Tru-D was going to be used helped us feel everything was being done to make sure she did not have an infection with the amputation.”

Once a hospital staff member cleans a room using traditional cleaning methods, Tru-D is brought in to complete the process. Its patented Sensor360 technology analyzes the space, including shape, size and contents, to determine the proper UV dose to be administered. Spending the minimum time necessary to successfully eliminate infectious germs from all room surfaces, including shadowed areas, Tru-D alerts the operator when the disinfection process is complete.

Tru-D has been clinically validated by more than a dozen third-party studies including the recent Benefits of Enhanced Terminal Room Disinfection (BETR-D) study funded by the

Centers for Disease Control. •

For more information, visit www.Tru-D.com



NEWS & NOTES

Discomfort from overheating is an on-the-job reality for many workers — and health care professionals like surgeons, who endure bright lights, sterile gowns, lead aprons, physical exertion and time stress as they perform high-intensity procedures, aren’t immune.

The Glacier Tek Cool Vest, an American-made, self-contained lightweight wearable personal cooling system that maintains a cool — but not cold — temperature, is a patented, USDA bio-based cooling solution that is a game-changer for surgeons and staff seeking tempera-ture comfort in the sometimes-try-ing conditions of a typical operating room. This vest could also lead to better patient outcomes.

“Our product is a perfect solution to a situation many surgeons and operating room staff face. In fact, surgeons first came to us seeking the Glacier Tek Cool Vest because it is self-contained, bio-based and allows unencumbered freedom of movement in the OR,” said David Land, president, Glacier Tek. “Research indicates a low tempera-ture in the operating room can have adverse effects on not only a patient’s comfort, but recovery time as well. The Glacier Tek Cool Vest is one way to help surgeons and OR staff keep cool even during long, physically demanding surgeries.”

Glacier Tek’s patented phase change material (PCM) is superior to water-based personal cooling solutions in several ways. Worn around the body’s core in an easy-on, easy-off vest without tubes or tethers, Glacier Tek cools the body safely to a comfortable temperature. •

For more information, visit www.glaciertek.com.

GLACIER TEK ANNOUNCES COOL VEST

HEALTHMARK INTRODUCES STAINLESS STEEL WASHER SLEEVES

Healthmark Industries has announced the addition of Stainless Steel Washing Sleeves to its ProSys Instrument Care line.

Manufactured for effective transportation, washing and storage of sensitive medical instruments, the perforated Stainless Steel Washing Sleeves have a 17mm internal diameter and external diameter of 19mm. Included with the washing sleeves are two silicone caps that have crossed perforations for alternatively inserting fine tipped instruments, a circular stainless-steel identification tag capable of laser engraving and a stainless-steel ring-holder that joins the tag to the washing sleeves.

The Stainless Steel Washing Sleeves are heat-resistant up to 275 °F, and are available in four different lengths. •

Visit www.hmark.com or call 800-521-6224 for more information.

RTI Surgical Inc. has announced a limited launch of the Unison-C System, an anterior cervical fixation system. The first human implantation of the Unison-C System took place during an anterior cervical discectomy and fusion (ACDF) procedure in February. The Unison-C System will expand RTI Surgical’s hardware portfolio into the growing standalone interbody market.

The Unison-C Anterior Cervical Fixation System is indicated for stand-alone anterior cervical interbody fusion for the treatment of degenerative disc disease at a single level of the spine from C2 to T1 in skeletally mature patients. The implant consists of an intervertebral body device made of PEEK-OPTIMA from INVIBIO Biomaterial Solutions with an integrated locking mechanism and two screws. The Unison-C System is designed to be used with autograft and/or allograft.

This standalone device is contained and secured within the disc space, alleviating the need for supplemental fixation, such as an anterior plate and screws. In order to improve surgical efficiency, the system’s instrumentation features an all-in-one implant inserter and guide, which allows surgeons to complete all required steps from insertion to final locking. •For details, visit www.rtix.com.

RTI SURGICAL ANNOUNCES FIRST IMPLANTATION OF UNISON-C ANTERIOR CERVICAL FIXATION SYSTEM


ENCOMPASS GROUP INTRODUCES LONG SLEEVE REVERSIBLE UNISEX STAFF APPAREL TOP

The De Mayo V2 E Knee Positioner, from Innovative Medical Products, is designed with the surgeon and patient in mind. IMP’s new position-er uses a patent-pending sterile extension arm that extends the knee positioner base plate off the end of the OR table, enabling the surgeon to stand between the patient’s legs and allows the surgeon the ability to look straight down onto the surgical site. Surgeons no longer have to lean over the OR table when performing procedures. IMP is the first com-pany in the marketplace to make and sell a sterile extension.

The IMP solution is especially useful for surgeons performing unicompartmental replacements where the surgical site is on the inside of the patient’s knee. When an extension is not needed, surgeons can opt for the De Mayo V2 Knee Positioner for procedures carried

out on top of the standard OR table. The De Mayo V2 employs the De Mayo V2 E base plate and clamp and the De Mayo aluminum boot with distractor block.

Besides these benefits for the surgeon, the De Mayo V2 E Knee Positioner increases patient safety with new features to the knee positioner’s locking mechanisms. The system’s carriage has been fitted with a sliding bar, the Varus Tilt Control, that prevents a patient’s knee/leg from tilting out, regardless of patient height or weight. Patients stay solidly in place during the entire surgical procedure, while still allowing the surgeon to adjust the rotation, flexion and extension of the knee. The V2 E Knee Positioner also comes with an optional new handle on the carriage for ease of locking the boot.

The De Mayo V2 E Knee Position-er has been made lighter, without

decreasing its positioning strength. Hospital staff can easily disassemble the system’s carriage for cleaning, as well easily replace the plastic Teflon pad used to slide the carriage back and forth on the positioner. •

DE MAYO V2 E KNEE POSITIONER USES STERILE EXTENSION ARM

Encompass Group is introducing a new Synergy Unisex Long Sleeve Reversible Staff Apparel top (style #46831) to meet the needs of hospital staff that require or desire long sleeves to cover bare arms.

“The purpose for creating this top is based on the recommendations from AORN for the circulating nurse,” Tom Inglis, Vice President, Product Management, HTX Apparel Encompass Group LLC said. “This long sleeve top will help contain shed of skin cells to prevent contamination in the periop suite and when performing the sterile prep. We have also found that due to the cold atmosphere created in the OR, this will also provide

a layer of warmth to the individual.”Synergy professional apparel blends

durability and value with a variety of styles and colors. The Unisex Long Sleeve Reversible top is constructed of time-tested, high-performance 65 poly/35 cotton, stain-release color-fast fabric. It includes a reversible design with a breast pocket on one side or two hip pockets when reversed, and color-coded neckline. Staff can wear the top either side out to meet their preference. It comes in a multitude of colors and in sizes XS-5XL. •

For information, call 800-245-4636 or email [email protected].



Xenex Disinfection Services has launched its new LightStrike Germ-Zapping Robots, a portable disinfection system that destroys antibiotic-resistant bacteria in a four-minute cycle. More than 300 hospitals, long-term acute care, outpatient surgery and skilled nursing facilities use Xenex’s full-spectrum high intensity pulsed xenon light technology to destroy deadly superbugs before they harm patients.

Numerous hospitals have reported significant decreases in their infection rates after using Xenex’s Germ-Zapping Robots for room disinfection, and published their infection reduction results in peer-reviewed journals. LightStrike uses pulsed xenon to create broad spectrum, highly intense light covering the entire germicidal spectrum and is the only ultraviolet disinfection technology shown, in multiple peer-reviewed published studies, to help hospitals reduce infection rates.

The new CDC report points to six antibiotic-resistant threats, which include:1. Carbapenem-resistant Enterobacteriaceae (CRE);2. Methicillin-resistant Staphylococcus aureus (MRSA);3. ESBL-producing Enterobacteriaceae (extended-

spectrum β-lactamases);4. Vancomycin-resistant Enterococcus (VRE);5. Multidrug-resistant Pseudomonas aeruginosa; and6. Multidrug-resistant Acinetobacter.

LightStrike robots destroy all of these superbugs, as well as Clostridicum difficile (C.diff ) spores, in a four-minute disinfection cycle.

In addition to its 20 percent faster cycle time, LightStrike includes patented SureStrike technology, which validates bulb ignition and guarantees a proper broad spectrum pulse for every disinfection cycle. Xenex robots also include HAI rate tracking, which correlates use of the robot and the hospital’s own real-time HAI data to track the disinfection program’s effectiveness.

Xenex officials believe that LightStrike’s shortened cycle time provides tremendous value to hospitals, especially in the operating room environment.

Designed for speed, effectiveness and ease of use, hospital cleaning staff operate the LightStrike robot without disrupting hospital operations. Without contact or chemicals, the robot eliminates harmful microorganisms safely and effectively. According to Xenex customers, LightStrike can disinfect 30 to 62 hospital rooms per day, including: patient rooms, operating rooms, equipment rooms, emergency rooms, intensive care units and public areas. •

XENEX DISINFECTION SERVICES LAUNCHES LIGHTSTRIKE GERM-ZAPPING ROBOTS

Sealed Air’s Diversey Care division has launched a test drive program for TASKI IntelliTrail, a full-service, intelligent fleet management system that allows facility managers to remotely monitor their TASKI floor care machines with ease. IntelliTrail is part of Diversey Care’s expanding Internet of Clean platform, which includes a variety of connected technology solutions for commercial cleaning.

IntelliTrail combines smart technology, GPS tracking and web applications to provide managers with real-time visibility of fleet performance. A device is physically

mounted on the designated equipment and contains a SIM card and hardware to record and transmit data. Users have access to machine data including geographical position, run time and critical service information such as battery state, which can help reduce total cost of ownership and enhance quality of service.

Beginning March 1, customers who purchase a TASKI scrubber drier can trial the cloud-based fleet management system for free for six months. •

For more information, visit www.sealedair.com/intellitrail.

SIX-MONTH INTELLITRAIL TRIAL FREE TO TASKI CUSTOMERS

NEWS & NOTES


NEWS & NOTES

Nihon Kohden has commercially launched its new Neuromaster MEE-2000A, a highly individualized intraoperative monitoring system that allows clinicians to respond to the neuro-physiological needs of any patient. Available as a laptop or desktop, the technology allows health care professionals to set patient-specifi c protocols and tailor monitoring parameters to ensure the highest level of fl exibility and responsiveness in any operating room.

The Neuromaster MEE-2000A off ers several modules for electrophysiology such as electro-encephalography, electromyography, and a variety of evoked potentials that can be confi g-ured according to surgical indication and patient need. At the core of the technology is a unique transcranial stimulator, the TcMEPro Matrix Stim, which allows health care professionals to set patient-specifi c protocols within seconds by tailoring parameters such as duration, inter-stimulus interval (ISI) and train length. In addition, the laptop system is smaller and lighter than other systems, which allows for enhanced portability.

The Neuromaster MEE-2000A builds upon Nihon Kohden’s Neuromaster MEE-1000A device, which has been integrated into operat-ing room workfl ows at hospitals across the U.S •

NIHON KOHDEN LAUNCHES NEUROMASTER MEE-2000A

SEALED AIR, SURFACE MEDICAL FORM PARTNERSHIP

Surface Medical Inc. and Sealed Air Corporation have entered into a strategic partnership to exclusively distrib-ute the CleanPatch branded product line in the United States through Sealed Air’s Diversey Care division.

As part of the multi-year agreement, Diversey Care will lead the sales, marketing and distribution activities of CleanPatch products designed for the safe and eff ective repair of hospital bed mattresses, operating room tables and stretchers. The focus of this partnership will be in the U.S. health care market, including acute care hospitals, long-term care facilities and ambulatory surgery centers.

CleanPatch is a fi rst-in-class Food and Drug Administra-tion-registered medical surface repair technology that restores damaged hospital mattresses to an intact and hygienic state. Studies have demonstrated that damaged surfaces in health care facilities are common and cannot be properly disinfected, leading to the risk of potential cross-contamination. Already implemented by hundreds of leading U.S. health care facilities, CleanPatch provides the unique benefi t of enhancing patient safety while directly reducing health care costs. •

Ethicon has announced a defi nitive agreement to acquire NeuWave Medical Inc. Their products are currently used by physicians in over half of the top cancer centers in the United States. This acquisition is consistent with the Johnson & Johnson Medical Devices’ strategy of advancing innovation and investing in areas of unmet medical needs such as surgical oncology. Financial terms of the transaction have not been disclosed.

NeuWave Medical’s ablation technology was originally developed by physicians and microwave scientists from the University of Wisconsin to maximize energy delivery to tissue, minimize invasiveness and provide physician-friendly

workfl ow. NeuWave Medical’s Certus 140 ablation system’s high-powered computer and intuitive touchscreen interface enables activation of single or simultaneous multiple probe procedures for patients with soft tissue lesions. This allows physicians to eff ectively tailor ablations for lesions of varying shapes and sizes. NeuWave Medical’s probe family includes conventional probes and the only Precision PR probe to limit the ablation length, allowing precise and controlled ablations.

The closing of the transaction is subject to clearance under the Hart-Scott-Rodino Antitrust Improvements Act and other customary closing conditions. The transaction is expected to close during the second quarter of 2016. •

ETHICON TO ACQUIRE NEUWAVE MEDICAL INC

Customer needs are our first priority.

• Warming Cabinets• Stretchers• Surgical Scrub Sinks• Processing Sinks• Cabinetry• Tables• Carts• IV Stands• Mayo Stands• Solution Stands

• Prep & Pack Workstations• Linen Hampers• Kick Buckets• Step Stools• Wall Shelves• Pass Through Windows• Peg Boards• MR Conditional Products• Any other customized

stainless steel need

MAC Medical, Inc. manufactures the highest quality healthcare equipment available. Our engineering capabilities allow us to custom design any specific product your facility may have. With no project too large or too small for our capability, we are committed to providing solutions for your custom needs with our American made products. Some of our products include:

Medical EquipmentQuality built, American made

Corporate Office325 West Main Street Belleville, IL 62220

Manufacturing Plant 820 South Mulberry Street Millstadt, IL 62260

Phone: 618-476-3550Toll Free: 877-828-9975Fax: [email protected]


Incidents that “almost happen” go by many names: medical error, accident avoidance, close call, narrow escape, error-prone situations. It doesn’t really matter what terminology you use. What matters most is that your staff understands exactly what is meant by a near miss; that it should be taken seriously; and that it should be reported freely so the cause can be ascertained and a remedy decided on to make sure it never happens again.

Myself, I prefer to call these incidents “good catches” because of the more positive tone it connotes. It’s more likely that people will report them when they can be congratulated for making a good catch than berated for experiencing or witnessing a near miss that they were reluctant to report or perhaps did not report. Of course, the reason why near misses should be reported is to determine how or why they occurred so that corrective action can be taken to prevent similar, or more serious, incidents from happening in the future. Whatever we call these events – a rose by any other name, as Shakespeare said, still means the same thing – it’s vital that you deal with them quickly, honestly and constructively. They could be caused by missing steps in the procedure chain, lack of support staff at a critical moment, medication errors, ambiguous instructions,

hard-to-read labels, lack of double-check procedures, or lack of a clear policy, etc.

How do you approach near misses or good catches? How do you encourage your staff to report them? Do you have an electronic reporting system, or do you require that a paper form be completed? Do you permit reporting to be anonymous? Who at your center looks at these? What happens after they are fi led?

Do you discuss good catches soon after they happen? Do you trend them and wait to see a pattern before discussing them with the staff and, when appropriate, the physicians who work at your center?

Or do you just collect the data and keep it on fi le? The main purpose of collecting this data is to use it for staff and physician education so that near misses do not become actual misses with the possibility of patient or staff harm.

Frankly, any good preventive ideas suggested by staff or physicians – or anyone – should be listened to and considered with an open mind. The corrective measure will ultimately help all patients and staff experience a safer environment for care; and a safer environment in which to work!

The most important point is that your organization must foster and encourage a reporting culture. There

must be an environment in which the person reporting is free to announce a near accident without stigma, not pilloried for voicing it or viewed negatively as though he or she is somehow “disloyal” or “not a team player.” Playing an active role in detecting risks to patient safety is not necessarily limited to staff ; patients themselves may contribute, for example, by being encouraged to ask questions about their care.

Near miss incidents must be openly investigated to identify the root cause and any weaknesses in the system that led to the near miss. These are learning and improvement opportunities. Use them to improve safety systems, achieve risk reduction, and heed the lessons learned. If you put a positive spin on the process, it represents a unique opportunity for training, feedback on performance, and a commitment to continuous improvement.

ABOUT THE AUTHORDr. Jack Egnatinsky is an anesthesiologist with extensive experience in the ambulatory surgery arena, both HOPD and ASC. He is a Past President of the Board of FASA, a predecessor to the ASC Association, and Past President of AAAHC. He is also on the board of the Accreditation Association for Hospital and Health Systems (AAHHS) and is a representative of Acreditas Global, the international arm of AAAHC. He remains extremely active as a Medical Director for AAAHC, in addition to being a well-travelled AAAHC accreditation surveyor in the U.S. and internationally.

INDUSTRY INSIGHTSAAAHC UPDATE

Everybody, or nearly everybody, experiences a “near miss” at some time or another. AAAHC Standards in both risk management and safety address near misses;

and at AAAHC, our surveyors look for how ASCs comply with these standards on every survey.

NEAR MISSES OR GOOD CATCHES?

BY JACK EGNATINSKY, MD

NEAR MISSES OR GOOD CATCHES?

AAAHC UPDATE

A A A H C A C C R E D I T A T I O N{ }

It’s validation of howwell you deliver care.We send physicians, nurses, administrators – professionals whose opinion you can respect. Their mission is to help your organization be the best it can be.

• We are the leader in ambulatory accreditation.

• Our Standards are nationally-recognized.

• Our surveys are consultative not just a checklist.

Improving health care quality through accreditation

Contact us to learn more847-853-6060 • [email protected] • www.aaahc.org


IN THE ORSUITE TALK

SUITE TALKConversations from the OR Nation’s Listserv

A: We use Techni-Care (chloroxylenol 3%). It was off the market for quite a while but it is back now.

A: Can you share ordering info for Techni-Care? I hadn’t heard that it was available.

A: It (Techni-Care) is ordered direct from the company. Care-Tech Laboratories Inc. in Saint Louis, Missouri 63139. The phone number is 800-325-9681. The website is www.caretechlabs.com.

A: This was a recent question for us as well. Our policy states that if the patient is allergic to iodine to use hibiclens. Hibiclens (CHG) is 4% chlorhexidine gluconate with 4% percent

alcohol. If the patient is allergic to both we are advised to use a product called Shur Clens. I found an interesting article that mentions that the reason “CHG acquired the warning not to use it in the genital area seems to be lost to history. Companies say pursuing a change in the label claim is difficult because the FDA has not established testing criteria for skin antiseptics to be used on vaginal tissue and because of the expense of such studies.”(OR Manager Vol 27, No. 8, p.23) So it sounds as if one of the reasons that hibiclens says not to use on mucous membranes may be simply because its too expense to change the historical label. The same article also men-tions a study that suggested that CHG had been more effective.

VAGINAL PREPS WITH IODINE ALLERGYWhat is being used for vaginal preps for patients with iodine allergies? I’ve found litera-ture regarding dilute Hibiclens but it still states on the bottle not to use it for mucous membranes. One colleague heard about using peroxide or baby shampoo or castile soap. I can’t find a legitimate recommendation.

Q

A: No drains are being used here at our facility.

A: No.

A: We have a surgeon who has done this his entire career. He uses a 15 fr. round drain with a JP bulb. He pulls it in second stage recovery.

A: We do not use drains, but that sounds like a good idea.

POST-OP DRAINS FOR LAPAROSCOPIC PROCEDURESSome surgeons have started placing drains after laparoscopic and robotic procedures to help eliminate the CO2 trapped in the body cavity. This has shown to decrease post-op shoulder pain in some patients. The drains are then removed in PACU prior to discharging the patient. Has anyone seen this practice at their facilities?

Q


POST-OP DRAINS FOR LAPAROSCOPIC PROCEDURES

SUITE TALK

A: How can you properly count without popping the tab? The AORN guideline says that each sponge/lap should be visualized and separated to count. Our policy is not to remove the band until we are ready to count them, that way we know what has/has not been counted. Without removing the tab, if you aren’t separating the sponges, you could have an extra sponge folded and stuck between the sponges that you don’t see during the count.

A: We pop the tape and separate the sponges as we count.

A: We pop the tape and count them.

A: The requirement is to separate each sponge when counting. You cannot do that until the tape is broken and each sponge is laid out individually.

COUNTINGWhen counting laps and Ray-Tec sponges, is it OK to pop the paper tab prior to counting with the circulator? Some scurb nurses will only pop the paper once the pack is counted.Q

Mitral Valve Repair or Replacement Surgery

Exceptional Exposure for Right & Left Atrium

Secure flexion & extension stabilization

Easy hook & loop adjustment

Frees surgical practitioner’s hands to retract soft tissue

Sterile and disposable for single use

Economical solution

Call for FREE samples

The

Original

Keeps sterile tethered appliances from falling to the floor with 4 hook & loop closures

Latex free self adhesive back for attachment to the surgical field

Economical - Saves pre-op time

Several sizes and configurations - yellow or red iridescent for laser surgery

Sterile shelf life 2 years

Call for FREE samples

®Cosgrove Mitral Valve Retractor System

Sterile Adhesive Organizer

Surgical Knee Immobilizer/Positioner

FOR ARTHROSCOPIC AND ALL KNEE SURGERY PROCEDURES

AWARD WINNER!

call 800.541.7995 or visit keysurgical.com

OMG! Key Surgical Identification Tape is GR8! It’s fun, it’s colorful, it’s easy to use, and BTW, it’s

available in the brightest colors and boldest patterns. With the option to create your own custom

identification tape you’ll have no problem tracking and organizing instruments. Place your order today.

key surgical identification tape will make youkey surgical identification tape will make you


A series of fatal Carbapenem-resis-tant Enterobacteriaceae (CRE) infections that attracted national media attention in 2014 and 2015 – combined with ECRI Institute’s studies into endoscope cleaning and disinfection practices — prompted ECRI safety engineers to elevate fl exible endoscope reprocessing to the top of the organization’s 2016 list of hazards. This year’s top hazard specifi cally addresses the need to adequately clean fl exible endoscopes before disinfection to help prevent the spread of deadly pathogens.

The focus on endoscopes caused by bad news the past two years is expected to help fuel the growth of the endoscope reprocessing and cleaners market in the future.

A report from the market research fi rm MarketsandMarkets predicts signifi cant growth in the endoscope reprocessing and cleaners market.

The MarketsandMarkets report “Infection Control Market by Disinfection (Endoscope Reprocess-ing, Disinfectant, Disinfector, Surgical Drapes, Gowns, Disinfectant

Wipes, Face Mask), Sterilization (Moist Heat, Dry Heat, Ethylene Oxide, E-beam, Contract Services) – Global Forecast to 2020” forecasts that the global infection control market is estimated to reach $16.7 billion by 2020, growing at a compi-ound annual growth rate of 6.7 percent during the forecast period (2015 to 2020).

The report lists hospital-acquired infections among the reasons for the growth of this market.

“The infection control market witnessed healthy growth in the last decade owing to rising aging popula-tion and prevalence of chronic diseases, an increase in the number of surgeries performed, and the rising occurrence of hospital-acquired infections,” according to Marketsand-Markets. “However, stringent regula-tions and saturation in developed economies will restrict the growth of the market to a certain extent.”

“However, endoscope reprocessors is the fastest growing segment in the disinfection technologies market during the forecast period,” accord-ing to MarketsandMarkets. “This market is expected to grow at a highest CAGR of 9 to 10 percent during the forecast period. Growing importance of diagnostic and therapeutic endoscopy procedures and increasing number of minimally invasive surgeries across the globe are some of the key factors contribut-ing to the growth of this market.”

The entire endoscopy market is also expected to grow in coming years thus propelling the reprocessing and cleaners segment of the market.

According to a market report published by Transparency Market Research, “Endoscopy Devices Market (Endoscopes, Endoscopic Operative Devices, and Visualization Systems) – Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2013-2019,” the global endoscopy devices market was valued at $24.9 billion in 2012 and is expect-ed to grow at a compound annual growth rate of 6.8 percent from 2013 to 2019, to reach an estimated value of $36.9 billion in 2019.

On the basis of end user, the infec-tion control market is segmented into hospitals, life sciences, medical device companies, pharmaceutical compa-nies, food industry, and others, according to MarketsandMarkets.

“In 2014, the hospitals segment accounted for the largest share of the infection control market, whereas the medical device companies segment is expected to grow at the highest CAGR from 2015 to 2020,” according to the research fi rm’s report.

D irty endoscopes made headlines in 2015 for all the wrong

reasons. These helpful medical devices become problematic when they are not cleaned properly or completely.

MARKET ANALYSISEndoscope Reprocessor Among

Fast-Growing Markets

IN THE ORSTAFF REPORTMARKET

ANALYSIS

“This market is expected to grow at a highest CAGR of 9 to 10 percent during the

forecast period.”


IN THE ORPRODUCT

SHOWROOM

EVOTECH® ENDOSCOPE® CLEANER AND REPROCESSOR

The EVOTECH® Endoscope Cleaner and Reprocessor is the first commercially available system that both cleans* and high-level disinfects endoscopes. Developed by Advanced Sterilization Products (ASP), a Johnson & Johnson company, the EVOTECH® System makes endoscope reprocessing a highly automated process, eliminating tedious brushing* resulting in confidence that endoscope reprocessing is effective and consistent. This can save valuable time, improve health care professional safety and reduce the risk of infection.

*Does not eliminate bedside pre-cleaning. Manual cleaning of qualified medical devices (endoscopes) is not required prior to placement in the EVOTECH® ECR when selecting those cycles that contain a wash stage (for those endoscopes qualified for clean & disinfection only). Not all endoscopes can be automatically cleaned, but may be high-level disinfected. The EVOTECH® ECR will only disinfect an EUS scope. The customer will be responsible for the manual leak testing and manual cleaning of the scope per the manufacturer’s instructions for use. Please refer to the EVOTECH® ECR User’s Guide and specific connection diagrams for more detailed information regarding cycle capabilities. •


PRODUCT SHOWROOMPRODUCT FOCUS

HEALTHMARK INDUSTRIESELEVATOR MECHANISM BRUSH

Healthmark Industries has added the Elevator Mechanism Brush to its ProSys Instrument Care line. It is uniquely designed for cleaning endo-scope elevator mechanisms; the small-scale brush head is comprised of polyamide brush fi laments attached to a plastic-coated wire core for effi cient scrubbing in and around the endoscope elevator mechanism. The Elevator Mechanism Brush also features an ergo-nomic handle fashioned from recyclable polypropylene for inten-tions of controlled grip and precision movement, the adjoining fl exible neck provides ease of access when cleaning endoscope elevator wires and the immediate area of the wire channel opening (when present) surrounding it. •


IN THE ORPRODUCT

SHOWROOM

KEY SURGICALSCOPE TAGSWhen was the scope processed? Did it pass the leak test? When does it need to be reprocessed? Who per-formed the pre-cleaning? There are many questions that need answers in regards to scope cleaning and repro-cessing. Key Surgical Scope Tags help ensure these questions get answered and that communication is clear and recorded. Available in several colors (blue, shown) with month, day and date to select on one-side or a bright white design that includes more in-depth detail to capture (leak test, air flush, scope model, hang time, etc.) as well as a place for a barcode if necessary. These self-looping tags easily attach to the scope. Scope Tags from Key Surgical were designed with efficient communication and patient safety in mind. They may be used after processing is complete or during the sterilization process. For information, visit www.keysurgical.com. •

May 2016 | OR TODAY 27WWW.ORTODAY.COM May 2016 | OR TODAY 27WWW.ORTODAY.COM

OLYMPUSOER-PRO AUTOMATED ENDOSCOPE REPROCESSOR

The Olympus OER-Pro Automated Endoscope Repro-cessor is designed to comply with the most rigorous industry standards while simplifying and expediting proper cleaning and reprocessing between procedures. Up to two fl exible endoscopes can be simultaneously cleaned and disinfected in 26 minutes. The OER-Pro is FDA cleared to automate seven of the 11 manual endoscope cleaning steps, including the most labor-intensive and variable parts of the process: manual fl ushing of the endoscope channels with detergent, water and air. Its built-in Radio Frequency Identifi ca-tion (RFID) management system automatically traces the endoscope serial and model numbers, operator and time of reprocessing for additional time savings and improved accountability, eliminating cumbersome manual input from a keypad or barcode. •

PRODUCT FOCUS


IN THE ORPRODUCT

SHOWROOM

RUHOFSCOPEVALET™ VALVESAFE™Valvesafe™ is a single-use endoscope valve cage for the safe storage of endoscope valves ensuring they remain as part of a unique set with the parent endoscope. It helps meet national and international recommended guide-lines (AORN, ANSI/AAMI, SGNA, BSG, ESGE) stating endoscope valves (including rinsing valves) stay with the named endoscope throughout the cleaning process. Valves (including rinsing valves) should stay with a named endoscope as a set, to prevent cross-infection and enable full traceability. This is a single-use product which can-not be reused and thus aids in the reduction of cross-contamination. For more details, visit ruhof.com. •

ScopeIs that

safe?Check the cleanliness of flexible endoscopes with EndoCheck™

from HealthmarkFlexible endoscopes are notoriously difficult to clean. More

EndoCheck™ is a miniature chemistry kit that is simple to use

and interpret. Simply swab the biopsy channel of the scope with

check for a color change. Depending on the type of test used, a

color change indicates that blood residue or protein residue

remains in the channel, and should be reprocessed.

HEALTHMARK INDUSTRIES • WWW.HMARK.COM • 800 521 6224

Visit www.HealthmarkGI.com

reprocessing of your endoscopes.Healthmark and our GI products help the Endoscopy center manage the reprocessing of their scopes. We do this through

organize and track the steps in reprocessing (accessories, including labels). If it is not clean, it can not be considered high-level

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

the best one for you designed by you!

best one for you designeddesignedone for you designed

WE ONLY MAKE ONE SINK…

OPTIONAL FEATURES INCLUDE

Additional Options not shown: Push-button Height Adjustment - Auto sink bowl filling | Heated Sink Bowls | Custom Sink Bowl sizes | DI/RO faucets | Integrated Sonic Irrigator | Etched sink gallon markings | Storage shelves and drawers | Deck mounted Eyewash | Stainless steel peg board storage system

Integrated Ultrasonic System

Air and water pistols

Hydro-Force rinse Endo-Flush SystemSystem pistols

717.261.9700 • [email protected] • www.tbjinc.com

BLEED 8.5”

TRIM 8.25”

SAFETY 7.75”

BLEED 11”

TRIM 10.75”

SAFETY 10.25”

FULL PAGE



CLIENT SIGN–OFF:

AD SIZE

NOTES


PROOF SHEET


BUYERS GUIDE OTHER

PUBLICATION

MONTH


Rather than rely on cabinet air temperature,

we meticulously test the fluids inside to

ensure accurate warming.

From worry-free operation for caregivers

to ultimate comfort for patients, it’s what’s

inside that counts.

Do you trust your fluid temperatures?

We do.

Confident care from Enthermics.

www.enthermics.com | 1-800-862-9276

An ISO 13485:2003 certified company

FluidWarmers-FullPg-20150801.indd 1 8/25/15 2:16 PM


IN THE ORCONTINUING EDUCATION

CE664B

BY SUSAN PAULY-O’NEILL, DNP, RN, PPCNP-BC


I n the same-day-surgery recovery area, Mr. Shapiro awakens from anesthesia after a minor surgical procedure to repair an inguinal hernia and complains of new onset chest pain. He has a history of hypertension but has not had trouble with angina in the past. He takes a small daily dose of a diuretic and exercises regularly. He is extremely anx-

ious, calling for the nurse. The RN notes diaphoresis, cyanosis and an irregular heart rhythm, and hits the code button. Within minutes the team arrives: a charge nurse, a resident and a respiratory therapist. The patient deteriorates quickly into V-fibrillation, and the team springs into action. They begin chest compressions at a ratio of 30:2, but nobody re-members to place a backboard under Mr. Shapiro. The RT effectively opens the patient’s airway but soon realizes that the oxygen tubing is not attached to the ambu-bag. While trying to secure the tubing, the facemask falls to the floor. The charge nurse begins to draw up epinephrine at the resident’s request, but notices that Mr. Shapiro has a shockable rhythm. Why hadn’t the MD called for the defibrillator? The RN chimes in: “Can we please start over?”

Fortunately, this was a simulated interprofessional exercise in which mistakes cause no harm and practice makes perfect.

The goal of this simulation continuing education program is to provide nurses with an overview of simulation as an instructional strategy not only for nursing education, but also for interprofessional training. After studying the information presented here, you will be able to:

• Explain the potential benefits of augmenting healthcare education with simulation

• List three professions that have found interprofessional simulation training helpful

• Describe the advantages and limitations of this state-of-the-art technology

ContinuingEducation.com guar-antees this educational activity is free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See Page 39 to learn how to earn CE credit for this module.

CONTINUING EDUCATION CE664B

SIMULATION BASICS GETTING READY FOR

THE REAL THING

When simulated clinical experiences recreate the dynamics of real encounters, learning is sure to take place. This strategy is not new. In fact, in aviation and the military it has been a widely accepted format to train both novice learners and experienced personnel. Simulation is an immersive technique used to replace or amplify experiences found in real life. In healthcare, it improves patient safety and enhances care not only by refining individual skill and decision-making, but also by honing the performance of clinical teams.1 It’s a time-efficient, cost-effective method to teach healthcare provid-ers to recognize and avoid errors. Simulation can be used to enhance readiness for practice, teamwork and collaboration, communication, and leadership. It can take a variety of forms, from simple to complex.2

Anatomical models, also known as “task trainers,” replicate a portion of the body and can be used to practice skills. An anatomical model of an arm, with realistic-looking veins filled with red liquid, are used to teach IV line insertion, for example. Another strategy is the use of a

standardized patient. These simu-lated patients are actors playing the role of a patient so that a student may perform a physical assessment, take a history and practice communi-cation techniques.

Much more advanced technology – “human patient simulators” (HPSs) – are state-of-the-art mannequins equipped with realistic physiologic functions, and they closely resemble humans. What the educator is trying to accomplish determines the equipment to use. Learning to administer an IM injection may require only a task-trainer. Improv-ing a nurse’s ability to gather a patient history may require a stan-dardized patient while teaching a team to resuscitate a patient quickly and effectively may require an HPS.

The term “fidelity” is used to illustrate the model’s believability. The higher the fidelity, the greater the realism. A low-fidelity item, such as a static mannequin with no response capability (similar to a doll), may be used to teach simple psychomotor skills, such as nasogas-tric tube placement or body position-ing. High-fidelity HPSs can simulate


breathing, bowel sounds, heart sounds, pupil reaction and urinary drainage. Because the HPS interfaces with a computer monitor, users can see parameters on a screen, such as cardiac rhythm, continuous blood pressure, oxygen saturation and even more complex waveforms, including central venous pressure. The values can be changed with a few taps on the computer keyboard, recreating the responses likely to occur when interventions are used. When oxygen is applied, the educator or technician can raise the oxygen saturation reading, for example. Conversely, when the correct action is not taken, vital signs can be quickly turned to life-threatening levels.

These top-of-the-line human lookalikes are available from new-born to adult. But the equipment is only part of the technique. Case scenarios are what illustrate the potential course of events, often replicating a high-risk, low-occur-rence event, such as postpartum hemorrhage or cardiac arrest. In nursing programs, students may rotate into the simulation laboratory and participate in increasingly more complex cases from well checkups to septic shock. Some users purchase preprogrammed scenarios; others develop their own. In either case, working in small groups, participants are assigned roles before the simula-tion begins. Typically, one team member becomes the leader and directs others as the simulated scenario unfolds.

During the simulated scenario, the team members collect assessment data, prioritize care, provide treat-ments and communicate with one another. The case scenario typically runs for 20 to 30 minutes depending on the complexity of intervention and teamwork required. After the scenario is completed, the partici-pants spend additional time debrief-

ing, which allows them time to talk as a group, reflect on their reactions, share their observations and discuss their evaluation of personal and team performance. Faculty present during debriefing can help lead the discus-sion, correct misconceptions, review best practices and help students work through their emotions.

WHY SIMULATION?Traditionally, students in the health-care professions have learned by doing: See one, do one. However, concerns about patient safety have given us a push to reassess this largely unstructured apprenticeship approach. An alarming rate of morbidity and mortality among patients in the hospital has intensi-fied the scrutiny placed on health-care providers, including nurses.2 Quality and safety initiatives in both practice and academia demand top-notch competency and perfor-mance from healthcare providers and teams. The pressure is on to find a way to reduce errors and minimize patient risk. This has spilled over from the practice setting into the world of nurse education. How can we educate students with the least risk for patient harm?

In addition, there is a severe shortage of clinical sites for qualified students.3 Student learning is restricted by this limited availability and access to patients coupled with an apprehension about medical errors.4

Placing nursing students into clinical settings in which by random opportunity they provide whatever care they can during a shift may no longer suit the needs of healthcare. In addition, the inconsistency in what is available allows some students to fall through the cracks. Many students may complete an entire rotation without participating in activities critical to mastering

important competencies. As students are typically assigned to a single stable patient on a medical/surgical unit, they may not witness significant cardiac dysrhythmias, hemorrhage, shock or seizures. Here’s where simulation comes in: Students can be exposed to events in which they are expected to be competent yet do not often participate in during a clinical rotation. For example, an employer would expect that a new graduate nurse would be proficient in recog-nizing and responding to a deterio-rating patient condition, such as impending respiratory failure. If a student completed all clinical rotations without ever having witnessed this event, the student would be unlikely to react effectively when it occurs on the patient care unit. Simulation can fill in that gap, offering a realistic recreation of that event, with repetitive practice in how to respond quickly and accu-rately.

Nursing education is retooling to better prepare students for complex care, using simulation as an impor-tant component. Rehearsing re-sponses to challenging events is a vital contribution of simulation in the promotion of patient safety, development of decision-making skills and refinement of interprofes-sional communication. Students can use their time in simulation to assess both the patient and the environ-ment, isolate the important informa-tion that should be communicated to other healthcare providers and practice that communication.2 It provides an arena comparable to the clinical setting where students can learn to delegate.

Simulation allows legitimate practice without patient risk. Students are free to make errors and learn from their mistakes while causing no patient harm. In addition to the safety benefits, the expansion


CE664B


of simulated clinical experiences may reduce the time students need to spend in hospital settings, thus relieving some of the pressure on available clinical sites.3 Nurse educators may substitute a percent-age of clinical hours with simulation hours based on the regulations stipulated by the state’s board of nursing. Clinical groups of up to 10 students may split into two groups: one in acute care and the other in the simulation laboratory, rotating back and forth. This allows for smaller groups in the clinical arena at any given time.

WHO USES SIMULATION?It’s easy to imagine why incorporat-ing simulation into nursing educa-tion makes sense, from learning basic nursing skills, such as IV fluid management, to perfecting advance practice competencies, such as anesthesia induction and airway management. Simulation is used widely in prelicensure nursing programs across the nation to practice skills and decision-making before applying knowledge to real patients. A mixed educational model that combines classroom lectures, traditional clinical rotations and simulation is becoming a popular approach to basic nursing education. In fact, a large study by the National Council of State Boards of Nursing of 10 prelicensure nursing programs across the country supported the use of simulation as a substitute for up to 50% of traditional clinical time.5

Simulation has also been useful after graduation in nurse refresher courses, advanced cardiac life support training and critical care reviews, to name a few possibilities. Many healthcare facilities use simulation to validate competencies and help in the transition from student to newly employed nurse during orientation programs. The

anesthesia community uses the HPS to teach not only technical skills but also crisis management.6

But what about teamwork? We know that performance is strongly influenced by the interaction be-tween the task, the environment and the behavior of team members.7 Everyone has a role to play. In simulated exercises involving teams, members learn how not to step on each others’ toes. In practicing together, they become aware of their synergistic roles.7 Learners from several disciplines can practice relating to one another while providing safe care.

A variety of teams use simulation as a training tool. Student teams comprising pharmacy, medical and physician assistant students found success in a simulated interprofes-sional rounding experience in which they provided comprehensive medical care for a simulated patient in an inpatient setting.8 At the University of Washington, fourth-year medical, nursing and pharmacy students joined by second-year physician assistant students partici-pated in scenarios developed to help integrate interprofessional team training into the curriculum.9

Simulation holds promise in the area of professional regulation. While variability, validity, cost and difficul-ties in standardization may be barriers to using simulation as part of regulatory programs such as licensing and certification, some experts believe that simulation-based assess-ment may be integral in ensuring that the public is cared for by competent practitioners.10 The Institute of Medicine report “The Future of Nursing” proposes that simulation scenarios be used for professional assessment.10 In addition, the report suggests that simulation should be considered whenever new procedures and equipment are introduced.2

IS SIMULATION EFFECTIVE?When the human patient simulator is used to teach basic skills and even crisis management, the benefits have been widely recognized.5 The literature suggests that simulation makes a valuable contribution to healthcare education and training. Among its many positive effects, simulation has been shown to improve nursing students’ critical thinking, skills performance and knowledge; enhance their ability to care for a deteriorating patient; increase their confidence in personal abilities to perform in a given situation; communicate critical information to interdisciplinary team members; and boost medication calculation and administration abilities.11 ,12-15

Students benefit from observing one another’s successes and errors.2 Nurse educators in academic and practice settings have been using simulation to help improve learning, clinical competency, communication and confidence.16 The deliberate and repetitive practice available during simulation has been shown to improve nursing competence. But the positive effects transcend nursing. Interprofessional team training using high-fidelity simula-tion in advanced life support has been shown to improve proficiency better than clinical experience alone.17 In fact, hospital resuscitation teams trained in advanced life support using simulation improved patient outcomes after cardiac arrest.18 After interdisciplinary training with both nursing and medical school students, participants had more knowledge of team skills with a statistically significant improvement in attitudes toward teamwork. Several studies demon-strate that simulation training does transfer into measureable benefits for patients.10



Real improvement in clinical performance as a result of simulation is beginning to be established in the literature. A recent study involving nursing students revealed that those who participated in simulation had higher performance scores than those who did not participate. The higher performance levels were maintained on the clinical unit, where faculty observed that these students acclimated more quickly and achieved performance expecta-tions faster than the control group.19 In a study of medical/surgical nurses trained via simulation to react to deteriorating patient conditions, such as cardiac, respiratory and neurologic changes, participants showed an enhanced ability to respond in a systematic way.20 The participants were especially pleased with their increased skills in manag-ing breathing difficulties after this training. This was particularly important as the participants reported using these newly height-ened skills between one and five times in the three months after the simulations.20

LIMITATIONS Simulation is not real. The manne-quins may resemble humans, but clearly they are not real patients. Hence, participants may have trouble suspending disbelief and working through the scenario as though it were an authentic event. The team members’ ability and willingness to engage fully affects the communica-tion that takes place among partici-pants, which may have an effect on learning. While disbelief can be a hurdle, so too can anxiety. Some students worry about their ability to work through a critical event and may fall victim to their own fears. This is understandable as a student would never be expected to take on a

crisis in real life while that is routine in the simulation lab. Anxiety may be heightened further when students are evaluated based on their perfor-mance.2

Simulation has been found most effective when using small groups or teams. The logistics of rotating all students through the simulation laboratory can be difficult. Faculty must be present, which may result in the need for additional instructors. There are faculty training, ongoing technical support and administrative commitment to consider, as well. Learning to incorporate simulation requires commitment and dedication at a time when faculty workload is already heavy. Equipment in the simulation laboratory can be expen-sive. Additional laboratory space may not be available, and annual operat-ing costs may be prohibitive.21

While the HPS simulators may cost $20,000 to $60,000 or more, the overall price tag associated with simulation can range widely depend-ing on whether additional space, training and faculty time are includ-ed.2 However, experts agree that efficiencies in care and reduced errors can more than offset that cost.1

FUTURE PROJECTIONSThere is little debate: Simulation is indeed useful for reasons of patient safety, standardization of education and assessment of performance.5 The Institute of Medicine report advises us to develop and test new approach-es to prelicensure clinical education, including the use of simulation.22 While cost is certainly a big issue, schools of nursing and healthcare institutions can partner to share the cost and benefits of the technology.2

Moving forward, research that helps us know when to use simula-tion and how to use it most effective-ly will be key.23 For those who may

worry about losing the human touch, experts seem to be on the same page: Simulation is not expected to replace supervised work with real patients.1 Rather, the test ahead is to learn which combinations produce the best outcomes in the most efficient and cost-effective manner and with the most positive, lasting impacts on safe patient care.24 In a nutshell, finding the right combination of simulation and supervised clinical practice is our next important challenge. That process has been described as the opposite of the Rubik’s cube puzzle, when a player tries to create sides with a single solid color. Rather, successful simulation programs will be multi-colored, with a mix of the best components for the goals we want to meet. The combination of the abilities of the instructor, researcher and administrators put into play the best practices for success in what may be called the “simulation puzzle.”24

In light of the need to train and maintain a workforce of highly skilled nurses who can navigate an ever-increasingly complex health-care arena, nurse educators in practice and academia must be selective in determining which models of training work best. Learning techniques and activities that promote competence and enhance effective teamwork are surely the ones that should grab our attention.

RESOURCES International Nursing Association for Clinical Simulation and Learning http://www.inacsl.org/i4a/pages/index.cfm?pageid=1

Society for Simulation in Healthcare http://www.ssih.org/


CE664B

http://www.inacsl.org/i4a/pages/index.cfm?pageid=1

http://www.inacsl.org/i4a/pages/index.cfm?pageid=1

http://www.ssih.org/


The National League for Nursing, Simulation Innovation Resource Center http:// sirc.nln.org

University of Washington Center for Health Science Interprofessional Education, Research and Practice http://collaborate.uw.edu/faculty-development/teaching-with-simula-tion/teaching-with-simulation.html-0

Susan Pauly-O’Neill, DNP, RN, PPCNP-BC, assistant professor at the University of San Francisco School of Nursing and Health Professions, has developed a program of fully integrated clinical rotations using high-fidelity simula-tion throughout the BSN curriculum and conducted research on using simulation to improve patient safety.

REFERENCES1. Gaba D. The future vision of

simulation in health care. Quality Safe Health Care. 2004;13(suppl 1):i2-i10.

2. Durham, C, Alden, K. Chapter 51. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043. Rockville, MD: Agency for Healthcare Re-search and Quality; 2008.

3. MacIntyre R, Murray T, Teel C, Karshmer J. Five recommenda-tions for prelicensure clinical nursing education. J Nurs Edu. 2009;48(8):447-453.

4. Shreve J, Van den Bos J, Gray T, et al. The economic measure-ment of medical errors. Agency for Healthcare Research and Quality Web site. http://psnet.ahrq.gov/resource.aspx?resourceID=18975. Pub-lished 2010. Accessed January 15, 2015.

5. Hayden J, Smiley R, Alexander M, Kardong-Edgren S, Jeffries P. The NCSBN national simulation study: a longitudinal, random-ized, controlled study replacing clinical hours with simulation in prelicensure nursing education. J Nurs Regul. 2014;5(2 suppl):S2-S64.

6. Hawkins R, Bendickson L, Benson P, et al. A pilot study evaluating the perceptions of certified nurse anesthetists toward human patient simulation. AANA J. 2014;82(5):375-384.

7. Lateef, F. Simulation-based learning: just like the real thing. J Emerg Trauma Shock. 2011;3(4):348-352.

8. Shrader S, McRae L, King W, Kern D. A simulated interprofes-sional rounding experience in a clinical assessment course. Am J Pharm Educ. 2011;75(4):61.

9. Taibi D. SIM 101: Introduction to clinical simulation. University of Washington Web site. http://collaborate.uw.edu/faculty-development/teaching-with-simulation/basic/sim-101/sim-101-introduction-to-clinical-simulati. Accessed January 15, 2015.

10. Holmboe E, Rizzolo M, Sachde-va A, Rosenberg M, Ziv A. Simulation-based assessment and the regulation of healthcare professionals. Simulation Healthcare. 2011;6(7):S58-S62.

11. Lapkin S, Levett-Jones T, Bellchambers H, Fernandez R. Effectiveness of patient simula-tion manikins in teaching clinical reasoning skills to undergraduate nursing stu-dents: a systematic review. Clin Simulation Nurs. 2010;6(6):e207–e222.

12. Fisher D, King L. An integrative literature review on preparing

nursing students through simulation to recognize and respond to the deteriorating patient. J Adv Nurs. 2013;69(11):2375-2388.

13. Bambini D, Washburn J, Perkins R. Outcomes of clinical simula-tion for novice nursing stu-dents: communication, confi-dence, clinical judgment. Nurs Edu Perspectives. 2009;30:79-82.

14. Liaw S, Zhou W, Lau T, Siau C, Chan S. An interprofessional communication training using simulation to enhance safe care for a deteriorating patient. Nurs Educ Today. 2014;34:259-264.

15. Harris M, Pittiglio L, Newton S, Moore G. Using simulation to improve the medication admin-istration skills of undergraduate students. Nurs Educ Perspect. 2014;35(1):26-29.

16. Kaddoura, M. New graduate nurses’ perceptions of the effects of clinical simulation on their critical thinking, learning and confidence. J Continuing Educ Nurs. 2010;41(11):506-516.

17. Wayne DB, Butter J, Siddall VJ, et al. Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial. Teach Learn Med. 2005;17(3):210-216.

18. Moretti MA, Cesara LMA, Nusbacher A, et al. Advanced cardiac life support training improves long-term survival from inhospital cardiac arrest. Resuscitation. 2007;72,458-465.

19. Meyer M, Connors H, Qingjiang H, Gajewski B. The effect of simulation on clinical perfor-mance: a junior nursing student clinical comparison study. Simulation Healthcare. 2011;6:269-277.


http://sirc.nln.org/

http://collaborate.uw.edu/faculty-development/teaching-with-simulation/teaching-with-simulation.html-0



http://psnet.ahrq.gov/resource.aspx?resourceID=18975



http://collaborate.uw.edu/faculty-development/teaching-with-simulation/basic/sim-101/sim-101-introduction-to-clinical-simulati







20. Buckley T, Gordon C. The effectiveness of high-fidelity simulation on medical/surgical registered nurses’ ability to recognise and respond to clinical emergencies. Nurs Edu Today. 2011;31:716-721.

21. Hanberg A, Brown S, Hoadley T, Smith S, Courtney B. Finding

funding: the nurse’s guide to simulation success. Clin Simula-tion Nurs. 2007;3(1):e5-e9.

22. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Acad-emy Press; 2011.

23. Cook D. One drop at a time:

research to advance the science of simulation. Simulation Healthcare. 2010;5(1):1-4.

24. Groom J. Creating new solu-tions to the simulation puzzle. Simulation Healthcare. 2009;4(3):131-134.

An instructor presents a simulation scenario to students, who must quickly intervene to avoid impending patient deterioration. A high-fidelity human patient simulator (“Jeff”) is in the bed with a computerized monitor visible. Participants are assigned the roles of primary nurse, charge nurse, resident physician and pharmacist. Jeff is an 18-year-old with acute lymphoid leukemia. He has been receiving chemotherapy for the last three months and has a triple-lumen central venous access device. He was admitted to the unit with weight loss, fever, fatigue, neutropenia and vomiting. His admission assessment reveals several deviations from normal: temp of 39 C, a productive cough and ulcers inside his mouth. His initial medical orders include neutropenic precautions, blood and urine tests, IV antibiotics, maintenance fluid therapy, antipyretics and pain medication.

The medical orders include collection of blood from a central venous access device. Simulation is an ideal place to practice skills like this because:

A. Students have no anxiety when practicing skills in the simulation laboratory.B. Repetitive practice during simulation has been shown to improve nursing competence.C. If the student does not know how to complete the skill, he or she can cancel the order.D. There is no pressure on participants to complete the skill correctly.

As the designated leader in any interdisciplinary simulation scenario, the primary nurse should:

A. Assign tasks to each participant so that everyone remains active.B. Wait until the physician tells the team what to do.C. Instruct the pharmacist to go obtain the medications.D. Directs others as the simulated scenario unfolds.

A high-fidelity mannequin is an excellent tool to use for this simulation scenario because:

A. Vital signs on the monitor screen can be manipulated to mimic deteriorating condition.B. Students can’t cause any pain in a mannequin.C. There is no risk to an actual patient.D. Students will not be distracted by any patient conversation.

Which statement is TRUE about simulation?

A. Nurses call the attending physician for further instructions if an emergency arises.B. Nurses ask the charge nurse to prioritize the interventions.C. Simulation may be important to ensure patients have competent practitioners.D. Nurses defer to the pharmacist to decide which medications need to be administered first.

CLINICAL VIGNETTE

2

4

1

3

IN THE OR1. Correct Answer: B—Deliberate and repetitive practice during simulated scenarios helps to enhance abilities to complete skills. 2. Correct Answer: D—Interdisciplinary simulations are most effective when team members are aware of their synergistic roles.3. Correct Answer: A—The human patient simulator interfaces with a computer monitor so that users can visualize parameters on a screen that can be set to imitate worsening patient condition.4. Correct Answer: C—Some experts believe that simulation-based assessment may be integral in ensuring that the public is cared for by competent practitioners.


HOW TO EARN CONTINUING EDUCATION CREDIT1. Read the Continuing Education article.2. Go online to ce.nurse.com to take the test for $12.

If you are an Unlimited CE subscriber, you can takethis test at no additional charge. You can sign up for an Unlimited CE membership at www.nurse.com/unlimitedCE for $49.95 per year.

DEADLINECourses must be completed by 2/28/2017.3. If the course you have chosen to take includes a

clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.

4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test.

5. All users must complete the evaluation process to complete course. You will be able to view a certifi cate on screen and print or save it for your records.

ACCREDITEDContinuingEducation.com is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Accredited status does not imply endorsement by the provider or ANCC of any commercial products displayed in conjunction with this activity.

ContinuingEducation.com is also accredited by the Florida Board of Nursing and the Georgia Board of Nursing (provider # 50-1489). ContinuingEducation.com is approved by the California Board of Registered Nursing, provider # CEP16588.

ONLINENurse.com/CEYou can take this test online or select from the list of courses available.Prices subject to change.

QUESTIONSQuestions or for a complete listing of our coursesPhone: 800-866-0919Email: [email protected]

SAVETHE

DATE

AUGUST 28-30, 2016

CHICAGOHILTON OAK BROOK

HILLS RESORT

WWW.ORTODAYLIVE.COM

Empowering the Surgical Services Community

EDUCATIONNETWORKINGEXHIBIT HALL

FULL PAGE AD IN ALL MAGAZINES MOVING FORWARD

REST EASY KNOWING THERE IS A SOLUTIONyour source for anesthesia systems, monitors, and warranteed parts at a fraction of the cost of o.e.m.Paying a fortune for repair parts? No one to call for Free Tech Support? Doctors Depot can cure your Anesthesia Machine nightmares!

NOW OFFERING:• Free technical support (800)979-4993 (anesthesia machines)

• GE PDM module depot repair or exchange

100% satisfaction

or your money back

All refurbishing done in-house by Factory trained and certified technicians.

100% satisfaction

or your money back

All refurbishing done in-house by Factory trained and certified technicians.

GE Datex-Ohmeda S5 ADU Carestation• • Several configurations available.

• Includes 12” Screens

• Complete S5 Monitoring System

• Ohmeda ADU certified technician in-house

Dräger Fabius GS and Fabius GS Premium • Includes Ventilator modes: Pressure

Support, SIMV, Volume and Pressure Control.

• Heated Absorber

• CLIC system for Soda Sorb

• Color display

Datex-Ohmeda Aestiva 5 • Includes 7900 Smartvent

(Optional PSV Pro Software)

• Option: S5 Anesthesia Monitor (as shown in picture)

GE Avance• Complete patient monitoring capabilities:

respiratory gas, hemodynamic and adequacy of anesthesia.

• Our state of the art electronic gas mixer with pneumatic back-up control.

• Advanced Breathing System(ABS)

• All modes of ventilation available.

Mindray A5• 15” Touchscreen

• VCV, PCV-VG, PS, SIMV-VC, and SIMV-PC Ventilation Modes

• Heated Absorber

• Data output compliant with most EMR systems

GE Aisys • VC, PC, PS w/Apnea Backup, SIMV Volume and

Pressure, Electronic PEEP, PCV-VG, PCV-PG.

• Fully upgradeable to add new technologies as your needs change.

• Can be integrated with your hospital information system.

• Low circuit volume contributes to a fast response well suited for low flow cases - 2.7 L in vent mode, 1.2L in manual mode.

Dräger Fabius Tiro• Compact, space-saving design

• High performance ventilation w/all major modes

• CLIC Absorber systems

• Intelligent safety features for enhanced patient protection

• Standardized Dräger user interface for easy and intuitive operation

GE Aespire 7100/7900• 7900 Smartvent includes PSV Pro SW

• 7100 Ventilator features volume and pressure control modes with Electronic PEEP.

• Advances Breathing System(ABS)

• Pressure waveform for visual reference on a breath-by-breath basis

• Smart Alarms direct user to specific problems and affected parameters

Doctors Depot800.979.4993 | doctorsdepot.com | [email protected]

REST EASY KNOWING REST EASY KNOWING SOLUTION

monitors, andcost of o.e.m.

Doctors Depot can cure your Anesthesia Machine nightmares!

800.979.4993 | doctorsdepot.com | [email protected]

Zzzzzz... What a relief, Drs Depot

Tech Support helped me

save $1,200!

BLEED 8.5”

TRIM 8.25”

SAFETY 7.75”

BLEED 11”

TRIM 10.75”

SAFETY 10.25”

FULL PAGE



CLIENT SIGN–OFF:

AD SIZE

NOTES


PROOF SHEET


BUYERS GUIDE OTHER

PUBLICATION

MONTH


2x2 surgical fixture (2x4 also available)

Clean Your EnvironmentClean Your Environment

CONTINUOUSLYCONTINUOUSLY

Current environmental disinfection methods are applied (episodically) at discrete moments in time and the results are short-lived as harmful bacteria re-populate the space. Unlike UV light, patients and staff can be in the room while Indigo-Clean safely, automatically and continuously disinfects the environment.

Indigo-Clean™ is an overhead light fixture that continuously disinfects the environment using safe, visible light.

Don’t Just Clean... Indigo-Clean™

Indigo-CleanTM is available in three configurations:

• Mixed White: A solution combining Indigo (405nm) and standard white LEDs to create the look of white overhead lighting. Use when room is occupied.

• Indigo-Only: A solution which emits the highest dosage of bacteria killing light (exclusively 405nm). Use when room is occupied or unoccupied.

• Switchable: A solution where you can conveniently toggle between mixed white or Indigo-only, depending on room usage patterns or personal preference (shown to the left)

Surgical Suite Application

www.indigo-clean.com

Indigo-Clean Featured in: ECRI Top 10 Watch List

Indigo-Clean is exhibiting at the APIC Annual Conference in Charlotte, NC, June 11-13 and at the OR Manager Conference in Las Vegas, NV, Sept. 21-23

CREATING THEULTIMATESURGICALENVIRONMENTBY DON SADLER

The word ultimate gets thrown around a lot these days. Whether it’s the ultimate sub sandwich, the ultimate sports car, the ultimate

big-screen TV or ultimate Frisbee, it seems like everybody wants to call their favorite whatever-it-is “the Ultimate.”

So we thought we’d focus our cover fea-ture article in this issue on creating “the ultimate surgical environment.” To fi nd out how, we spoke with several periopera-tive veterans to get their thoughts on what it takes to create the ideal surgery center.

It Starts With LeadershipEveryone we spoke with said the same thing when fi rst asked what it takes to create the ultimate surgical environment: great perioperative leadership.

“It starts at the leadership level,” says Virginia Chard, the director of surgical services at Pen Bay Medical Center in Rockport, Maine. “Perioperative leader-ship needs to clearly defi ne a commit-ment to excellence. OR staff needs a leader they can trust who is engaged in the daily challenges of the unit.”

Perioperative leadership needs to clearly defi ne a commitment to excellence. OR staff needs a leader they can trust who is engaged

in the daily challenges of the unit.”

Everyone we spoke with said the same thing when fi rst asked what it takes to create the ultimate surgical environment:

“It starts at the leadership level,” says

defi ne a commitment to excellence. OR staff needs a leader they can trust who is engaged

WWW.ORTODAY.COM

“Having a smooth-running OR has a lot to do with the leadership capabilities at the top of the organiza-tion,” adds James X. Stobinski, Ph.D., RN, CNOR, the director of credential-ing and education at the Competency & Credentialing Institute.

“Leaders need to balance the needs of OR staff with the increasing demands for effi ciency in health care delivery,” says Stobinski. “There are a lot of balls that have to be kept up in the air.”

Jan Davidson, MSN, RN, CNOR, CASC, the director of the Ambulatory Surgery Division for the Association of periOperative Registered Nurses (AORN), notes that there are many diff erent leadership styles.

“However, great leaders are able to adapt their leadership style to the demands of the situation or challenges that the organization may face,” Davidson says.

There are pros and cons to all leadership styles, says Davidson.

“Unfortunately, the classic model of military-like leadership is the model most often used in the OR — and this is probably the least effec-tive leadership style,” she explains.

“If employees are rarely praised for

their good work, this will eventually lead to low job satisfaction and low employee morale,” Davidson adds. “And this, in turn, leads to low physi-cian satisfaction, poor teamwork and poor communication. It can even impact surgical outcomes.”

Stobinsky points to the ability of OR leadership to help staff navigate all of massive changes health care organiza-tions are facing today as critical to cre-ating the ultimatesurgical environment.

“Invest in ongoing education and training for your staff , including your managers,” he says. “By taking good care of your people, you’ll cre-ate a better OR environment and get better results.”

“Having clearly defi ned goals and practicing constant communication with your front-line staff will drive both the morale and effi ciency of your team,” adds Chard.

Quality Over QuantityAnother change OR leadership and management has to deal with today that they didn’t in the past

is the increased focus on quality over quantity.

“The old saying that volume cures a lot of ills no longer holds true,” Stobinsky says.

“Managing the OR today is about much more than just maintaining a high-utilization rate,” he adds. “With the shift to accountable care organizations and changes in health care reimbursement, qual-ity outcomes are more important than ever in creating the ultimate surgical environment.”

Having a patient-centered focus is critical.

“Everyone on the OR team should share one common goal: to support patients with safe, high-quality care in a cost-eff ective and effi cient model of practice. This requires a commitment to cost awareness and fi nding safe ways to improve ef-fi ciency,” Chard says.

Stobinsky echoes her sentiment about being patient centered.

“For example, what are patients’ expectations for how long they should have to wait for surgery?” he asks. “Many ORs need to change the way they do things so the focus is on the patient and not the surgeon. Oth-erwise patients will go somewhere else — they have choices today.”

Addressing Key ConcernsIn the 2015 OR Today Reader Survey, issues listed among perioperative nurses’ biggest concerns include deal-ing with diffi cult personalities and creating accountability in the OR. All of the perioperative veterans we spoke with agreed that addressing these con-cerns is one of the keys to creating the ultimate surgical environment.

“Difficult personalities and a lack of accountability in the OR can be demoralizing and lead to

Jan Davidson

ULTIMATECREATING THE

SURGICALENVIRONMENT

is the increased focus on quality

If employees are rarely praised for their good work, this will eventually lead to low job satisfaction and low employee morale.”–Jan Davidson


WWW.ORTODAY.COM

Virginia Chard

low morale among staff,” says Davidson. “But while staff mem-bers need to be held accountable for their actions, this doesn’t mean mistakes have to be punitive.”

“Instead, mistakes should be viewed as a learning opportunity for everyone and a chance to make improvements,” Davidson adds. “In fact, statistics show that the majority of medical errors occur due to a flaw in the system rather than human error.”

Stobinski notes that in the past, many hospitals tolerated abusive behavior on the part of surgeons because they brought in volume and revenue.

“But not anymore,” he says. “Cre-ating the ultimate surgical envi-ronment requires dealing head-on with difficult personalities in the OR, including difficult surgeons.”

One simple step that Davidson recommends to help create a more relaxed and productive OR environ-ment is to allow everyone on the team to be called by their fi rst name.

“This tends to put everyone on an equal playing field, removing the hierarchy and making each team member feel valued,” she says.

“In front of patients and family members, it should still be the expecta-tion that physicians be called ‘doctor,’ ” Davidson adds. “But otherwise, allow-ing everyone in the OR to be on a fi rst-name basis will do a great deal to raise the morale and improve teamwork.”

A Few Best PracticesChard lists a few best practices followed at her facility that help as they strive to create the ultimate surgical environment.

“For one thing, we have a review of our operating room dashboard data every month at our staff

meetings,” she says. “In addition, we have clearly defined perfor-mance goals and benchmarks. And, we utilize data driven key perfor-mance indictors in our Lean Daily Management within the unit.”

Davidson acknowledges the challenges staff face in room turn-over between cases, especially in ambulatory surgery centers.

“A consistent surgical volume equals a profitable surgery center,” she says.

She recommends ensuring that there’s adequate help with room turnover.

“Having an extra person to ‘float’ can be invaluable,” she says. “This extra person can not only help with room turnover, but also with covering during lunch and other breaks. Also, staff is less likely to cut corners if they have adequate help and don’t feel so rushed.”

“With enough help, you might even be able to add an extra case or two, which will more than pay for the extra staff person,” she adds.

Celebrate Success!Finally, Davidson strongly rec-ommends that OR leadership and staff celebrate success every month.

“Whether this be that you exceed-ed your volume from the previous month, you had no surgical site infections, or your patient satisfac-tion scores continue to rise, it’s important that everyone on the team be included in the recogni-tion,” Davidson says.

“Creating the ultimate surgical environment is all about com-munication, shared goals and shared purpose,” Chard stresses in summing everything up. “It’s the people who make a great OR.”

It’s the people who make a great OR.”–Virginia Chard


Use the Coupon CodeSTERILIZE

For $15 O� Calzuro Orders

Autoclave Your Calzuro & Personalize Scrubs Today!

CALZURO.COM800-257-9472

The Italian Calzuro ergonomically designed for medical professionals. The 1.5 “ heel reduces fatigue by setting the body anatomically correct. Massaging

bumps aid to blood circulation. Protect against contamination by sterilzing the Calzuro in the autoclave, machine wash, or disinfecting with bleach.

EXTENDED BLEED FOR FULL PAGE

[email protected] USFIND US ONLINE

800.261.9953CALL US

Patient positioning solutions for MIS & robotic surgery.

PatientGuard™ Robotic Positioning System

PatientGuard™ Lateral Positioner

ArmGuard™ Arm Protector

FaceGuard™ Face Protector/ Tray

No shoulder braces. Non-structural lateral stabilizing pillows con-trol body mass shift.

No patient sliding. Patented “Speed Bump” bolster is clinically proven to stop patient sliding.

System easily accommodates High BMI pa-tients up to 550 lbs.

.

.

.“TrenGuardTM is the ONLY safe restraint for extreme Trendelenburg without a single report of a patient sliding. There has never been a report of post-operative discomfort or patient injury.”

– Dan Allen

TrenGuard™ Trendelenburg Restraint

FEATURING

Trendelenburg Patient Restraint

Visit our website for a link to our webinar: “The Trendelenburg Position for Robotic

Surgery.” Earn one free contact hour!

TrenGuardTM

TrenGuard™ Covered by Patent # 9149406B2, Other Patents Pending Copyright 2016 D. A. Surgical All Rights Reserved AD201603271


800.261.9953CALL US









.

.


– Dan Allen


FEATURING




TrenGuardTM



800.261.9953CALL US









.

.


– Dan Allen


FEATURING




TrenGuardTM


BLEED 8.5”

TRIM 8.25”

SAFETY 7.75”

BLEED 11”

TRIM 10.75”

SAFETY 10.25”

FULL PAGE



CLIENT SIGN–OFF:

AD SIZE

NOTES


PROOF SHEET


BUYERS GUIDE OTHER

PUBLICATION

MONTH



Spotlight on: Mary Salabounis

RN, Aspen Valley Hospital

"A few nurses stood out as having made a difference in the world and being patient

and kind. They inspired me that I could work just as hard, but rather than

changing a corporation’s bottom line, I could change someone’s life."


When Mary Salabounis arrived at Aspen Valley Hospital in Aspen, Colorado, it was as a travel nurse. In the mountains, health care workers count ski seasons instead of years,

and Salabounis is on her third, having relocated for good after two prior seasons interrupted by a summer tour of duty in Bozeman, Montana. She’s fl ourished in Aspen, having taken home a Colorado Health Care Stars Award in February for her work educating surgical staff on LEAN methodology and earning a promotion to charge nurse along the way. It seems only fi tting that Salabounis should be lauded for bringing her peers up to speed on best practices; after all, she said, it’s how she was brought up in the fi eld.

About 13 years ago, Salabounis was in the middle of successful a sales career in Chicago. Looking for a way to give back in her down time, she discovered that the nearby Advocate hospital in Libertyville, Illinois, broadcast an inpatient bingo channel on its closed-circuit network. Salabounis thought it would be fun to be a caller, but discovered that the Advocate bingo network only aired during business hours, while she was working. The only alternative

volunteer opportunity available was in the emergency room, which Salabounis “just really couldn’t wrap [her] brain around.”

“I really was not familiar with the environment,” she said. “I had never been around people with an illness or an emergency. I just wanted to be the lady that provided the fun. I said I would try it once.”

When she arrived, Salabounis saw how hard the fl oor staff was working; how anxiety and anticipation

weighed on patients waiting to be seen. She decided to come back for a second day, armed with crossword puzzles and coloring pages. The nurses started sending her on kitchen errands to fetch meals for patients who were being admitted. Suddenly, an unenviable chore became an opportunity to make people comfortable, and Salabounis found herself making a routine of her three-hour Monday night visits. Along the way, the examples of a few hard-working staff ers motivated her to take up nursing full-time.

“A few nurses stood out as having made a diff erence in the world and being patient and kind,” Salabounis said. “They inspired me that I could work just as hard, but rather than changing a corporation’s bottom line, I could change someone’s life. At 32 years old, I quit my job in sales and entered nursing school.”

One of those was nurse Karen Turel, who set an example of kindness and professionalism, Salabounis recalled, particularly in treating inmates, the homeless, or patients with fetid wounds. Another ER nurse, whom she only remembers as Michael, helped her with a nursing-school paper on anaphylaxis and told her, “You’re going to be great at this.”

“The whole crew of doctors and nurses who were there on a Monday night inspired me to open that door,” Salabounis said. “Had I been somewhere else, I don’t know if I would have been so welcomed into the profession.”

From those early moments, or perhaps in deference to them, Salabounis still takes inspiration from the variety of challenges she encounters in the nursing fi eld, be they from coworkers, patients, or diffi cult

Mary Salabounis is seen with her nursing staff.


surgical cases. Emergencies have a way of clearing the mind of all distractions, and she appreciates how clearly it crystallizes her attentions and reactions. Salabounis fi nds that one of the most reliable tests of her nursing acumen is how well she responds to patients at multiple levels of acuity who need things simultaneously, or in balancing the demands of diff erent colleagues in the operating room.

“I know that if we have a situation going on or a patient going in, you turn all those other thoughts off ,” she said. “You’re thinking about step one, step two, step three; who do I need to contact, what’s the priority? In the OR setting, you’re really in close collaboration with your anesthesia provider, who is 50 percent of the equation; the other 50 percent is the surgeon. Working with both of them simultaneously, and communicating with your scrub tech to seamlessly make their orders happen while it’s all going on at once, you’re

synthesizing all this information coming to you and providing care in the best way that you know how.”

Coming to nursing later in life has its benefi ts as well, Salabounis said. In the operating room, where a nursing professional must be able to have the confi dence of his or her convictions, age has allowed her to keep from being easily intimidated. She entered the fi eld with a variety of problem-solving experiences from a previous career. Even enrolling in nursing school as a change-of-life student gave her a level of comfort in the classroom that her classmates didn’t necessarily possess.

“Any life experience brings confi dence,” Salabounis said. “I wasn’t quite as fearful of tests; I wasn’t as burdened by homework. I knew I had a solid goal. I had been in the working world for a time. With changing technology and advancing disease processes, nursing is something that I will always continue to learn to stay current with my

career and to enhance myself as a person and a nurse.”

“Career change can be inspiring,” she said. “If you don’t have that calling in your initial time in college, don’t be afraid to change. Nursing programs are very accommodating. It’s a second chance to have a great career.”

Some lessons aren’t learned in the classroom, however: the way it feels to comfort a nervous patient, or the look of relief on the face of a frightened patient who opens his or her eyes to fi nd a procedure has been completed. In those moments, Salabounis fi nds the ability to take pride in her work, “because even though you’re getting paid, you’re still making a diff erence in someone’s life.”

“Even though it’s technically my job, I get to secretly know that I made somebody comfortable; that I kept them safe,” she said. “It’s very satisfying.”

Fall Hike on Tiehack overlooking the Maroon in Bells, Aspen, Colorado.Mary Salabounis is seen on Tiehack/

buttermilk Mountain, Aspen, Colorado.

Mary Salabounis is seen above Sydney

Harbor in Sydney, Australia.

"Career change can be inspiring. If you don’t have that calling in your initial time in college, don’t be afraid to change."


Making the most of an opportunity while giving back to the community isn’t some-thing most people do. It’s not easy and it

doesn’t happen as often as it should. Edward McKay isn’t like most people.

McKay, the surgical technician in the pediatric operat-ing room at John Hopkins University Hospital who was featured in the January/February issue of OR Today, is no stranger to powerful individuals. He works with surgeons and that includes working alongside presiden-tial hopeful and surgeon Ben Carson for almost a decade earlier in his career.

McKay grew up in the Latrobe projects of East Baltimore and was one of the few people in his group of friends to complete high school. From there, he was able to obtain a job in the John Hopkins University Hospital’s environmen-tal services department. He later found out about a program that helped with education costs while he continued to work. He applied and, through dedication and hard work, was able to obtain a degree from Baltimore City Community College. It was that degree that empowered him to become a surgical technician.

A biographical video on McKay that is used as part of the hospital’s orientation program has been seen by thousands and prompted the OR Today feature story that ran earlier this year.

The OR Today story written by Matt Skoufalos was well received by McKay and the hospital staff . It also received recognition from President Barack Obama. McKay, interested in the My Brother’s Keeper initiative started by Obama, emailed the President of the United States, Vice

President Joe Biden and the White House to share his story because of his interest in the program and a desire to get involved.

“It’s a program where you mentor young black men from the inner city. I thought it would be cool to join the Program and share my story of overcoming my obstacles growing up in the projects with the program,” McKay said.

“I was reading online and I saw President Obama talking about it in a couple of diff erent interviews. One was with Charles Barkley and the other one was with Kendrick Lamar,” he added. “I was interested in joining it while I was listening to them discuss what the program was about. I felt like it is a program that was needed. I like sharing my

CONTINUATION FROM JANUARY

SPOTLIGHT ON ARTICLE

PRESIDENTIAL RECOGNITION

By John Wallace, Editor

Edward McKay, Jr.

is seen with a framed letter from President Barack Obama. (Photo: Cathleen Hannah, RN)


story with young people from diff erent backgrounds to show them that you don’t have to be a product of your environment.”

McKay was shocked when he received a response from one of his emails.

“When I fi rst started sending emails, I never thought that I would get a response. I had just begun sending them the week before and I’m sure that the White House gets thousands of emails and letters each day,” McKay said. “I was sending emails to Joe Biden, President Obama and the White House, itself. The day that I received the email, I had just fi nished working out at the gym and I stopped to check my messages before I left. It completely blew me away. I never thought that I would see my name and the president’s name on the same piece of paper.”

“When you send the email you can choose your heading,” he continued. “You can choose from civil rights or health care or education, but the My Brother’s Keeper campaign wasn’t an option. So, that tells me that some-body really did read my article and watch my video.”

The letter from Obama has motivated McKay to do more outreach to youth in the community.

“My plans now are to move forward and help out with programs like this as much as I can. I’ve been doing speaking engagements with fourth-graders, high school-ers and some community colleges. I love talking to young kids and telling them about my background and taking questions,” McKay said. “My ultimate goal is to write a book and further tell my story to help inspire the youth of America. I used to watch Ben Carson do speaking engagements every year and he also had the Carson Scholarship Program to help get more children to read and think big. I would like to do the same thing.”

Knowing that Obama has his back helps. McKay said even the adults in attendance at his talks have a positive reaction to his letter from the Oval Offi ce.

“I bring that letter from President Obama with me when I speak to children and they love it. The adults get goose-bumps when they see it, too,” McKay said. “That video that I did opened up a lot of doors for me and now the magazine article has helped take things to a new level.”

READ THE LETTER online at www.ortoday.com/presidential-recognition.

“ I used to watch Ben Carson do speaking engagements every year and he also had the Carson Scholarship Program to help get more children to read and think big. I would l ike to do the same thing.”

DESIGNER:

Prepared To Endure

YOUR PATIENT IS PREPPED AND COMFORTABLE. ARE YOU?

Prepared To EndurePrepared To Endure

Contact us at 321-752-4130 to find out how you could receive a free 30-day trial coolvest.com/OR



CLIENT SIGN–OFF:


PROOF SHEET

1/4 Page VerticalAD SIZE

NOTES

TRIM 4.5”

TRIM 3.25”


BUYERS GUIDE OTHER

PUBLICATION

MONTH



Infusion Pump Support and Power Relocation Devices

888.656.0755 • [email protected] • www.aiv-inc.com

Infusion Pump Sales & Support

• Flat Rate Repairs• AIV Certified Refurbished

Pumps• Replacement Parts

PowerMATE® Special PurposeRelocatable Power Taps

• CMS Waiver Compliant• UL-1363A Recognized• Locking IV Pole Mount• 15 & 20 Amp Models

616A

AIV Gives You ConfidenceEverything we manufacture and repair at AIV is done to ISO-13485 standards.

Our facility is audited annually to ensure we are held to these high standards, giving our customers confidence in the products they recieve from us.

FOR 65+ YEARS SUBURBAN SURGICAL HAS DESIGNED, ENGINEERED & MANUFACTURED QUALITY STAINLESS STEEL PRODUCTS. IF YOU ARE LOOKING FOR CASE CARTS, LINEN CARTS, UTILITY CARTS, LINEN HAMPERS, INSTRUMENT TABLES, MAYO STANDS, IV STANDS SOLUTION STANDS, STEP STOOLS, BASSINETS, INSTRUMENT & WORK TABLES, SCRUB SINKS, KICK BUCKETS OR RECEPTACLES YOU WILL FIND OUSTANDING QUALITY AT SUBURBAN SURGICAL COMPANY.

800.323.7366 PHONE: 847.537.7320 EMAIL: [email protected] WWW.SUBURBANSURGICAL.COM

New & Refurbished Anesthesia Equipment

www.ParagonService.com800-448-0814 Fax 734-429-3197

SPECIALParagon/Penlon

$8,900

Regional Biomedical ServiceIn-house Biomedical Repairs

New and Refurbished VaporizersVaporizer Pole Mounts

Gas Fittings and Hoses- All TypesAnesthesia Accessories

Oxygen SensorsHeine Laryngoscopes

Oral Surgery Analgesia Units

Refurbished Refurbished Refurbished New MindrayPassport 2 Cardiocap/5 Mindray Spectrum Passport 8 & 12

Video Stylet Masimo Pronto StimPod Nerve Masimo Root w/ Only $499 each SpHb Spot-Check Stimulator & Locator EtCO2 & Multigas

New Gomco Aspirators &

Suction Equipment

S/5 Aestiva Refurbished Refurbished RefurbishedSPECIAL $9,800 Fabius GS Aespire 7900 S/5 Avance

Paragon Service


APPLE-CIDER VINEGARApple-cider vinegar helped increase “good” HDL cholesterol in animal studies. Plus, it contains a polyphe-nol, chlorogenic acid, thought to reduce “bad” LDL cholesterol. Apple-cider vinegar has a pale- to medium-amber color and can be found fi ltered or unfi ltered. Apple-cider vinegar can help draw out fl avors in recipes, and is often used in salad dressings, apple-based desserts or to make a glaze for pork chops.

RED-WINE VINEGARAcetic acid, which gives red-wine and other vinegars their sour taste, helps you stay satisfi ed after eating by minimizing blood sugar spikes. As you might expect from its name,

red-wine vinegar is made from fermented red wine. It’s commonly used in vinaigrette salad dressings, or stirred into a bit of butter to dress wilted or sauteed greens.

BALSAMIC VINEGARThe antioxidant quercetin, found in grape-based vinegars like balsamic and apple vinegars, may help tame high blood pressure, says research in the Journal of Nutrition. True balsamic is made from cooked and pressed Trebbiano or Lambrusco grapes, which are aged in barrels. Check your label to be sure sugar hasn’t been added to mimic the inherent sweetness of a high-quality aged balsamic. Balsamic vinegar is delicious in salad dressings, or can be

reduced by boiling and drizzled over pork chops or even ice cream.

RICE VINEGARVinegars contain phenols, naturally occurring plant compounds linked with reduced cancer risk. One type of rice vinegar, kurosu, boasts more than any other. Rice vinegar is typically a very pale yellow color, and is most com-monly used in Asian cooking because of its mild acidity and slight sweetness. You’ll also fi nd seasoned rice vinegar on grocery shelves, but regular rice vinegar is typically a more versatile choice to keep in your pantry, as you can choose what seasonings to add yourself.

RASPBERRY VINEGARRaspberry vinegar is made by fi lling a jar with whole, fresh raspberries, and adding enough good-quality red-wine vinegar to cover the berries. After sitting for about a week (covered), the raspberries are strained out, leaving behind a fruity-tasting vinegar that can be drizzled over ice cream or used in vinaigrettes. A bottle of raspberry vinegar should be used within six months.

BY GINA ROBERTS-GREYEATINGWELL.COM

OUT OF THE ORHEALTH

V inegar’s not a magic elixir – but it may be able to help your waistline, cholesterol and more! Research sug-gests that a splash of vinegar may give your weight-

loss efforts a small boost, as people who added raspberry vinegar or apple-cider vinegar to their diets daily for at least four weeks slimmed down more than those who didn’t get vinegar. Who knew? Here’s a little more information about some common vinegars, plus some ideas for how to work vinegar into your daily diet.

A SPLASH OF VINEGAR OFFERS SURPRISING

HEALTH BENEFITS


TOP SURFACE

• Provides necessary friction with surgical booties

• Easy-to-clean with hospital grade quaternary cleaners

• NFPA 260 & CAL 117 compliant

• Anti-microbial & anti-bacterial

NON-SLIP BOTTOM

• Certifi ed for high traction by National Floor Safety Institute

GELPRO®

MEDICAL ANTI-FATIGUE MATS SIGNIFICANTLY REDUCE PAIN AND FATIGUE WHILE STANDING

1.866.435.6287

GelProMedical.comMADE IN THE USAWITH IMPORTED TOP FABRIC

Ideal for Operating Rooms, Procedure Areas, Cath Labs, Radiology & Pharmacy

ENERGY-RETURN FOAM

100% GELPRO GEL

EXCLUSIVE

DUAL DENSITY™

COMFORT

PROFESSIONAL COMFORT FOR SURGEONS, NURSES & TECHNICIANS

Stop the Hurt While You Work


OUT OF THE ORFITNESS

OUT OF THE ORFITNESS BY MARILYNN PRESTON

Yes! What could be better? No time-sucking commute to the gym. No monthly dues. No comparing yourself to the thinner and more buffed in your spinning class. (Never ever do that.)

At home, it’s just you and the practice and your growing awareness that regular exercise is the rock solid foundation of a healthy lifestyle.

You’ll gain strength, reduce stress, and duh, you’ll make your body great again. Exercising at home burns pounds of calories. But keep in mind: You can’t outrun your fork. If weight loss is your goal, a home gym is a dear friend, but it’s no substitute for smaller portions and a personal ban on processed foods and sweetened cola drinks, especially the ones with fake sweeteners. So make space, even if it’s the corner of your bedroom or a portion of the family room, and need I mention ... far from the fridge.

MAKE IT INVITINGYour workout space can be small, but if it’s nasty – a dirty basement, a stuffy attic, a chilly garage – you’ll find a reason to avoid it. Treat it like the sacred space it is. An area with natural light, fresh air and no clutter is the feng shui ideal, but if that’s

not possible, start with what you’ve got. Make it clean and appealing. A yoga mat and a fresh flower in your living room can work wonders on your mind and body. Your space doesn’t matter nearly as much as your intention.

FEEL GOOD ABOUT WHAT YOU SPEND I don’t know what your budget is for home gear, but two things I do know for sure: First, investing in your own wellness is money well spent. And second, don’t buy cheap stuff. It will feel junky, and you won’t use it. If you’ve got $5,000 or more to outfit an entire room, be thankful, but you can get just as fit for $500 or less, using free weights, stability balls, jump ropes, resistance bands, etc. It’s easier than ever to find high-quality used gear – online, in specialty stores

L ooking to boost your well-being? I’m a big believer in home gyms.

You wake up, throw on what passes for workout clothes ... or nothing ... and before you can find an excuse to skip it, you’re walking the treadmill or pumping the weights and spreading joy throughout your body.

HOME WORKOUTS ARE GYM DANDY


FREECATALOG!

With almost 30 years of

experience, Bulb Direct is

your source for medical and

scientific bulbs. Specializing

in replacement bulbs for your

microscopes, operating lights,

optical, diagnostic and other

medical devices. We pride

ourselves in providing excep-

tional customer service, great

prices, and brand name quality,

such as GE, Phillips, etc.

Contact us for your Bulb Direct Catalog! [email protected] 800-772-5267

Visit us online at Bulbdirect.com

– but it’s best to try it before you buy it, to make sure everything feels good and sturdy

PLAN FOR CARDIO, STRETCHING, STRENGTHENING For a balanced workout, your home gym should have at least one solid piece of aerobic equipment (a bike, a treadmill, an elliptical cross-trainer, your choice), plus space and gear for stretching and strengthening. If you’re new to exercising, buy some time with a per-sonal trainer (or consult with books, DVDs, etc.) and get started on a home routine that will safely deliver the results you want.

MAKE IT USER-FRIENDLY Equip your space with whatever it takes to make your workout enjoyable. Music can be a great motivator. Watching TV or reading a book while you work out are options, but exercise purists think these distractions make your workout less eff ective. To get into the zone of peak performance, focus your attention on your inner body, your breathing. If you prefer to be distracted, no blame.

Retreating to a workout space you’ve created mindfully – embellishing it with photos you love, stones you’ve kept, quotes that inspire you – will exert a powerful infl uence on your willingness to come back to it. And don’t forget to add a meditation pillow to the mix, even if you’re not sure what to do with it. Someday, if you keep your brain healthy and curious, you’ll want one.

KEEP A JOURNALTo make the most of your home gym, show up every day. Keep a notebook and jot down every workout, even if it’s just 5 or 10 minutes at a time. Note the date, what you did and how you felt. If writing intimidates you, do it anyway. It’s fi ne to keep it simple. Keeping track in a journal helps you develop the habit of a daily exercise practice. I promise you that when that happens, your whole life will change in remarkable and delicious ways.

MARILYNN PRESTON is a healthy lifestyle expert, well-being coach and Emmy-winning producer. She is the creator of Energy Express, the longest-running syndicated fi tness column in the country. She has a website, marilynnpreston.com, and welcomes reader questions, which can be sent to [email protected].

FITNESS

DESIGNER: JLDESIGNER:

CHECKLIST BOARDSARE PROVEN TO

Checklist Boards improve health care outcomes by adherence to standardized processes. Each custom designed board contributes to best practice in: processes. Each custom designed board

Checklist Boards helped one client REDUCE RE-ADMISSION BY 30% & SAVE $2MILLION. View sample designs at

ChecklistBoards.com!

Get a free trial board to share with your team! 585.586.0152 or email us at [email protected]

REDUCEPREVENTABLEERRORS

Process Improvement

Trapping/Reducing Errors

Standardizing Your Time Out



CLIENT SIGN–OFF:


PROOF SHEET

1/4 Page VerticalAD SIZE

NOTES

TRIM 4.5”

TRIM 3.25”


BUYERS GUIDE OTHER

PUBLICATION

MONTH



HALF PAGE HORIZONTAL



CLIENT SIGN–OFF:

AD SIZE

NOTES


PROOF SHEET

WIDTH 7”

HEIGH

T 4.5”


BUYERS GUIDE OTHER

PUBLICATION

DESIGNER: JL

MONTH


Drills Saws Accessories Consoles Batteries Attachments

Refurbished Powered Surgical Equipment

Sales • Repairs • ServiceSurgical Power Equipment

(574) 267-8207 [email protected]

DESIGNER: JL


BUYERS GUIDE OTHER

MONTH



CLIENT SIGN–OFF:


PROOF SHEET

1/3 Page Square 4.5”x4.5”AD SIZE

NOTES

TRIM 4.5”

TRIM 4.5”

PUBLICATION


ORTODAYLIVE.COM

AUGUST 28-30, 2016 • CHICAGO •

SAVE THE DATE

Empowering the Surgical

Services Community

CALL US BEFORE YOU BUILD! (800) 201-3060Systems require plumbing most conveniently

installed during new construction or remodeling.

USE OUR DM6000-2AIN SURGERY...(Arthroscopy, Urology)


BY JUDY THALHEIMER, R.D., L.D.N. ENVIROMENTAL NUTRITION NEWSLETTER

OUT OF THE OR

CALCIUM IS KEYMuscles, nerves, veins and arteries, enzymes and hormones all depend on calcium to function properly. If we don’t get enough calcium in our diets to do these important jobs, our bodies take some from our bones. It stands to reason that if we don’t take in enough calcium, our bones will eventually become weak and easily broken. But how much is enough? Is there such a thing as too much? And what is the best way to get calcium?The Institute of Medicine (IOM) recommends most adults should aim for 1,000 milligrams (mg) per day, and women over 50 and men over 70 should get 1,200 mg. Since vitamin D is necessary for calcium absorption, the IOM recommendations include guidelines for vitamin D intake as

well: 600 to 800 International Units (IU) a day for adults.

While lots of experts, like the National Osteoporosis Foundation, the Dietary Guidelines, and the American Society for Bone and Mineral Research agree with the IOM’s recommendations, a number of researchers think the recommen-dations are too high. They cite numerous studies that fail to show any relationship between calcium intake and bone density or fracture risk. To make matters worse, calcium supplements make a lot of people constipated, and some studies suggest they may increase risk of kidney stones and heart attacks.

Supporters of the recommenda-tions counter that a lot of these studies are inconclusive or flawed.

While all of this confusion gets sorted out, here is what we know for sure:• Food is better than supplements.

Everyone is in agreement that we should get our calcium from food first. If you are unable to get enough calcium through food, then use supplements to make up the shortfall.

• Don’t overdo it. There is no benefit to eating or taking more calcium than the recommended daily amount, and too much may even be harmful.

• Got D? Vitamin D is added to milk and a number of other foods, and it’s found naturally in some fatty fish like salmon, but spending 15 minutes outside two or three times a week (without sunscreen) may be all you need. (In colder climates, increase vitamin D dietary intake from October through March, since the sun is weaker.)

• Phosphorus for us. Other nutri-ents, like phosphorus, also are critical to bone health. Phospho-rous is found in foods like fish, dairy, poultry, meat, lentils, nuts and whole-grains.

A mericans are encouraged to get more calcium to build and maintain strong healthy bones. But recent headlines suggest that too much calcium could actu-

ally be bad for your health and may not, after all, do much to protect your bones. So, what should you do? Until new research provides clear answers, ditch those supplements in favor of calcium-rich foods … and don’t overdo it.

CALCIUM CONTROVERSY

NUTRITION


NUTRITION

• Dairy plus. Dairy foods are an excellent source of calcium, but they are far from the only source. Non-dairy foods such as tofu, greens and brown rice are good sources of calcium.

• Grin and bear weight. Exercise doesn’t just build muscle it also builds bone. People of all ages should do weight-bearing exercises, like running, brisk walking, climbing stairs or dancing for a total of 30 minutes a day, and do muscle-strengthening exercise two or three times a week.

• Hold the salt. The more sodium you eat, the more calcium you excrete. If all that calcium came from your bones, you could lose up to 1 percent more bone a year for each extra gram of sodium you eat a day.

We need more research to work out the inconsistent and inconclusive information we have on calcium. Until then, aiming for – but not above – the current recommenda-tions (preferably from food), eating a healthy balanced diet and staying active are the best.

– Environmental Nutrition is the award-winning independent newsletter written by nutrition ex-perts. For more information, visit www.environmen-talnutrition.com.

203-377-6424 www.palmerohealth.com

TB (Tuberculosis bacteria) Mycobacterium bovis

MRSA Methicillin-resistant Staphylococcus

Hepatitis B HBV

Hepatitis C HBC

VRE Vancomycin Resistant Enterococcus

RSV Respiratory Syncytial Virus

Avian Influenza A H3N2 strain

Influenza A Influenza A Virus Hong Kong Strain

Adevovirus Adenovirus type 2

AKA

Aureus

Microorganism

Faecalis

HIV-1 Aids

Coronavirus Human Coronavirus

Pseudomonas aeruginosa Pseudomonas aeruginosa

Salmonella Salmonella

Staph Staphylococcus aureus

Carbapenem-Resistant E-Coli E Coli

Athlete’s Foot Fumgus Trichophyton mentagrophytes

Swine Flu H1N1

Candida Diet Candida albicans

Herpes 2 Herpes Simplex Virus 2

Escherichia coli E Coli

Proteus mirabilis Proteus mirabilis

Palmero Healthcare DisCide Ultrahttps://www.youtube.com/watch?v=QcO3caPc-nMhttps://www.youtube.com/watch?v=0tmixzHqIR8

Palmero Healthcare DisCide Ultrahttps://www.youtube.com/watch?v=QcO3caPc-nM

Request a free samplehttp://www.palmerohealth.com/requestSamplesPlease mention ORTODAY when requesting a sample


Athlete’s Foot Fumgus Trichophyton mentagrophytes

Swine Flu H1N1

DisCide®

ULTRA kills in one minute:



Hepatitis B HBV

Hepatitis C HBC

AureusMRSA Methicillin-resistant Staphylococcus AureusMRSA Methicillin-resistant Staphylococcus

Faecalis







Hepatitis B HBV

Hepatitis C HBC

VRE Vancomycin Resistant Enterococcus

RSV Respiratory Syncytial Virus

Avian Influenza A H3N2 strain

Influenza A Influenza A Virus Hong Kong Strain

Adevovirus Adenovirus type 2

HIV-1 Aids



Salmonella Salmonella


Carbapenem-Resistant E-Coli E Coli Carbapenem-Resistant E-Coli E Coli

Herpes 2 Herpes Simplex Virus 2

Escherichia coli E Coli

Proteus mirabilis Proteus mirabilis

Your Patient Monitoring Experts 844-246-7437


BY EATINGWELL

OUT OF THE ORRECIPERECIPE


RECIPE

Tortilla soup is a signature Mexican dish, and there are about as many versions of it as there are cooks. In Mexico you can find any style you like: with only

vegetables, no vegetables, no chicken, a chicken leg, shredded chicken or a combination of all of these ingre-dients. Sometimes you’ll even find corn or tomatillos in the ingredient list. Tortilla soup can also be very spicy or rather mild, depending upon what chilies are included. In this recipe a crumbled, dried chile is sprinkled on top to control how much heat you want in your bowl.

In a medium soup pot heat the oil over a medium heat. Add the onion and sauté until golden brown, making sure the mixture does not burn, about 7 minutes. Add the garlic and cilantro and sauté anoth-er minute. Add the tomatoes and cumin and cook another 5 minutes, stirring occasionally, until thickened. Add the broth. Remove from the heat and puree until smooth in the pot using a hand immersion blender.

Return the soup to the heat. Add the carrot and zucchini, and simmer, partially covered, over medium low heat for about 15 minutes, stirring occasionally or until the soup is slightly thickened and the vegeta-bles are tender. Add the chicken slices and simmer another 2 to 3 minutes or until just cooked through. Taste for seasoning.

While the soup is cooking prepare the toppings. To toast the tortilla strips: Preheat the oven to 400 F place the tortilla strips on a baking sheet, spread them evenly over the pan. Bake for 7 to 8 minutes or until crisp and beginning to brown. Reserve for the garnish.

Place the chile in a nonstick skillet over medium high heat and toast for about 2 minutes on a side or until it

is fragrant and puffed but not burnt. Remove the stem and the seeds (squeeze seeds out through the top); crush the chile in a mortar or with the side of a heavy knife and reserve for the garnish.

To serve: Ladle the soup evenly into each bowl. Squirt some lime juice over the soup. Garnish with the toasted tortilla strips, cilantro, crushed chile, avocado and cheese. Serve immediately. TASTY TIPSTry to find fresh, handmade tortillas for a more authentic flavor. Cut them as directed, and dry them out by leaving them on the counter for an hour before cooking.

While the tortillas are toasted in this recipe, you can fry them in vegetable oil for a richer result. Heat about 1/2 cup of vegetable oil in a medium skillet on medium-high heat. Drop a tortilla strip in the oil and see if it begins to fry. If so, drop handfuls of tortilla strips in the oil and fry, turning with tongs, until crisp and brown, about 3 minutes. Drain on paper towels.

To make this vegetarian, substi-tute vegetable broth for chicken broth, and omit the chicken.

TURN UP THE HEATHEARTY TORTILLA SOUP IS SPICY AND COLORFUL

INGREDIENTS:2 tbsp vegetable oil1 onion, thinly sliced3 garlic cloves, peeled and left

whole2 tbsp chopped fresh cilantro1 14 1/2-ounce can diced fire-

roasted tomatoes, or regular diced tomatoes, with juice

3/4 tsp ground cumin4 cups chicken broth1 medium carrot, peeled and cut

into 1/2-by-2-inch strips1 medium zucchini, cut into

1/2-by-2-inch strips1/2 pound skinless, boneless

chicken breasts (or tenders), 1/2-by-2-inch strips

Salt and freshly ground black pepper

For the topping:2 tsp fresh lime juice4 corn tortillas, preferably stale

or at least dry, halved crosswise and sliced into thin strips

1/4 cup chopped cilantro leaves1 dried chile, such as pasilla1 ripe avocado, peeled and cut

into 1/4 inch cubes1/4 cup shredded Monterey Jack

cheese or Pepper Jack cheese

– Diane Rossen Worthington is an authority on new American cooking. She is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Award-winning radio show host. You can contact her at www.seriouslysimple.com.


OUT OF THE ORPINBOARD

The News and Photos That Caught Our Eye This MonthPINBOARD

DO YOU LIKE TO SHARE??Do you share your OR Today magazine with cowork-ers? Email a photo of a colleague reading OR Today magazine to [email protected] to be entered to win lunch for your department. We will share your photo with our readers and select one lucky person to win a $50 gift card to Subway!

OR TODAY

CONTESTS• MAY •

THE WINNER GETS A$50 SUBWAY

GIFT CARD{ { ‘A NACHO ABOVE’ DEBUTS

AT FOOD SHOWLive Better Brands’ new tortilla chip variety A Nacho Above made its debut at the Winter Fancy Food Show in San Francisco earlier this year.

It is the fi rst new everyday fl avor to be added to Way Better Snacks’ tortilla chip line since March 2014. The new fl avor’s moniker, A Nacho Above is made with only the highest quality ingredients, such as sprouted chia, fl ax seed and quinoa. The new chip gets its nacho-rifi c fl avor from organic cheddar cheese and a blend of herbs and spices including pure sea salt, onion, garlic, paprika, black and red pepper.

The new variety was borne out of CEO Jim Breen’s desire to make a favorite fl avor “way better.”

“When Way Better Snacks launched in 2011, we showed snackers that fl avorful chips don’t have to be greasy and fake,” Breen said. “Our new fl avor A Nacho Above is evidence that you can enjoy a deliciously cheesy chip that’s made from simple, sprouted ingredi-ents.”•

FOR MORE INFORMATION, visit gowaybetter.com.

‘A NACHO ABOVE’ DEBUTS

Way Better Nachos

“Every time you smile at

someone, it is an action of

love, a gift to that person, a

beautiful thing.”

–Mother Teresa

Win Lunch!

May 2016 | OR TODAY 69WWW.ORTODAY.COM May 2016 | OR TODAY 69WWW.ORTODAY.COM

PINBOARD

OR TODAY MARCH

CONTEST WINNERS

Congratulations to Delee Murray

& the Bayshore Medical Center

ENERGEMS CHOCOLATE ENERGY HITS WALMART STORES NATIONWIDE

Energems Chocolate

The dark chocolate energy supplement Energems are now available in select Walmart stores across the country in mint and dark chocolate fl avors.

At only 50 calories per serving, three Energems are equivalent to 133 mg of caffeine (i.e., a large cup of coffee) and contain antioxidants naturally found in dark chocolate.

“We’re excited to partner with an American staple like Walmart,” said General Manager of Energems, Kristopher Trust. “We appreciate that Walmart shares our goal of putting healthier, cleaner energy into the hands of consumers, and this partnership gives us both the capacity to do just that.”

Energems recently closed a successful year that included acceptance into the Council for Responsible Nutrition as well as recognition as Best New Product by the National Association of Chain Drug Stores and Best New Product of 2015 by Vitamin Retailer Magazine. •

FOR MORE INFORMATION, visit www.energems.net


INDEXALPHABETICAL AAAHC ………………………………………………………19AIV Inc. …………………………………………………… 55AORN …………………………………………………… IBCBulb Direct Holding, LLC …………………………61C Change Surgical ………………………………… 10Checklist Boards Corp. ……………………………61Cincinnati Sub-Zero ……………………………… 59D.A. Surgical …………………………………………… 47Doctor’s Depot ……………………………………… 40Enthermics Medical Systems, Inc …………31GelPro ……………………………………………………… 59Glacier Tek ………………………………………… 9, 54

Gopher Medical ……………………………………… 65Healthmark Industries…………………………… 29Indigo-Clean ………………………………………………… 41Innovative Medical Products, Inc …………… BCInterpower Corporation ………………………… 5Jet Medical Electronics ………………………… 62Kaap Surgical Insturments ………………………21Key Surgical Instrument, Inc. ……………… 22MAC Medical ………………………………………………17MD Technologies …………………………………… 63Pacifi c Medical LLC ………………………………… 6Palmero Health Care …………………………… 65

Paragon Service …………………………………… 56Rubbermaid ……………………………………………… 4Ruhof Corporation …………………………………2-3Sealed Air ……………………………………………… 57SMD Waynne Corp. ……………………………… 46Suburban Surgical Company, Inc. ……… 55Summit Medical Inc. ……………………………… 52Surgical Power ……………………………………… 62TBJ, Inc. …………………………………………………… 30

ACCREDITATIONAAAHC ………………………………………………………19

ANESTHESIAChecklist Boards Corp. ……………………………61Doctor’s Depot ……………………………………… 40Gopher Medical ……………………………………… 65Paragon Service …………………………………… 56

APPAREL Healthmark Industries…………………………… 29

ASSOCIATIONSAAAHC ………………………………………………………19AORN …………………………………………………… IBC

BEDSInnovative Medical Products, Inc ……… BC

CARDIOLOGYC Change Surgical ………………………………… 10Gopher Medical ……………………………………… 65

CARTS/CABINETSCincinnati Sub-Zero ……………………………… 59Enthermics Medical Systems, Inc …………31MAC Medical ………………………………………………17Suburban Surgical Company, Inc. ……… 55

CLEANING SUPPLIESRuhof Corporation …………………………………2-3

CLAMPSInnovative Medical Products, Inc ……… BC

DISINFECTANTSIndigo-Clean ………………………………………………… 41Palmero Health Care …………………………… 65Sealed Air ……………………………………………… 57

DISPOSABLESKaap Surgical Insturments ………………………21Pacifi c Medical LLC ………………………………… 6

ENDOSCOPYBulb Direct Holding, LLC …………………………61Kaap Surgical Insturments ………………………21MD Technologies …………………………………… 63Ruhof Corporation …………………………………2-3TBJ, Inc. …………………………………………………… 30

GEL PADSGelPro ……………………………………………………… 59Innovative Medical Products, Inc ……… BC

GENERALAIV Inc. …………………………………………………… 55Checklist Boards Corp. ……………………………61

GelPro ……………………………………………………… 59Rubbermaid ……………………………………………… 4Surgical Power ……………………………………… 62

HAND/ARM POSITIONERSInnovative Medical Products, Inc ……… BC

HIP SYSTEMSInnovative Medical Products, Inc ……… BC

INFECTION CONTROL/PREVENTIONPalmero Health Care …………………………… 65Ruhof Corporation …………………………………2-3Sealed Air ……………………………………………… 57Summit Medical Inc. ……………………………… 52

INSTRUMENT TRANSPORTSummit Medical Inc. ……………………………… 52

INVENTORY CONTROLKey Surgical Instrument, Inc. ……………… 22

KNEE SYSTEMSInnovative Medical Products, Inc ……… BC

LABORATORYTBJ, Inc. …………………………………………………… 30

LEG POSITIONERSInnovative Medical Products, Inc ……… BC

MONITORSDoctor’s Depot ……………………………………… 40Jet Medical Electronics ………………………… 62

OR TABLES/ ACCESSORIESD.A. Surgical …………………………………………… 47Innovative Medical Products, Inc ……… BC

ORTHOPEDICSurgical Power ……………………………………… 62

OTHERAIV Inc. …………………………………………………… 55SMD Waynne Corp. ……………………………… 46TBJ, Inc. …………………………………………………… 30

PATIENT MONITORINGGopher Medical ……………………………………… 65Pacifi c Medical LLC ………………………………… 6

POSITIONERS/IMMOBILIZERSD.A. Surgical …………………………………………… 47Innovative Medical Products, Inc …………………………………………… BC

POWER COMPONETSInterpower Corporation ………………………… 5

REPAIR SERVICESPacifi c Medical LLC ………………………………… 6

REPLACEMENT PARTSDoctor’s Depot ……………………………………… 40Bulb Direct Holding, LLC …………………………61

SHOULDER RECONSTRUCTIONInnovative Medical Products, Inc ……… BC

SIDE RAIL SOCKETSInnovative Medical Products, Inc ……… BC

STERILIZATIONKey Surgical Instrument, Inc. ……………… 22Summit Medical Inc. ……………………………… 52TBJ, Inc. …………………………………………………… 30

SURGICALAAAHC ………………………………………………………19Bulb Direct Holding, LLC …………………………61Checklist Boards Corp. ……………………………61Key Surgical Instrument, Inc. ……………… 22MD Technologies …………………………………… 63Surgical Power ……………………………………… 62

SAFETY GEARChecklist Boards Corp. ……………………………61Glacier Tek ………………………………………… 9, 54Key Surgical Instrument, Inc. ……………… 22

SURGICAL SUPPLIESIndigo-Clean ………………………………………………… 41Kaap Surgical Insturments ………………………21Key Surgical Instrument, Inc. ……………… 22Ruhof Corporation …………………………………2-3

SUPPORTSInnovative Medical Products, Inc ……… BC TEMPERATURE MANAGEMENTC Change Surgical ………………………………… 10Cincinnati Sub-Zero ……………………………… 59Enthermics Medical Systems, Inc …………31MAC Medical ………………………………………………17

WARMERSCincinnati Sub-Zero ……………………………… 59Enthermics Medical Systems, Inc …………31Glacier Tek ………………………………………… 9, 54MAC Medical ………………………………………………17

WASTE MANAGEMENTRubbermaid ……………………………………………… 4Sealed Air ……………………………………………… 57

INDEXCATEGORICAL

Designed for nurse executives, materials managers, and SPD managers, this seminar will provide surgical preference card best practices.

Learn strategies and techniques toimprove collaboration and to helpfind cost savings throughout theperioperative process. Make thecommitment to attend today andimprove the most important resultof all – quality of patient care.

THIS JUST MADE YOU SMILE.Do you know what else makes you smile?Updated preference cards.

DIAMOND SUPPORTERS RUBY SUPPORTERS SUPPORTED BY

TM

THANK YOU TO OUR INDUSTRY PARTNERS SUPPORTING THE 2016 NURSE EXECUTIVE LEADERSHIP SEMINARS

CENTER FOR NURSING LEADERSHIP

SPRING 2016 NURSE EXECUTIVE LEADERSHIP SEMINARS DATES AND CITIES4/16 New York

4/21 Seattle

5/5 Tampa

5/7 San Francisco

5/10 Cincinnati

5/12 Philadelphia

5/14 Chicago

5/21 Atlanta

5/24 Cleveland

5/26 Austin

CENTER FOR NURSING LEADERSHIP

NURSE EXECUTIVE LEADERSHIP SEMINARS

Register now at aorn.org/cnlseries

14918_nels_may.indd 2 3/28/2016 2:21:32 PM

© 2015 IMP

The complete positioner….for small to obese Discover the De Mayo Hip Positioner® Systems

The hip positioner you can customize for any patient

Stop breaking your back positioning patients. Now there’s a simple, adjustable positioning alternative for any OR table. The doctor-designed De Mayo Hip Positioner®

is a complete system that gives you everything you need to secure any patient –obese or small – with unobstructed access to the surgical site. Latex-free, single-usePatient Protective Pads provide superior protection and added stability to the overallconstruct. Move up to the positioning alternative that’s better for every body. Visitwww.impmedical.com or call 800-467-4944 to order your complete system today.

The operative word in patient positioning.

Secure obese patients without lifting Foam pads protect patients securely

Security without abdominal pressure Unobstructed access to surgical site

De Mayo Hip Positioner® US Patent No. 6,820,621

The smarter positioner you build around your patient

DeMayoHipAd_OR Today_JUNE2015_OR Today 3/31/15 9:38 AM Page 1

or today - may 2016

Documents