OR Today - March 2015

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NURSE RETENTION PAGE 34

TAKE GOOD CARE

NURSES • SURGICAL TECHS • NURSE MANAGERS

MARCH 2015

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CONTENTS

features

58

DO YOU HAVE AN OR SUCCESSION PLAN?

Succession planning is vital for a successful department, but it is not seen as an urgent need compared to all of the tasks that have to be completed on a daily basis in the hectic OR environment. Industry leaders share tips on how to generate and maintain a winning department at all levels while also preparing for the future.

OR TODAY | March 2015

66

RUHOF HEALTHCARE

OR Today sat down with Ruhof Healthcare to find out the latest developments at the cleaning solutions company responsible for creating the very first enzymatic detergent for cleaning surgical instruments.

OR Today (Vol. 15, Issue #2) March 2015 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. 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 advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. Š 2014

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MARCH 2015 | OR TODAY

7

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

28

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

EDITOR

10

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT Jonathan Riley Yareia Frazier Jessica Laurain

ACCOUNT EXECUTIVES

Sharon Farley | sharon@mdpublishing.com Warren Kaufman | warren@mdpublishing.com

60

68

Jayme McKelvey | jayme@mdpublishing.com Andrew Parker | andrew@mdpublishing.com

CIRCULATION Bethany Williams

INDUSTRY INSIGHTS 10 News & Notes 14 Clorox Advice 17 AAAHC Update

ACCOUNTING Sue Cinq-Mars

WEB SERVICES Betsy Popinga Taylor Martin

IN THE OR 20 27 28 34

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 60 62 66 68 72

Health Fitness Nutrition Recipe Pinboard

75 Index

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OR TODAY | MARCH 2015

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INDUSTRY INSIGHTS NEWS & NOTES

KARL STORZ’S IMAGE 1 SPIES NAMED INNOVATION OF THE YEAR Karl Storz Endoscopy-America Inc. has announced that its Image 1 Spies Visualization Enhancement Tools system was recognized as a 2014 Innovation of the Year by the Society of Laparoendoscopic Surgeons (SLS).

The new Image 1 Spies system represents the company’s latest solution for giving surgeons superior views of challenging anatomical areas during complex surgeries, ranging from skull base and orthopedic to gynecologic, urologic and thoracic.

Combined with new full-HD three-chip camera heads, Image 1 Spies includes the Clara and Chroma apps that activate proprietary image enhancement algorithms. Spies Clara automatically identifies and brightens dark areas of an image — without lag time.

This addresses common problems encountered when some anatomical areas are illuminated better than others, requiring overall brightness to be increased or the scope to be moved closer to visualize darker areas.

Increasing the brightness level, however, prompts tissue in the foreground to reflect light and cause glare.

Moving the scope closer narrows the visible area, making it difficult to manipulate instruments and can

result in mucus or blood obscuring the lens. Now, by using Spies Clara, dark areas are adjusted in real time.

This avoids overexposure and reflections, providing a clear view of bright and dark regions.

Additionally, surgical interventions can be made more efficient if clear differentiation of key tissue areas is possible. Spies Chroma helps accomplish this by intensifying color contrast levels, enabling surgeons to more easily discern blood vessels and other critical anatomy. Clearly visible structure surfaces are emphasized while retaining the natural color perception of the image. •

FRESENIUS KABI INTRODUCES NAROPIN IN FREEFLEX BAG Fresenius Kabi has announced that it has received approval from the U.S. Food and Drug Administration to market Naropin (ropivacaine HCL Injection, USP) 0.2 percent 100mL and 200mL premix bags in the company’s proprietary Freeflex delivery system. These new presentations are available now for U.S. customers.

Fresenius Kabi is a global health care company that specializes in life-saving medicines and technologies for infusion, transfusion and clinical nutrition.

“We introduced Naropin in Freeflex containers to give clinicians more choices and greater convenience in treating patients 10

OR TODAY | MARCH 2015

requiring continuous epidural infusions or local infiltration,” said John Ducker, president and CEO of Fresenius Kabi USA. Fresenius Kabi offers the broadest ropivacaine portfolio, providing the most options for patient care in surgical anesthesia, labor and delivery, and acute pain management. In addition to the new 0.2 percent Freeflex bags, Naropin is available in multiple presentations including single-dose vials, plastic ampule sterile-paks, and infusion bottles in four different strengths – 0.2 percent, 0.5 percent, 0.75 percent and 1 percent.

Freeflex is a bag designed for infusion solutions that has been

marketed globally since 2005 and in the U.S. since 2008. Freeflex’s multilayer polyolefin film is nonPVC and non-DEHP that is designed for easy handling with enhanced safety and environmental performance in mind. • WWW.ORTODAY.COM

NEWS & NOTES

STUDY FINDS CERTIFICATION MAY IMPACT SURGICAL OUTCOMES Results from a recent study indicate specialty nursing certification contributes to improved surgical patient outcomes in hospitals nationwide. Published in the November 2014 issue of AORN Journal, the research was conducted by the staff at the National Database of Nursing Quality Indicators (NDNQI) and the University of Kansas. It was sponsored by the Competency & Credentialing Institute (CCI).

The study examined surgical patient outcomes in two unit types — surgical intensive care units (SICUs) and surgical units — and assessed some of the most common complications in surgical units and their occurrences amongst patients being cared for by certified vs. non-certified nurses. Researchers studied four specialty certifications commonly held by perioperative nurses in the hospital setting: certified ambulatory perianesthesia nurse (CAPA), certified postanesthesia nurse (CPAN), certified nurse operating room (CNOR) and certified RN first assistant (CRNFA).

The research showed higher rates of CPAN and CNOR/CRNFA certification in perioperative units were significantly associated with lower rates of central-line associated bloodstream infections in SICUs. Specifically, the study indicated that a 10 percent higher rate of CNOR/ CRNFA and CPAN certification in perioperative units resulted in 16 percent and 8 percent (respectively) lower rates of central-line associated bloodstream infection rates in SICUs. “While there has been much anecdotal speculation about the benefits of specialty nursing certification, our aim was to ascertain if a positive connection exists

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between certification and surgical patient outcomes,” said James Stobinski, PhD, RN, CNOR, one of the study authors and Director of Credentialing & Education at CCI. “We found that higher rates of CPAN and CNOR/CRNFA contributed to improved surgical patient outcomes in SICUs when controlling for a variety of unit and hospital characteristics.”

Using data from the largest, unit-based, national nursing quality program, the National Database of Nursing Quality Indicators (NDNQI), the researchers analyzed secondary data submitted from participating NDNQI hospitals, ultimately spanning 447 nursing units over the same time periods.

Merging 2011 unit-level clinical and administrative data — including patient outcomes, staffing and RN education — with the same survey data specific to national specialty certification and perceptions of the unit practice environment, the researchers were able to assess the impacts of specific specialty certifications on surgical patient outcomes. Aside from looking solely at what occurred within the OR, the data also assessed how those actions impacted patients as they moved from the OR into other areas of the hospital.

The study also found that higher rates of CNOR/CRNFA certification in perioperative units were associated with higher rates of hospital-acquired pressure ulcers and unit-acquired pressure ulcers. The association between certification rates and catheter associated urinary tract infections (CAUTIs) was also investigated. In this instance, while some positive correlations were discovered, the results were not found to be statistically significant.•

MARCH 2015 | OR TODAY

11

INDUSTRY INSIGHTS NEWS & NOTES

SHOCKWAVE MEDICAL ANNOUNCES CE MARK APPROVAL OF ITS LITHOPLASTY SYSTEM Shockwave Medical has announced CE Mark regulatory approval for the company’s Lithoplasty balloon catheters for the treatment of peripheral artery disease (PAD).

Lithoplasty is a novel balloonbased technology that utilizes integrated lithotripsy, a pulsatile mechanical energy commonly used to break up kidney stones, to disrupt both superficial and deep calcium and normalize vessel wall compliance prior to low-pressure balloon dilatation.

“Lithoplasty is a breakthrough that could revolutionize the treatment of peripheral artery disease – a common circulatory problem that can lead to serious complications, including amputation,” said Marianne Brodmann, M.D., of the Medical University of Graz, Austria. “With Lithoplasty, even historically very challenging PAD patients with deep calcium can be treated effectively without significant injury to the vessel.”

In advanced vascular disease, atherosclerosis becomes calcified deep inside the vessel walls, obstructing blood flow. These deposits make interventions challenging and prone to both procedural and long-term failure. Lithoplasty is designed to be naturally gentle on the soft, healthy, portions of the vessel, while remaining hard on difficult-to-treat calcified tissue.

Shockwave’s technology allows for low-pressure balloon dilatation,

12

OR TODAY | MARCH 2015

reducing the potential for soft tissue vascular injury, which is known to occur with current endovascular technologies.

CE Mark for Lithoplasty was supported by safety and utility clinical data from the multicenter DISRUPT PAD study, which was presented in November 2014 at the Vascular Interventional Advances (VIVA) Annual Conference in Las Vegas, Nevada. Early results demonstrated safe and effective dilatation of calcified stenosis with no acute failures, very favorable residual stenosis, no major adverse events and no restenosis out to 30 days.

“CE Mark approval for Lithoplasty in peripheral artery disease is an exciting milestone for Shockwave Medical and sets the stage for regulatory approvals in other

geographies. We are also investigating applying this therapy to calcified coronary lesions – another important unmet clinical need,” said Shockwave Medical CEO and co-founder Daniel Hawkins. “Our initial clinical results in the coronaries are promising. Data presented at TCT 2014 from our first-inman study demonstrated safety, tolerability, deliverability, and effectiveness.”

“We look forward to bringing this disruptive technology to patients with challenging calcified lesions in a number of vascular beds, as well as applying the technology platform to calcified valvular disease,” said Todd Brinton, M.D., co-founder of Shockwave Medical and Clinical Associate Professor of Interventional Cardiology, Stanford University. •

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DRÄGER WINS AWARD FOR OUTSTANDING RESPIRATORY PRODUCTS AND SERVICES Dräger has received the Zenith Award from the American Association for Respiratory Care for delivering outstanding products and services to the respiratory care profession. The award was presented during the AARC 60th International Respiratory Convention.

Established in 1989, the AARC Zenith Award is considered the “people’s choice” award of the respiratory care profession and highly prized by its recipients. Each year, AARC asks its membership, which comprises 52,000 respiratory therapists and other clinicians, to vote for those manufacturers, service organizations and supply companies that provide the respiratory care community with exemplary service based on the following criteria: • quality of equipment and/or supplies; • accessibility and helpfulness of sales personnel; • responsiveness; • service record; • truth in advertising; and • support of the respiratory care profession.

For the sixth straight year, AARC members selected Dräger for this prestigious recognition. Dräger’s Respiratory Care devices span the spectrum of critical care, neonatal care, acute care, noninvasive therapy and emergency/transport ventilation.

“Our members have consistently chosen Dräger as a company that provides products and services to help them improve patient care,” said AARC Executive Director and WWW.ORTODAY.COM

CEO Thomas Kallstrom, MBA, RRT, FAARC. “We are pleased to again this year honor Dräger for its commitment to respiratory care in terms of product excellence, exceptional customer service and overall support of our profession.“ “In this era of health care reform, health systems and hospitals are tasked with delivering high-quality care at an affordable cost and those in the respiratory care profession play a central role in this effort,” said Ed Coombs, MA RRT-NPS/ACCS,

FAARC Director of MarketingIntensive Care & Neonatal Care Draeger Medical Inc. “From managing patient respiratory status in the acute care setting to facilitating effective long-term care, the work of respiratory care professionals is critical to saving lives, improving outcomes, reducing readmissions and enhancing quality of life. We are honored that the members of the AARC have recognized Dräger as their partner in these efforts.”

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13

INDUSTRY INSIGHTS CLOROX ADVICE

BY ROSIE D. LYLES, MD, MHA, MSc

PUTTING THE PATIENT AT THE CENTER OF SURGICAL SITE INFECTION PREVENTION

T

his March 8-14 marks the annual National Patient Safety Foundation’s Patient Safety Awareness Week. As we think about this year’s theme, “United in Safety,” it is an important reminder that patient safety, specifically surgical site infection (SSI) prevention, is a team effort – from the healthcare products used, to the healthcare professionals, and all the way back to the patients under their care. During this awareness week, and throughout the year, I hope you will join me in prioritizing patient safety.

SSIS AND YOUR PATIENTS When a patient is scheduled for an operation, there are numerous tasks to be completed before the time of surgery. Between the administrative needs and OR prep, it can be easy to breeze through some of the responsibilities at hand – including skin cleansing. But this can be a costly and harmful mistake: • SSIs, the most common and most costly healthcare-associated infection1, are associated with significant patient morbidity and mortality • SSIs account for an excess of up to $3.5 billion in healthcare expenditures each year2 While the incidence and burden of SSIs can seem overwhelming, these adverse events are often largely preventable. In fact, a recent study suggests that as many as 55 percent of SSIs could be prevented with current

evidence-based strategies3, which are developed to reduce the risk of infection among surgical patients. Working with our colleagues and actively engaging patients, we can help prevent SSIs and increase patient safety.

WORKING WITH PATIENTS TO PREVENT SSIS The preoperative chlorhexidine gluconate (CHG) shower has been embraced by many healthcare facilities for patients undergoing elective surgery, but the benefits of these protocols are seriously limited if the proper bathing regimen is not followed or if the product is not used correctly.

We have the responsibility to educate and empower our patients. We can do this, and improve compliance with preoperative skin cleansing protocols, by giving patients the tools, guidance, and support they need to confidently prepare for surgery by keeping the following in mind:

ROSIE D. LYLES, MD, MHA, MSc, HEAD OF CLINICAL AFFAIRS

• Provide your patient with CHG products that have easy-to-understand directions • Walk through the preoperative skin cleansing steps with your patient • Recommend products that also offer an automatic reminder system, which has been shown to improve adherence4 • On the day of surgery, confirm with your patient whether or not they completed the preoperative skin cleansing regimen FOR MORE on SSI prevention strategies and preoperative skin cleansing, visit www.CloroxHealthcare.com/CHGSkinPrep

[1] Magill SS, Hellinger W, Cohen J, et al. “Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida.” Infection Control and Hospital Epidemiology. 2012;33(3):283-291. [2] Anderson DJ, Podgorny K, Berrios-Torres SI, et al. “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update” Infection Control and Hospital Epidemiology. 2014; 35(6):605-627. [3] Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. “Estimating the Proportion of Healthcare-associated Infections that are Reasonably Preventable and the Related Mortality and Costs.” Infection Control and Hospital Epidemiology. 2011;32(2):101-114. [4] CE Edmiston JR, et al., Medical College of Wisconsin, Milwaukee, WI; “Empowering the Surgical Patient: A Randomized, Prospective Analysis of an Innovative Strategy for Improving Patient Compliance to the Preadmission Showering Protocol.” Journal of the American College of Surgeons. 2014; 219(2):256-264.

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OR TODAY | MARCH 2015

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AORN does not endorse any company’s products or services. AORN is a trademark of AORN, Inc. 1. CE Edmiston Jr, et al., Medical College of Wisconsin, Milwaukee, WI; JACS, 2014, Vol. 219, No. 2., pp. 256–264.

2. Association of periOperative Registered Nurses (AORN) Recommended Practices for Preoperative Patient Skin Antisepsis (2012). Perioperative Standards and Recommended Practices: 445–463. © 2014 Clorox Professional Products Company.

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If the patient was your child, your spouse, you’d want the facility to be AAAHC accredited.

Jack Egnatinsky, MD, Medical Director, AAAHC

”

Why more Health Care Professionals turn to AAAHC With Standards that are nationally recognized and annually reviewed, AAAHC accredits more than 6,000 health care facilities. Our surveys are conducted by experienced health care professionals, so they’re collaborative in nature and not just a check list.

For more information, Contact us: 847-853-6060 By email: info@aaahc.org Log on: www.aaahc.org

Improving Health Care Quality through Accreditation

16

OR TODAY | MARCH 2015

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INDUSTRY INSIGHTS AAAHC UPDATE

STAFF REPORTS

WHO IS

ACREDITAS GLOBAL?

AN INTERVIEW WITH JACK EGNATINSKY, MD, MEDICAL DIRECTOR TO ACREDITAS GLOBAL OR Today [ORT]: I’ve never heard of

Acreditas Global.

Jack Egnatinsky (JE): That doesn’t

surprise me; we’ve been operating under that banner for less than a year. But it’s the new name for AAAHC International. AAAHC is a leading brand name in the U.S., but it didn’t mean as much in Central and South America, where we mainly operate, so we gave it a new name; one that would mean more in Spanish-speaking countries.

ORT: So you accredit ASCs in Central

and South America?

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JE: We accredit a wide range of

international facilities, from small ambulatory, outpatient facilities and oncology centers to hospitals. We work with them in the same way we work with ambulatory facilities in the U.S., helping them raise the bar on patient care and patient safety.

ORT: Do the types of facilities that

Acreditas Global serves differ from those in the U.S.?

JE: Ambulatory surgery centers, as

we know them in the U.S., are not as widespread in Latin America, where we made our first signifi-

cant impact. We target smaller hospitals ranging from roughly 50 to 100 beds, as well as smaller ambulatory surgery centers such as dental clinics and oncology centers.

As we enter different markets throughout Central and South America, we’re finding that smaller hospitals have a very strong interest in accreditation.

Frankly, we didn’t foresee such strong interest from hospitals. But as a fairly new organization we can still be light on our feet, and quickly adapted our accreditation program to respond to their needs.

MARCH 2015 | OR TODAY

17

INDUSTRY INSIGHTS AAAHC UPDATE

ORT: How does Acreditas Global

differ from Joint Commission International?

JE: Well, in that respect we’re still

very similar to the AAAHC everyone knows and loves in the U.S. Our approach remains very much educational and consultative with on-the-ground training – much less of the audit profile that many individuals associate with the Joint Commission, stateside and internationally.

Following the mission of our parent organization, we believe that education and onsite, collaborative interaction between surveyor and staff allow greater growth for both the customer and the surveyors.

As we grow, of course, our aim is to nurture more and more host nation personnel in training roles and in conducting the surveys, rather than using American teams.

We’ve already introduced this concept in Peru.

ORT: AAAHC, the parent organiza-

tion, is still a key organization in the U.S. market, correct?

JE: Absolutely. But as far back as

2004, AAAHC began exploratory initiatives by forming an international task force, and quickly realized there were already hospital accreditors like Joint Commission International out there.

With our 30-some years of experience in ambulatory outpatient settings, we developed our international program based on the U.S. marketplace. But as I said earlier, what we had predicted as a market and what has become our market are different. Now it’s centered more on small hospitals and dental clinics – we have many of those types of medical and dental settings already accredited in Costa Rica and Peru, with a lot 18

OR TODAY | MARCH 2015

more showing great interest in pursuing Acreditas accreditation.

Based on knowledge of the market, we revised and added to our standards to better reflect what a small hospital accreditation program would seek in accreditation. The timing for this was perfect, as it fell during the routine updating and refinement of our core International Standards Handbook. For example, our new Standards increasingly focus on emergency room, maternity and occupational health services – all primary components that make up smaller hospitals.

ORT: Is accreditation as much of a

benefit to international markets?

JE: Whatever country you’re in,

accreditation raises the bar on quality and safety, and from a market perspective, when one facility demonstrates that it’s raised the bar, others inevitably follow. Universally, if individuals don’t know much about a certain facility or center, accreditation provides them with reassurance and peace of mind.

One of the first things we did in exploring the international market was to use our regular U.S. Standards to review an organization in Peru.

We found that they were remarkably applicable despite differences in language and culture. Since then, we‘ve refined and tailored our Standards to be even more relevant to Latin American health care environments.

ORT: Do you look at outcomes,

infection rates and patient satisfaction?

JE: Yes, those are all individual

standards, and in fact, we dedicate an entire chapter to safety and infection prevention in our accreditation handbook.

Of course, given that our mission of accreditation is based on quality

and safety, we dedicated a single chapter to quality and quality studies, many of which are internal to the institution we visit. The sophistication of quality studies has increased dramatically over the last decade in the U.S. We anticipate that this same curve will occur internationally as institutions begin to reframe the importance of developing a culture of quality and safety as a routine environment for health care delivery.

The way we teach internal quality studies and, if possible, external benchmark studies is with a focus on measurable outcomes – highly quantitative outcomes more so than highly qualitative outcomes. Our international teams realize that quality programs are in various stages of development throughout the region and within the facilities, and we view this as one of the greatest opportunities for our program. Training on quality is often a major component of a pre-assessment survey or the actual survey itself.

Similar to any standards set by an accreditor, we also consider how satisfaction is gauged, measured, and what changes are put in place to improve patient satisfaction if such opportunities exist.

ORT: If hospitals do not meet the

expectations necessary to become accredited, are they given a chance to remediate and re-apply?

JE: Yes, of course. Focused follow-

ups do sometimes occur, and our teams will go back and review the specific aspects that need more attention. But we’ve been fortunate to date; all facility revisits have resulted in full accreditation due to their remedial efforts on the focused concerns.

WWW.ORTODAY.COM

STAFF REPORTS

ORT: What percentage of the hospitals or institutions

surveyed by Acreditas Global earn the full three- year accreditation on the first go around?

JE: So far, they all have; but a small number of cases

were required to provide us with follow-up information.

There hasn’t been any facility that completely failed a survey – which is testament to the quality of care being provided in Central and South America.

With many of these international facilities, we actually go in and do pre-assessment surveys. This may consist of a facility visit six months before an actual survey where we engage in granular discussions that result in better performance. This is such a great environment, one in which the surveyors learn of the local challenges hospitals face, while hospital staff receive focused education and training opportunities on what will be looked at during the accreditation survey.

A pre-assessment really helps both organizations – the facility and the accreditor. It gives us a really local flavor of what to expect and helps the facility to become familiar with our standards.

ORT: How many hospitals outside the U.S. have you

surveyed?

JE: We have around 10 organizations already accredited,

with six more in the process of attaining accreditation, all located in Central and South America.

ORT: Are you going to market this program beyond

Central and South America?

JE: Well, we’ve had inquiries from Hungary and

Saudi Arabia among others; but we’re still relatively new to the international arena. While we set ambitious goals, we plan to expand markets in an orderly, measured way.

Dr. 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 the Medical Director of Acreditas Global and remains extremely active as a Medical Director for AAAHC, in addition to being a well-travelled AAAHC accreditation surveyor in the USA and internationally.

WWW.ORTODAY.COM

3 MARCH 2015 | OR TODAY

19

IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

Q

TURNOVERS

I’m just wondering if anyone has a form they use to keep up with turnover times in each room. Such as time out of room, time in room, and reason for delayed turnover. If so could you please share.

A: We do not have a record to show the reasons for any delays, but we try to make all accountable. We are not on any automated documentation system, so it is all manual. When a room moves out they take the strip off the white board and put 25 minutes on the board from the time they moved out.

Q OR TODAY | MARCH 2015

A: We just recently started doing this.

A: We track our turnover time in our electronic

medical record (Meditech) and monitor delays through reports we have devised which pull from specific fields. We are not tracking on paper any longer.

A: We have just started doing it electronically as well, but the reporting out is not perfect yet. •

TOTAL JOINT SHIFT CHANGE Is it acceptable to change out scrub personnel during total joints?

A: In order to reduce traffic in and out of our total joint rooms, we do not relieve scrubs or circs during total joints unless it is an emergency. Our joints are usually 1.5 to 2 hours in length. If they are in a revision total joint that goes over 3 hours then we will relieve the staff

20

That is the expected move in time for the next case. Our surgery controller keeps good track of why there are delays and they are documented.

if needed (this is very rare for us). This also plays into the continuity of care for these larger types of cases.

A: We try not to. Special occasions arise when we do.

For example, staff needs to leave for an appointment.

Normally not though.

A: We do not.

A: Our surgeons prefer not to change scrubs during any of our bone cases.

A: We do not allow changes in staff during a total joint replacement. •

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SUITE TALK

Q

CLOSING TRAYS Some gyn surgeons have requested closing trays for their C-sections and hysterectomies. Is this a new practice? It was suggested that when closing, all scrubbed staff are to re-glove and gown, and a small tray of instruments should be opened to close the wound to prevent infection. However does this include changing light handles, bovies and re-draping?

A: I have never heard of this before. It does not make sense. If instruments are on the field and sterile, then they are sterile. Why would you open new instruments?

A: NYS partnership for patients would like to see this on all bowel cases, but that is self explanatory.

We are in the process of making closing trays with basic instruments used for closing.

A: This is a new practice and part of the colon bundle, though we have not instituted it as of yet.

A: Hmmm, I have been in the OR for 41 years, we always kept the closing instruments separate from those used during closure of the vaginal cuff and/or the uterus.

Can’t understand why a whole separate set of instruments would be needed if the others are taken care of properly.

2

A: I agree … shouldn’t be; however, this is a push from the state due to the increase in bowel postop infection rates.

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MARCH 2015 | OR TODAY

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“Gel pad water blanket warming was more effective in maintaining normothermia after cardiac anesthesia compared with convective warming. This can be considered an advantage as the gel pad system is easy to use and quiet. Gel pad warming has replaced underbody convective warming during cardiac anesthesia at our institution.”

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IN THE OR MARKET ANALYSIS

MARKET ANALYSIS

BY JOHN WALLACE

Global Demand to Fuel Temperature Management Market

M

aintaining a patient’s core temperature is important before, during and after surgery. The importance of maintaining a healthy body temperature has spurred a specific health care market that continues to grow and is expected to reach new highs in coming years.

The most common complication of surgery is unintended hypothermia, which is the reduction of core body temperature to 35 C or lower, according to AORN. In the OR, 52 percent of patients and 42 percent in the PACU were found to have unintended hypothermia, according to one published study. In addition, some may be as high as 50 to 90 percent, according to another study published in 2011.

“For the surgical patient, hypothermia can be traced to heat loss due to the cold environment in the surgical room and the effects of anesthesia-induced thermoregulation impairment. Hypothermia can cause adverse events, such as cardiac arrhythmias, surgical site infections, increased mortality, metabolic acidosis, respiratory distress, increased blood loss, alteration of medication metabolism and muscle relaxation, and may prolong the post-surgical recovery time,” according to an article written by Sophia Mikos-Schild, RN, MSN, EdD, MAM/ HROB, CNOR. Risk factors for hypothermia include body weight, age, medicaWWW.ORTODAY.COM

tions, environment and patient procedure elements.

The global temperature management market is estimated to grow at a CAGR of 2.4 report through 2019, according to a recent report from the research firm MarketsAndMarkets.

“Development of technologically advanced intravascular systems, increasing prevalence of cancer and cardiovascular disease, rapidly aging population, and increasing adoption of temperature management systems are key factors fueling growth of the market,” according to the report.

“However, unfavorable health care reforms in the U.S. market and product recalls are some of the key restraints hampering the market.”

The global market will be aided by developing areas in Asia and Central and South America.

“Emerging markets, including China, India, Brazil, and Mexico are the new revenue pockets for companies that are engaged in the development and marketing of patient warming and cooling systems,” according to MarketsAndMarkets.

“Growing patient population, government initiatives for the

modernization of health care systems along with the supportive regulatory environment, and rising trends of medical tourism in these countries owing to low-cost surgeries are key factors propelling demand for temperature management systems in the emerging markets.”

Research and Markets also predicts growth in the temperature management market, including in the U.S. market.

“The analysts forecast the global patient temperature management market to grow at a CAGR of 7.4 percent over the period 2013-2018,” according to a news release. “One of the key factors contributing to this market’s growth is the increasing incidence of cardiac and CNS disorders. The global patient temperature management market has also been witnessing an increase in mergers and acquisitions among the leading vendors to increase their global presence and to achieve economies of scale. However, the unavailability of adequate scientific support for the systematic and protocol-driven application of these devices could pose a challenge to the growth of this market.”

Some key vendors in this space include 3M Health Care, Cincinnati Sub-Zero Products Inc., Covidien plc, Smiths Medical, Augustine Temperature Management LLC and Ecolab Inc. MARCH 2015 | OR TODAY

27

IN THE OR PRODUCT SHOWROOM

MÖLNLYCKE HEALTH CARE BARRIER® EASYWARM® The BARRIER EasyWarm active self-warming blanket has 12 air-activated warming pads consisting of 100 percent natural material, such as active coal, clay, salt, water and iron powder. When the blanket comes into contact with oxygen, the warming pads are activated.

The blanket reaches operational temperature within 30 minutes and maintains its temperature for up to 10 hours. Quick and easy to set up, the blanket can be used before, during and after surgery as it does not need any additional equipment such as fans, hoses or electricity. •

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OR TODAY | MARCH 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

CINCINNATI SUB-ZERO GELLI-ROLL® The Gelli-Roll® when used with CSZ’s thermal regulating systems offers patient warming and cooling. The revolutionary and simple-to-use Gelli-Roll® combine patient temperature management and comfort. It is a reusable water blanket encapsulated in Akton® polymer. It may be used before, during, or after surgery to effectively keep your patient normothermic. •

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MARCH 2015 | OR TODAY

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IN THE OR PRODUCT SHOWROOM

ENCOMPASS GROUP

THERMOFLECT® HEAT REFLECTIVE TECHNOLOGY® Maintaining patient normothermia before, during and after surgery can be a matter of life and death. Thermoflect Heat Reflective Technology banks the patient’s radiant heat by capturing and reflecting it back to the cutaneous layer (skin) as well as preventing convective heat loss (windchill). Thermoflect products provide an easy addition to any facility’s warming protocol, using no wires or external heat source, just proven reflective warming that works immediately for the patient. A wide range of products, including blankets, caps, patient gowns, pediatric products, and staff apparel are available. • FOR MORE INFORMATION about Thermoflect Heat Reflective Technology visit www.thermoflect.com or call 800-826-4490.

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OR TODAY | MARCH 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

AUGUSTINE TEMPERATURE MANAGEMENT

HOTDOG PATIENT WARMING SYSTEM HotDog® is the only patient warming system that can warm above and below the patient simultaneously, offering superior effectiveness over older technologies. This reusable, easily cleanable conductive fabric warming system eliminates costly disposables and keeps expenses flat and predictable. In six published studies, orthopedic surgeons and anesthesiologists recommend air-free warming — like HotDog — over forced-air during implant surgery for improved patient safety. One study showed periprosthetic joint infection (PJI) rates decreased by 74 percent after discontinuing forced-air warming; PJIs are now subject to Medicare penalties.

Finally all patients can receive the benefits of normothermia without increasing cost, using air-free HotDog Patient Warming. •

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MARCH 2015 | OR TODAY

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IN THE OR CONTINUING EDUCATION 328-60E

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OR TODAY | MARCH 2015

BY DENNIS SHERROD, RN, EDD

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CONTINUING EDUCATION 328-60E

KEEPING COLLEAGUES:

Nurse Retention Is Everyone’s Responsibility ContinuingEducation.com guarantees 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 41 to learn how to earn CE credit for this module.

The goal of this continuing education program is to enhance nurses’ skills in retaining colleagues in the workplace. After studying the information presented here, you will be able to: • Discuss benefits of retention to quality patient care • Identify reasons nurses leave an organization • Describe strategies for retaining nurses

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T

he entire staff was surprised to hear that Chris was leaving the unit to take a position across town. This was a real blow to the whole crew. Chris was a fabulous nurse who provided excellent care and always helped others. She worked hard to remain up to date on everything from new policies and procedures to the latest in medication administration and technology. The staff so enjoyed working with her that frequently they would look at the schedule to see if she was working their shift. She had told no one she was leaving, but no one had asked. Now she was gone.

When it comes to recruitment, retention is your best strategy. Quality workplaces attract quality staff and employers and nurses across the nation need to make nurse retention a high priority.

For years, employers have invested a majority of their resources in a recruitment revolving door. Large signing bonuses, free trips to Disney World and even pet health insurance have been used to entice nurses.

In reality, no matter what incentives are offered, skilled professionals won’t hang in there unless an employer provides meaningful work and creates an environment that meets professional and personal needs.1 While health care employers must focus on providing quality patient care, a primary goal for achieving that mission

is to provide a quality work environment that holds on to its nurses.

AT WHAT PRICE? The cost of replacing a staff nurse is estimated to run as high as 1.2 to 1.3 times the nurse’s annual salary.2,3 Replacing a nurse with additional training, such as critical care or labor and delivery, may cost even more.

High turnover produces staggering replacement costs. And let’s face it — if these costs were lowered, funds could be redirected to improving patient care services and the workplace environment.

Keeping the best nurses helps improve worker morale. Consider the extra workload that unfilled positions put on the nurses who remain.

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IN THE OR CONTINUING EDUCATION 328-60E

Vacancy rates of 2% to 3% in medium- to large-size staffs are manageable, since a group can collectively work the overtime needed to cover these open positions. But, as vacancy rates increase, nurses may experience loss of empowerment, incivility and burnout.4 Morale starts to plummet, and nurses begin leaving because it seems that everyone else is doing the same.

On the whole, retaining nurses reduces errors and improves continuity of care.5 Knowing the skills, strengths and routines of coworkers allows nurses to focus on evolving patient care demands. As trust in coworkers’ abilities is developed, nurses are more assured that delegated tasks will be completed. But when staff is pulled from another unit or a travel nurse arrives to fill a temporary staffing need, time and energy are redirected away from patient care to orienting all personnel on the unit.

The lesson here is that ultimately, retaining staff improves productivity and quality patient care. Activities such as transporting lab specimens, obtaining supplies and completing mounds of paperwork remove nurses from patient rooms and should be minimized. There’s an old saying: “Take care of the nurses and they will take care of the patients.”

That’s the nurse manager’s job, right? Wrong. While much of the responsibility for nurse retention has been placed on the nurse hierarchy, nurses themselves must take an active role in understanding why colleagues remain and help develop a work environment that promotes retention of nurse colleagues.

WHERE THE GRASS IS GREENER What makes a nurse want to look for greener pastures? Nurses can choose 36

OR TODAY | MARCH 2015

from a variety of jobs. Typically, though, multiple job options don’t cause a nurse to quit. Why a nurse leaves can be based on a number of factors, but the most frequent reasons fall into five categories: 6 • Intense workload • Lack of scheduling flexibility • Low compensation • Inadequate access to continuing education • Minimal opportunity for career growth Workload is a major issue for nurses. At the very least, nurses want to complete their shift knowing they have provided the care encompassed in their patient-care assignment.

Health care differs greatly from other employment settings. As acuity rates rise, lengths of stay are compressed and nurses are assigned larger patient loads. Meeting the goals of quality patient care and even patient safety needs may be overwhelming — perhaps impossible.

The perception of unsafe, unbearable or even unfair workloads can put a nurse over the edge.

Scheduling flexibility may take precedence, as well. Job seekers have many career options that offer much more flexibility than that of an RN. Look at information technology jobs that even allow you to set your own work times and schedule.

Though health care must be available 24 hours a day, to attract employees, employers need to provide flexibility through four-, eight- and 12-hour shifts, as well as a variety of full-time and part-time options. With the high value placed on family, recreation and time away from work today, health care employers need to provide scheduling options that are both worker and family friendly.

Provide competitive compensation and benefit packages. Employers should pay their staff fairly and review compensation levels at least twice a year to make sure they remain competitive. It all makes good sense.

Look around you — employers with high retention rates include flexible benefit programs and consistently provide competitive salaries.

The constant advances in medical science and treatment can make keeping up to date a Herculean task.

But doing so is the cornerstone of improving patient care and outcomes. Nurses know that staying abreast of new skills, procedures and medications is vital to their practice.

Yet in many settings, as budgets are tightened, continuing education is often put on the chopping block. Providing continuing education in a variety of user-friendly formats is a key to retaining nurses.

Last but not least, there’s career growth. To retain nurses, employers need to provide opportunities for nurses to explore their potential. For many years, excellent bedside nurses who looked for ways to boost their earning power or develop additional expertise were limited to manager or educator positions. Many, however, found that their passion was to remain at the bedside. Clinical care models that recognize expanded levels of patient care expertise would recognize and reward professional growth in direct patient care. Here’s another area in which employers need to develop strategies that encourage nurses to develop personal and professional growth and expertise.

Nurses can use a variety of strategies to directly influence the workplace even though their employer may determine workload, schedules, compensation, continuing education and career growth.

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CONTINUING EDUCATION 328-60E

Looking closely at each of these areas can help build a workplace environment that retains nurses as well as other health care personnel.

And while nurse managers are being asked to improve their retention skills, creating such a workplace environment is everyone’s responsibility.

HOLD ON TO WHAT YOU’VE GOT We nurses are great at providing care to patients, but how good are we at taking care of our own nurse colleagues? The bottom line is we all need to accept responsibility for creating a positive workplace environment. Let’s acknowledge positive work behaviors and suggest ways to improve behavior that detracts from a personally and professionally fulfilling workplace.

We need to turn some things around. Let’s think outside the box: Instead of giving a going-away party for colleagues who are leaving, why not throw a “welcome to the unit” party for those who’ve decided to join you? Consider giving staff nurses an opportunity to interview job candidates to get their take on how well that person might fit into the unit work culture. Once they arrive, welcome them with open arms. Be flexible with start dates and pair new employees with seasoned nurse preceptors who have similar interests. If you’re bringing in new graduates, connect them with one of your excellent nurse colleagues who’s been out of school for two or three years. He or she will remember what it felt like to be a novice. Tell them where the hidden supplies are located, and describe the different nurse preferences on the unit. Help them learn to blend into and shape workplace culture.

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Approach colleagues already in your workplace in a professional manner to discuss how behaviors affect the work environment. If a colleague consistently arrives late or tasks are not completed, talk with him or her about the impact that has on you. You might even openly discuss some of these issues in staff meetings and determine as a group what is acceptable and what is not.

Certainly, discuss workload situations when you feel it influences patient or nurse safety.

Communicate openly and honestly with your nurse manager. There’s a difference between complaining and communicating pertinent issues.

Approach your manager with a “What can we do about this?” attitude versus a “What are you going to do about this?” attitude. As actions are taken to address particular issues, clearly communicate these improvements to your colleagues and staff.

Suggest developing a retention committee on your unit. Talk about how to create a quality workplace.

The committee may wish to survey staff or hold focus groups to determine priority retention issues.

Members might collect information from other employers about how they distribute nurse workloads. The committee might compare and contrast scheduling models in other health care settings and develop a unique model to meet staff needs. It could develop a process for gathering nurse input by piloting the model before implementation. Self-scheduling may even be a part of the model.

The retention committee would be an excellent way to develop clinical advancement programs for your unit.

Tracks for management and education can be implemented for those

nurses interested in these areas.

You’ll certainly need to get buy-in from administration, but you should also help administrators understand the need for direct care nurses to improve salaries, grow professionally, and continue to provide direct patient care. Clinical advancement programs that provide higher salaries for expert levels of clinical expertise are an integral part of a professional work environment.

Help administration develop compensation methods that reward productivity. Request that the human resources department provides a written annual update on individual compensation packages.

Many nurses are unaware of how much their employers contribute to fringe benefits.

Nursing staff can discuss new competencies and skills required on your unit. Inform staff development personnel of the evolving clinical challenges nurses face as acuity levels rise. Also, include suggestions on education topics that improve the workplace, such as communication, teamwork and quality improvement.

And encourage programs that improve both work life and home life, such as stress reduction and financial management. Maintain a personal continuing education file and look at a variety of options from which to obtain offerings, such as professional journals and online courses.

Nurse-physician communication and work relationships are reported as a retention issue in a number of agencies. Many facilities have developed and implemented nursephysician policies that outline unacceptable behavior, a process for reporting that behavior, and recourse for correcting it. Not only will you want to promote a culture of trust

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IN THE OR CONTINUING EDUCATION 328-60E

and respect with physicians, but you’ll also want to value each employee’s unique contribution in nurse-to-nurse and nurse-to-nurse assistant communication. Any communication or behavior that demeans another should not be tolerated in workplace interactions.

Encourage employers to develop nurse council governance structures that promote nurse autonomy and allow nurses to provide input into workplace decisions.7 Council members usually consist of nurses elected to represent various units and/or committees in an agency.

DIFFERENCES DEFINITELY MAKE A DIFFERENCE Be aware of colleagues’ and your own behaviors that exclude others because they’re “different.” Understand that difference can be a great thing. Health care requires diverse ideas to care for our patients and provide a quality work environment.

Nurses need to embrace diversity in the workplace. While we want to encourage colleagues to conform to mutually agreed-upon work and performance standards, we also should recognize individual preferences and differences. We need to be open-minded and willing to learn from others. And not just the skills and competencies of nursing care — we need to learn and appreciate the individual perspectives that each person brings to the job. We need to be open to exploring and understanding how colleagues perceive health care and the world differently.

When diversity is discussed, the immediate thought or focus is usually ethnic background — African American, Asian, Caucasian, Latino, Native American, and so on. There’s no reason to categorize individuals,

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because we’re all different. Diversity is broad and includes many differences in our nursing workforce, including age, disability, ethnic or national origin, gender, race, religion, sexual orientation and a number of other attributes. There’s diversity in marital status, values and beliefs.

There’s even geographical diversity — east coast and west coast, northern and southern, and rural and urban.

Then, there’s short and tall, skinny and — well, you get the picture.

We’re all different.

And what difference do differences make? They can help patients quickly identify with particular caregivers. Diverse skill sets and expertise allow teams of nurses to provide care for a wider variety of patient needs. Think about how overwhelming it would be if the skills of only one nurse were available to care for the patient needs of an entire unit. Differences shape the work culture of a unit. And how a nurse reacts to colleagues’ differences can either encourage or discourage them from remaining on your unit.

Employ inclusive rather than exclusive practices with your colleagues. Exclusive practices include stereotyping, making assumptions about colleagues’ preferences, or deciding it’s their responsibility to blend into your workplace. Look for opportunities to include colleagues and make them feel an integral part of the work culture. As nurses are introduced to your unit, invite them to go on break.

Offer to make yourself available if they have questions and touch base often to see how they’re doing.

Use the Platinum Rule instead of the Golden Rule. Treat others the way they prefer to be treated rather than treating others the way you

would like to be treated. We can use similar assessment techniques that we use with our patients — ask.

Watch for nonverbal cues. When you observe that something is not quite right with a colleague, ask if something you did offended the person and how you might respond more appropriately in future interactions. Don’t be quick to criticize and react. Seek to understand others’ points of view.

Agree to disagree. Recognize and value individual nurse contributions, but you don’t always have to agree with colleagues’ ideas and opinions.7 However, you can be respectful in how you disagree. And if it’s an issue you feel passionate about, choose carefully when, where and how you express your beliefs. You might decide that a political rally would be appropriate, whereas a staff meeting might not be the place or the time to express your sentiments.

GROUPS REQUIRING SPECIAL RETENTION ATTENTION While retention efforts are important for all nurses, there are a couple of groups for which you’ll want to develop specific strategies. One is new graduates and the other is mature or experienced nurses.

Retention strategies must be individualized to meet specific needs of individuals and groups.

Much has been written on the challenges new nurse grads face as they move into the workplace. New graduates require transitional support through orientations, internships, residencies, preceptors, mentors, and close assessment and monitoring as they move from academia and acquire “real world” work experience. Some employers feel they’re providing adequate orientation periods of three months.

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CONTINUING EDUCATION 328-60E

However, evidence is revealing that new graduates begin to integrate evidence-based practice in the six- to 12-month period, and that can be the most difficult role adjustment time period. Therefore, they are most likely to become disillusioned with nursing and leave six to 12 months after starting their first job.8 Employers must work closely with new graduates throughout the first year and provide transitional support well into the second year.

Mature nurses 50 years and older are the fastest growing segment of the nurse workforce and they can make up anywhere from one-fourth to one-half of your nursing staff.

You’ll want to pay close attention to this group, as they are probably already considering retirement and it’s a great opportunity to develop strategies that might encourage them to continue in the workforce. Some hospitals are developing “Rehire Retirees” programs, but why would you ever want to let your highly valued employees leave? One of the best strategies for retaining valued nurses considering retirement is to ask, “What can we do to keep you?”

Consider work environment improvement strategies such as including larger text and fonts and improved lighting on your units.

Implement lift technologies and use supply, specimen, and patient delivery services. Maximize schedule flexibility and scheduling options by incorporating compressed work schedules, flexible start and stop times and job sharing alternatives.

Consider three-month and sixmonth contracts for your mature nurses who want to travel or your “snowbirds” who migrate from colder to warmer climates in the winter. Make sure you offer phased retirement options, since only about WWW.ORTODAY.COM

one-half of mature nurses plan to work full time up to their final day of retirement. That means the other half will be looking for phased retirement options such as working 30 hours a week and filling in 10 hours from retirement pay, working six months and taking off six months on retirement pay, drawing retirement pay and supplementing with contract work, or maybe working one day a week for insurance benefits. If you don’t offer options, these nurses may look somewhere else. Also, offer benefits that address specific needs of mature nurses such as health insurance and retirement contribution or catch-up programs.

Both new graduates and mature nurses require special retention attention. While both groups sit at opposite ends of the workforce continuum, specific strategies can be developed and implemented to address the individual needs of each and assure a capable and competent nurse workforce.

KNOW YOUR COLLEAGUES Talk occasionally with nurse colleagues to find out how they’re feeling about their work and their workplace environment. Ask how your unit can make their work more meaningful. Ask how you can help improve your workplace. Ask about areas that would make work more enjoyable for them. Be on the lookout for signs of employee discontent, such as argumentative behavior, episodes of absenteeism and distancing themselves from fellow employees. Intervene immediately by talking with your colleague to determine what needs to be done to rectify the situation. Keep the lines of communication open.

When you arrive at work each day, remember that each employee plays

an integral part in making the workplace exciting and rewarding.

Administrators, managers, educators and individual nurses play an important role in retaining our colleagues. Nurse retention is everyone’s business.

DENNIS SHERROD, RN, EDD, is the Forsyth Medical Center endowed chair of recruitment and retention at Winston-Salem State University, WinstonSalem, N.C. The author has declared no real or perceived conflict of interest that relates to this educational activity.

REFERENCES 1. Tourangeau AE, Cummings G, Cranley LA, Ferron EM, Harvey S. Determinants of hospital nurse retention to remain employed: broadening our understanding. J Adv Nurs. 2010;66(1):22-32.

2. Jones CB. The costs of nurse turnover: part 1: an economic perspective. J Nurs Adm. 2004;34(12):562-570.

3. Jones CB. The costs of nurse turnover, part 2: application of the nursing turnover cost calculation methodology.

J Nurs Adm. 2005:35(1):41-49.

4. Spence Laschinger HK, Leiter M, Day A, Gilin D. Workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes. J Nurs Manag. 2009;17(3):302-311.

5. Committee on the Work Environment for Nurses and Patient Safety, Board on Health Care Services, Institute of Medicine. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: The National Academies Press; 2004.

6. Cohen S, Sherrod D, Beckley NJ. The Essential Guide to Recruitment and Retention: Skills for Therapy Managers.

Marblehead, MA: Opus Communications; 2007.

7. Wieck K, Dols J, Landrum, P. Retention priorities for the intergenerational nurse workforce. Nursing Forum.

2010;45(1):7-17.

8. Ferguson LM, Day RA. Challenges for new nurses in evidence-based practice.

J Nurs Manag. 2007;15:107-113.

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IN THE OR CONTINUING EDUCATION 328-60E

CLINICAL VIGNETTE Sam, nurse manager of the ED, is considering strategies to help retain two of her most productive staff members. Anne is a 62-year-old ED nurse who holds ACLS, MICN, and a number of other certifications.

She has worked in her current position in the ED for the past 12 years, but has mentioned to Sam that she’s considering retirement within the next year. Terrie, a new grad from the local community college nursing program, is the youngest nurse in the ED and has been working on the unit for approximately seven months. She has quickly acquired basic competencies and seems to work well with her patients, but recently she mentioned that she doesn’t feel accepted or appreciated in the department.

1

Sam should consider which of the following as she meets with both nurses?

A. Develop specific retention strategies for each nurse.

B. Reduce each nurse’s workload.

C. Provide counseling services for each nurse.

D. Assess and monitor each nurse closely.

2

Sam realizes she should be prepared to provide transitional support for Terrie for up to: A. One month B. Three months C. Six months D. One year or more

3

Sam can help Terrie to feel more accepted as a part of the unit by: A. Closely monitoring her progress and making herself available for questions B. Helping her understand that nursing can be overwhelming at times C. Practicing the Golden Rule D. Criticizing Terrie quickly to correct mistakes

4

The best question to ask to help retain Anne is: A. Would larger text and fonts be helpful?

B. What can we provide to assist you to continue working here?

C. Would you be interested in a more flexible schedule?

D. What would you like as a retirement gift?

4. Correct answer: B — Ask what strategies and/or incentives you can provide to encourage your valued mature nurse to continue working.

3. Correct answer: A — New graduate progress should be consistently monitored, and embracing diversity requires that you make yourself available to answer questions.

2. Correct answer: D — New graduates may require transitional support for up to one or more years.

1. Correct answer: A — New graduates and mature nurses require retention strategies that are individualized for each nurse.

40 OR TODAY | MARCH 2015

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CONTINUING EDUCATION 328-60E

HOW TO EARN CONTINUING EDUCATION CREDIT 1.

2.

Read the Continuing Education article.

Go online to ce.nurse.com to take the test for $10. If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at www.nurse.com/unlimitedCE for $44.95 per year.

DEADLINE Courses must be completed by 1/15/2015.

3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the

vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a

question incorrectly, we will provide a clue to the correct answer.

4.

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

5.

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

ACCREDITED ContinuingEducation.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 (provider no. FBN 50-1489) and the California Board of Registered Nursing (provider no. CEP13213).

ONLINE Nurse.com/CE You can take this test online or select from the list of courses available.

Prices subject to change.

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CORPORATE PROFILE

RUHOF HEALTHCARE FIRST IN ENZYMATIC DETERGENTS FOR INSTRUMENT CLEANING

T

his month, OR Today sat down with Ruhof Healthcare to find out the latest developments at the cleaning solutions company responsible for creating the very first enzymatic detergent for cleaning surgical instruments. Read on to find out more about the company, including what makes their products unique and what you can expect from them in 2015.

OR TODAY: PLEASE SHARE A LITTLE BIT ABOUT YOUR COMPANY’S HISTORY AND HOW YOU ACHIEVED SUCCESS. Ruhof Healthcare was established in 1976 when Frank Bass and Bernard Esquenet became a team. Frank Bass’s role in the company is one of sales, marketing and research while Bernard Esquenet is the chemist behind Ruhof’s success. Prior to the launch of Ruhof, Frank recognized the need for hospitals to use more than simple dishwashing detergent in cleaning surgical instruments.

Bernard had created cleaning solutions for the Navy, which were used to clean barnacles and other crustaceous marine residues from the heat exchangers and water evaporators of submarines and other naval vessels. When Frank Bass approached him to develop cleaning solutions for hospital instruments, Esquenet realized that the enzymes he was using to eat away at the marine organism resi- dues would also dissolve proteins off of surgical instruments. Thus, Protozyme, the very first enzymatic cleaner for surgical instrumentation was born 44

OR TODAY | MARCH 2015

along with Surgistain, a product for refurbishing corroded stainless steel instruments.

Today Ruhof has a full line of surgical instrument cleaners and scope care and cleaning products which include our multi-tiered enzymatic detergents, enzymatic foam sprays, rust remover and lubricants, autoclave descalers, enzymatic sponges, and more. New from Ruhof is our ScopeValet™ line of products which includes our PULL THRU™ Endoscope cleaning device, endoscopy procedure kits, scope transport bags, Eco-Bedside kit, etc. providing a safe, convenient and efficient way to prepare, begin and perform a scope reprocessing procedure while meeting all reprocessing guidelines. Ruhof not only provides the most effective decontamination products on the market today, we also allow you to verify it with the Ruhof ATP Complete® Contamination

Monitoring System and the Clean Check Complete™ Monitor for both automated and manual enzymatic cleaning process.

OR TODAY: WHAT ARE SOME ADVANTAGES THAT YOUR COMPANY HAS OVER THE COMPETITION? Ruhof Healthcare sells the only enzymatic detergent on the market (ENDOZIME® BIO-CLEAN) clinically tested to pass the difficult ISO standard 15883 Annex F by dissolving biofilm and exposing underlying bacteria to high-level disinfectants or liquid chemical sterilants. Our products are of the highest quality available and we offer the most complete line of surgical instrument and scope cleaning and reprocessing supplies in the marketplace. In addition the company is innovative, continually developing new technologies to meet the needs of our customers.

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SPECIAL ADVERTISING SECTION

OR TODAY: WHAT ARE SOME CHALLENGES THAT YOUR COMPANY FACED LAST YEAR? HOW WERE YOU ABLE TO OVERCOME THEM? Addressing the ever-increasing challenges of cross contamination in hospitals and medical facilities, Ruhof’s research and development department introduced Clean Check Complete™ Monitor for Automated Enzymatic Cleaning Process (AEC).

Clean Check Complete™ monitors the cleaning efficacy of medical washerdisinfectors or ultrasonic cleaners using enzymatic detergents. Later in the year we launched Clean Check Complete® Manual, which detects the presence of active enzymes in manual bath solutions, guarding against using expired or inactive enzymatic detergents. The use of both products fosters routine monitoring and verification of the cleaning processes, which plays a pivotal role in continually assuring the highest possible quality standards for the decontamination of medical devices.

OR TODAY: PLEASE EXPLAIN YOUR COMPANY’S CORE COMPETENCIES AND UNIQUE SELLING POINTS. We are the only supplier of enzymatic detergents that manufactures its own product, guaranteeing consistency and quality. Ruhof is a registered ISO 14001 manufacturer and we pride ourselves on the superior products we manufacture.

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OR TODAY: WHAT PRODUCT OR SERVICE THAT YOUR COMPANY OFFERS ARE YOU MOST EXCITED ABOUT RIGHT NOW? We are most excited about our new instrument and endoscope cleaning devices, which feature ONE PASS technology. The ScopeValet™ PULL THRU™ is an endoscope channelcleaning device, which removes more than 96 percent of residual soil with one pass as opposed to three passes required when using traditional brushes. The CS/ SPD PULL THRU™ is an instrumentcleaning device, which can be effectively used to clean the hard-to-reach narrow lumen channels of laparoscopic and cannulated instruments also in a SINGLE PASS. The unique wiper design of both devices provides a 360-degree seal, which creates a vacuum that draws detergent through the channel. This results in a mechanical flush, which removes biofilm more effectively and saves time.

OR TODAY: PLEASE SHARE SOME COMPANY SUCCESS STORIES WITH OUR READERS— ONE TIME THAT YOU “SAVED THE DAY” FOR A CUSTOMER. Ruhof often receives positive feedback from customers regarding cost savings.

Perioperative and sterile processing professionals regularly tell us that they get better results and more cleaning efficacy using much less of our detergent than other brands. In addition we receive many reports about product

effectiveness. Recently a nurse contacted us about how Ruhof really “saved the day” for her. All other detergents failed to remove an unusual yellow/ orange oily deposit from the scopes she was cleaning but our Endozime SLR® enzymatic cleaner — which specializes in removing synthetic lipid residue – did the trick and she has been a loyal customer since.

OR TODAY: HOW DOES RUHOF SUPPORT ITS CUSTOMERS? Ruhof has a most knowledgeable and responsive customer service department and sales team ready to help our customers with questions, orders, troubleshooting, etc. Our user friendly website and informative technical data sheets/IFUs also provide support. This past year we began a program of free accredited continuing education for nurses and CS/SPD techs, as we understand that ongoing education, training and mentoring are critical to the success of any clinical department.

These CE opportunities – offered at both national and local trade shows — were so well received that we now offer multiple CE programs to help our customers continually advance their knowledge.

OR TODAY: PLEASE TELL ME ABOUT YOUR EMPLOYEES. MARC ESQUENET Marc Esquenet joined the Ruhof Corp. in 1996 as a quality control and formulation chemist and in 2001 was named MARCH 2015 | OR TODAY

45

CORPORATE PROFILE

publication articles for his expertise regarding instrument and scope cleaning. Jack’s experience, skills and successful sales record recently landed him a promotion to the position of Ruhof National Sales Manager. “Jack is a strong leader who’s been working closely with our sales team to motivate them to ever greater achievements”, stated Doug Mackay, Vice President of Sales & Marketing. chief chemist. It was in this role that Marc formulated the unique and innovative products that have given Ruhof its competitive advantage.

Marc has developed new technologies such as enhanced multi-tiered enzymatics, synthetic lipid removal products, Prepzyme® spray for removing dried on bio-burden, Endozime® SLR Bedside Kit, EndozimeTM Xtreme Power and Endozime APA enhanced detergent, and most recently Endozime® Bio-Clean biofilm solubilization formulations.

Marc’s responsibilities in this position included research and development projects in which he now holds several patents. In 2010 Marc was named Vice President of Research and Development, a role requiring him to meet with distribution and customers world-wide in order to better develop new product research, development and commercialization for the company.

DOUG MACKAY Joining Ruhof in 1993, Doug Mackay, Vice President of Sales & Marketing, has been instrumental in providing strategic leadership for the company. In 2009 Doug successfully launched ATP Complete, which then represented the first ATP system used in North America 46

OR TODAY | MARCH 2015

to test the cleanliness of scopes and surgical instruments. In 2012 he also launched ScopeValetTM as well as a complete line of new endoscopy care products. His innovative product launch has been received extremely well by the market and has further strengthened Ruhof’s standing in the endoscopy and medical communities.

JOSE OBREGON A Ruhof employee since 1984, Jose Obregon became International Sales Manager in 1990 and Chief Operating Officer in 2000. It was during this time that he successfully took part in opening new markets in South America, Europe and Asia and participated in the launch of more than 20 new products and four new product lines.

Moving forward, Jose’s goal is to continue to grow both the international and domestic markets for Ruhof with the aim of developing product lines which improve the quality of instrument care and patient safety.

JACK KINVILLE A 20-year veteran of the Ruhof Corp., Jack Kinville has played a major role in generating sales for the company while also assisting the president with many aspects of marketing. Over the years, he has been featured in many trade

OR TODAY: WHAT IS YOUR COMPANY’S MISSION STATEMENT, WHAT IS MOST IMPORTANT TO YOU ABOUT THE WAY YOU DO BUSINESS? At Ruhof we understand the importance of cleanliness in the health care field and are guided by our commitment to excellence. We demonstrate this by offering reliable solutions and

individualized service to help health care facilities meet and exceed their decontamination and infection prevention challenges. We are always finding new solutions and new ways to help fight HAIs and to provide a safe work environment for patient and staff. We value our customers as much as the patients that they care for.

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“

he simple fact is that senior T OR leadership is nearing retirement, but there isn’t a strong pool of leadership talent ready to replace them,” she says. “And the pool of leadership talent is expected to drop by 15 percent over the next few years.”

DO YOU HAVE AN

OR SUCCESSION PLAN? DON’T WAIT UNTIL IT’S TOO LATE

T

he job of an operating room or perioperative services director is an extremely hectic and busy one. OR directors and directors of surgical services (DSS) face a never-ending list of urgent deadlines and priorities on a daily basis that must be dealt with immediately, if not sooner.

By Don Sadler

Therefore, it’s not too surprising that most directors spend little, if any, time thinking about who will succeed them as the leader in the OR. “It’s hard to sell umbrellas when it’s not raining. When things are running smoothly in the OR, directors tend to focus on the immediate priorities that are urgent, rather than plan for something that might be years down the road,” says ChrysMarie Suby, RN MS, the president and CEO of the Labor Management Institute.

IMPORTANT BUT NOT URGENT The biggest challenge for hospitals with regard to succession planning is the simple fact that most of them aren’t doing it, says Sue Smith, RN, BSN, MHSA, CNOR, a principal with the

replace them,” she says. “And the pool of leadership talent is expected to drop by 15 percent over the next few years.”

Smith shares some other sobering stats regarding OR succession planning, including the fact that two-fifths of newly

simply are not attracted to careers in healthcare management.

“The result is an acute shortage of candidates for OR leadership positions,” says Gialanella.

Gialanella summarizes the main responsibilities and required skill sets of a director of

“OR succession planning is important, but it’s usually not urgent, so it isn’t prioritized,” says Smith. “As a result, many hospitals today are not prepared for the looming retirement of their OR and perioperative services directors and other leadership positions within the OR.”

Surgery Management Improvement Group.

“OR succession planning is important, but it’s usually not urgent, so it isn’t prioritized,” says Smith. “As a result, many hospitals today are not prepared for the looming retirement of their OR and perioperative services directors and other leadership positions within the OR.” The statistics bear this out. The average age of perioperative leaders today is 51, and 60 percent of them are over age 50, Smith notes.

“The simple fact is that senior OR leadership is nearing retirement, but there isn’t a strong pool of leadership talent ready to 50

OR TODAY | MARCH 2015

hired OR leaders do not remain past their first 18 months on the job. Also, the median length of time between leadership successors is 12 months. And as many as 25 percent of OR leadership positions currently remain open.

ACUTE CANDIDATE SHORTAGE There are a number of different causes for the potential looming crisis in OR leadership, says John Gialanella, RN, MPH, a principal with the Surgery Management Improvement Group. These include the increasing complexity of OR management responsibilities and the fact that many OR nurses

surgical services as follows: people management, physician management, materials management and financial management.

“This is the hardest perioperative position to fill,” he says, “but succession planning also needs to occur for other OR leadership positions. These include specialty coordinator roles, which can be good building blocks to help prepare staff for director positions down the road.”

Another factor is the limited financial resources that are available for OR management education and training.

“There is money for clinical training, but funding for education in financial management, WWW.ORTODAY.COM

THE MAIN RESPONSIBILITIES AND REQUIRED SKILL SETS OF A DIRECTOR OF SURGICAL SERVICES AS FOLLOWS: PEOPLE MANAGEMENT, PHYSICIAN MANAGEMENT, MATERIALS MANAGEMENT AND FINANCIAL MANAGEMENT. — John Gialanella, RN, MPH,

human resources, operations and regulatory training often isn’t available,” says Linda Groah, RN, MSN, CNOR, NEA-BC, CNAA, FAAN, the executive director and CEO of the Association of periOperative Registered Nurses (AORN). “This ultimately confines nurses to clinical practice.”

Suby concurs.

“There is an overall lack of financial and budgeting training for future OR leaders,” she says.

“Many hospitals have reduced or eliminated these training programs, which has resulted in a deficit in management skill sets among OR nurses.”

This is an especially big problem when you consider that the OR is a big revenue generator for most hospitals.

“This is why perioperative leaders need to have a solid understanding of the business aspects of running the OR,” Suby says.

In addition to financial and budgeting skills, OR leaders should also be strong communicators, Suby adds.

“OR leaders have to be comfortable dialoging with the executive team,” she says. “If you don’t know your numbers and can’t express yourself strategically to executives, instead of having a seat at the table you’re going to end up on the menu.”

THE END IS IN SIGHT Darlene G. Hinkle, RN, MSN, CNOR, the director of periopera-

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tive services at Fairgrounds Surgical Center/Lehigh Valley Hospital in Allentown, Pennsylvania, is among the current generation of OR

"The hard part is finding staff who want to manage the OR. With their family responsibilities and the stress and long hours that are part of OR leadership, staff nurses tend to view it differently now."

leadership that is eyeing retirement in the not-too-distant future.

“I’ve been in my job for 26 years and I know there’s an end in sight, probably about five to eight years out,” she says. “So, succession planning is top of mind for me right now. The hard part is finding staff who want to manage the OR. With their family responsibilities and the stress and long hours that are part of OR leadership, staff nurses tend to view it differently now.”

Hinkle says two of her managers have been with her for 20 years.

“But they are about my age so I don’t think they want my job,” she says. “My youngest manager recently went back to school for her MBA, so I’m excited about her potential for future leadership. I’m working with her to

make sure her OR schedule accommodates her education schedule.”

Suby believes that the responsibility for OR succession planning starts in the hospital’s C-suite.

“The hospital’s executive management team needs to initiate succession planning because it is a long-term, strategic process,” she says.

“Executives need to identify what skills are needed by OR leaders and whether existing staff possesses these skills,” she adds.

“If not, they’ll need to look outside the organization to recruit future leadership.”

There are pros and cons to recruiting OR leaders from outside the organization versus promoting existing staff to leadership positions.

“When leaders are brought in

MARCH 2015 | OR TODAY

51

“When leaders are brought in from the outside, they may bring fresh ideas for improvement and new perspectives in terms of how to deal with problems or issues,”

from the outside, they may bring fresh ideas for improvement and new perspectives in terms of how to deal with problems or issues,” says Groah.

“However, promotion from within is a great retention device

la estimates that about 75 percent of surgical services directors are now brought in from the outside because organizations haven’t adequately trained and groomed new leaders internally.

“It’s hard to sell umbrellas when it’s not raining. When things are running smoothly in the OR, directors tend to focus on the immediate priorities that are urgent, rather than plan for something that might be years down the road,” says ChrysMarie Suby, RN MS, the president and CEO of the Labor Management Institute.”

because your staff feels valued,” she adds. “This can help with recruitment. Also, promoting from within helps maintain important institutional knowledge, as long as it doesn’t trap the facility into the attitude of ‘that’s the way we’ve always done it.’ ” Of course, promoting leaders from within your organization is contingent on having staff that are motivated and prepared to move into leadership positions. Gialanel52

OR TODAY | MARCH 2015

A FORMAL PROCESS Smith recommends making leadership development a formal, ongoing process with each member of the surgical team who has expressed interest in increasing their leadership responsibilities.

“Conduct a leadership review with these staff members six months after you have conducted their annual performance review,” she says.

“These reviews will be similar, but

the leadership review will evaluate staff not for the job they have now, but for the job they might have one day in the future.”

Gialanella recommends “keeping your radar up at all times and keeping your finger on the pulse of your organization. This way, you will have a good idea not only when a leader might be leaving or retiring, but also which staff members might be ready to step up into this leadership position.”

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OR TODAY | MARCH 2015

1/23/15 12:45 PM

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OR TODAY | MARCH 2015

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NURSE LOVES HIGH-TECH ASPECT OF HER JOB SPOTLIGHT ON: TERESA JERSILD

By Matthew N. Skoufalos

Teresa Jersild, RN, BSN, CNOR, believes that every OR nurse enters the field “because they want to do the right thing for their patients.”

“I went into nursing because I like to help people,” she said. “I like to make them feel comfortable. I like people in general, and I like the science of it.”

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57

Out of nursing school in Au Clair, Wisconsin, Jersild headed for the operating room, training intensively in orthopedics and cardiovascular specialties for 12 years, many of which were spent learning on the job.

“I have always liked the OR,” she said. “I like to provide what the patient needs at the moment the patient needs it. I like to be with the patient right after surgery.”

When it was time for her Midwestern roots to branch out into the Southeastern United States, Jersild took a job at the Scottish Rite Children’s Hospital in Atlanta. The pediatric environment “was a wonderful place, and good things happened there,” she recalled, but with a newborn son of her own, working with children who had been injured and fallen ill made the job too emotionally taxing for her to stay.

Teresa Jersild is seen with Milka Andjelkovic, Cassandra Tabscott-Turin, Paula Floyd and Teresa Daniel. Not pictured are Linda Johnson and Linda Prince.

At the time, she recalls, the disease “was just starting to be noticed,” and women who complained of its attendant pains were often referred for mental health services.

“I have always liked the OR,” she said. “I like to provide what the patient needs at the moment the patient needs it. I like to be with the patient right after surgery.”

– Teresa Jersild

Fortunately, Jersild found a position right across the street: at Northside Hospital, where she’s worked for the past 25 years. Today she manages the third-floor surgical unit there, having risen through the ranks from her beginnings as a staff nurse.

Jersild’s career at Northside began as a laser coordinator with a particular interest in endometriosis cases.

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OR TODAY | MARCH 2015

“Some of these ladies, there’s just no way they needed to see a psychiatrist,” Jersild said. “We have quite a few doctors who treat it now; we only had one at the time.”

Later, Jersild accepted a position as a service coordinator in the gynecology department, an assignment that married her enthusiasm for women’s health with an interest

in cutting-edge technology. She associated the expertise and reputation of the physician staff at Northside with their access to the latest and greatest in medical devices, which Jersild said piqued frequently her technological curiosity.

“Because we have a lot of highprofile doctors here, we get to see a lot of new technology,” Jersild said.

“Now, it’s like second nature to everybody. We started with video systems that were so grainy you could hardly see anything, and now you’ve got 2D, 3D, robotics, and the imaging is amazing.”

“If you look at all the different electrosurgical modalities, we have pretty much everything here that anybody would ever want,” she said.

“There’s always something to see or to do or to learn.”

For all the technological achievements on display at the facility, Jersild said the engine of its service delivery is the professional staff.

“The other thing that’s important here is the people and that we treat each other well,” she said.

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Jordy is the family’s newest Packers’ fan. He is Teresa Jersild is seen with members of her family including her father Karl

named after Green Bay Packer wide receiver

Dix, her husband Chris, her mother Margaret and her daughter Kelley.

Jordy Nelson.

Teresa Jersild is seen with her husband and their two children

Teresa Jersild is seen with the family’s

cheering on the Green Bay Packers.

14-year-old Labrador Retriever, Madison.

“You can have all the equipment in the world, but if people aren’t enthused about it, it won’t help you a lot.”

Jersild has also previously worked as the nurse education coordinator at Northside — an experience she described as “a really great time for me”— and in which she traded on her passion for the job in the training of new staff.

“I’ve been very fortunate to have people here to mentor me and help me along in my career,” she said.

After so much time in the profession, Jersild said her enthusiasm for nursing remains undiminished. She believes that helping to encourage coworkers whose interest in the field may have waned is a critical part of maintaining morale in her department. Sometimes any nurse may require support “to find WWW.ORTODAY.COM

something that they are excited about,” she said, and emphasized that “work[ing] with people who you see are losing their enthusiasm to keep it up” is a critical part of her position.

“I think a lot of that is by showing them that they’re important,” she said; “showing them that they are your future. A lot of it starts with having a positive attitude, just going out there and helping your coworkers.”

Nurses must always keep an open mind, Jersild said; recognizing that they work in a field where change is inevitable is an opportunity to feel liberated, not overwhelmed or hemmed in. “[Nursing is] always changing, but it’s an awesome profession,” she said.

“You can always find something to do. There’s always so many different branches that if one doesn’t work out, you can find something else.”

Jersild said that nurses encounter people from all walks of life while on the job — especially other nurses.

The synchronicity was laid out for her plainly in a moment she shared with one of the hospice workers who was caring for Jersild’s ailing mother. “[The hospice nurse] had had surgery on my unit, and she just wanted [me] to know how big a difference it had made for someone to come in and make her feel that she was special,” Jersild said. “It made me feel better that she was taking care of my mother.”

“You have different people that you work with, and they go on to do different things,” she said. “There have been patients who will come back a second time through and ask for you, just tell you how much better they feel.”

MARCH 2015 | OR TODAY

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OUT OF THE OR HEALTH

ASHLEY COLPAART, M.S., R.D. ENVIRONMENTAL NUTRITION

FOOD TOXINS LINKED TO OBESITY T here are many factors behind the rising rate of obesity, such as the increased intake of highly processed foods and lower physical activity. But scientists also are exploring less obvious connections, such as stress, sleep deprivation, and even the presence of toxins in the food supply.

system – that can disrupt our metabolism and increase body fat. Examples include persistent organic pollutants (POPs), pesticides and heavy metals.

These chemicals come into contact with food on the farm from water, soil or crop inputs. They’re also released into the air and water where the compounds may be consumed by smaller creatures, like fish, and accumulate in the tissues of animals as they move up the food chain.

Almost 4,000 new ingredients have entered our food supply since the industrial revolution. Most are a good thing, as they provide benefits like flavor enhancement and extended shelf life. Others are unintentional compounds picked up during the food production process. While food and water are essential to life, they also serve as a vehicle for exposure to some compounds that pose potential health concerns.

PLASTICS IN THE FOOD SYSTEM One concern is potential harm from compounds in plastics, which come into contact with food during production and packaging. These compounds include bisphenol A (BPA), phthalates, and organotins, which can leach into foods during contact, especially when temperatures are high or the food is acidic.

OBESOGENS IN THE FOOD SUPPLY The term “obesogens,” coined in 2006, refers to chemicals in our environment – including the food 60

OR TODAY | MARCH 2015

HOW DO THEY WORK? These compounds (called endocrine disrupters) can disrupt metabolism by mimicking hormones responsible for blood sugar regulation and fat storage. A 2014 review in “Current

Obesity Reports” concluded that, although there is not strong evidence in humans that endocrine disrupters directly contribute to obesity, the current research is compelling, and warrants additional vigorous research.

AVOID FOOD TOXINS Here are things you can do to avoid potential obesogens, according to Kim Robien, Ph.D., R.D., C.S.O., researcher in environmental nutrition at George Washington University School of Public Health and Health Services:

1 2 3 4

Prepare food from scratch, when possible.

5

Avoid plastics with the recycling codes 3 (contains phthalates), 6 and 7 (contains BPA).

Store food in glass or stainless steel instead of plastic.

Never heat food in plastic containers or dishes.

Do not place plastics in the dishwasher.

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HEALTH

6

Avoid leaving plastic water bottles in warm places.

FOOD TOXINS WITH A POTENTIAL LINK TO OBESITY

‌compounds (called endocrine disrupters) can disrupt metabolism by mimicking hormones responsible for blood sugar regulation and fat storage.

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1

Bisphenol A (BPA): Found in polycarbonate bottles, canned foods. Endocrine disruptor

2

Phthalates: Found in a variety of food; enters via food production, procession and preparation.

Trigger fat storage.

3

Organotins: Found in seafood.

Modifies fat storage and

regulation and energy metabolism.

4

Persistent organic pollutants and pesticides: Found in oils, seafood, foods cooked in non-stick pans, berries, fermented foods, meat/ animal products. Impairs blood surage regulation and fat metabolism.

5

Heavy metals: Found in rice, spinach, lettuce, herbs (from contaminated water or soil).

Endocrine disruptor; interferes with adrenal signaling.

MARCH 2015 | OR TODAY

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OUT OF THE OR FITNESS

EATING WELL

STRETCHING

I

Improves Flexibility, Posture & Balance

f you’re trying to improve your overall fitness, you might be tempted to spend most of your exercise time doing some type of cardio, such as walking or swimming. Aerobic exercise is an important part of staying healthy, but you might want to take a more balanced approach to fitness, one that includes strength-training exercises and stretching.

Stretching doesn’t count toward meeting the aerobic or musclestrengthening guidelines, but it’s relaxing, doesn’t require any fancy equipment and can be done anywhere – even waiting in line at the grocery store. Plus, done right, stretching may provide real benefits. So don’t throw in the towel at the gym before reaching for your toes. The benefits of just 5 to 10 minutes of stretching before and after your workout are too good to be ignored.

WHY IT’S IMPORTANT TO STRETCH Stretching can help increase your overall flexibility, but it may also help improve your posture, manage pain caused by tight muscles and help you stay balanced. Since muscles come in pairs that ideally counterbalance each other, stretching and strengthening the muscles opposite the ones that

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OR TODAY | MARCH 2015

always seem tight might help.

If you have a sore back, for example, overdeveloped chest muscles or underused back muscles may be to blame. Try stretching the muscles in your chest with arm rolls, or clasp your arms behind your back and gently pull your shoulders down and back.

Stretching tight muscles can also help counteract the negative effects of sitting for long periods of time. Hunching over a desk can create muscle tightness that can lead to poor posture and pain, notes Joshua Duvauchelle, an ACE-certified personal trainer in Vancouver, Canada.

“Stretching helps correct habitual posture problems, which can translate to reduced lower back pain,” he says.

One of the best reasons to stretch is to help prevent injuries.

“Stretching increases a joint’s range of motion,” says Diana Dove,

an AFAA-certified personal trainer in New York City. “Without sufficient range of motion, the body is vulnerable to injury: the likelihood of pulling a muscle due to overexertion increases, as does the potential to lose balance and/or take a fall.”

HOW TO STRETCH New research suggests that stretching is most beneficial when you incorporate both static and dynamic stretching into your routine. Static stretching – reaching and holding a position for a set amount of time – can help lengthen and counterbalance tight muscles, but your routine should also include dynamic stretching, which incorporates movement.

Gentle exercises such as brisk walking, arm circles, trunk rotations, WWW.ORTODAY.COM

FITNESS

Pilates or moderate calisthenics are examples of dynamic stretches that can help “warm up” the body and prepare it for more rigorous exercise.

“Dynamic moves do a better job of increasing blood flow and warming up the muscles than static moves,” says Kristen Hislop, an AFAA-certified personal trainer and USAT-certified coach in Clifton Park, N.Y. “Dynamic moves engage more muscles and engage the brain, and require balance.”

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WHEN YOU SHOULD STRETCH Take 10 minutes before your workout to do a mix of static and dynamic stretches as a warm-up, then, after your workout, counterbalance the muscles you used with a short cool-down. For example, if you did a bunch of squats (which work the quadriceps on the front of your thigh), be sure to stretch your hamstrings (back of your thigh).

Don’t limit your stretching routine to the gym – shoulder rolls, ear-to-shoulder stretches and toe-touches performed throughout the day can greatly improve your comfort and flexibility.

EATINGWELL is a magazine and website devoted to healthy eating as a way of life. Online at www.eatingwell.com.

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MARCH 2015 | OR TODAY

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ONE SOLUTION FOR ALL YOUR PATIENT MONITORING NEEDS

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IN SURGERY...

(Arthroscopy, Urology)

OUT OF THE OR NUTRITION

BY SHARON PALMER, R.D.

MALIGNED HEMP SEED HAS MANY HEALTH, ENVIRONMENTAL BENEFITS

I

n the past, hemp has gotten a bad rap because of its close relative, marijuana. However, while both plants are in the cannabis family, they’re very different. Unlike marijuana, hemp seeds contain only 0.001 percent of the active compound tetrahydrocannabinol (THC), thus hemp does not cause a psychoactive effect, and is completely safe. In fact, hemp has some distinct health and environmental benefits.

Since 1937, growing hemp has been prohibited in the U.S. because of confusion over its relationship to marijuana, although it can be sold here. In fact, hemp is a historic crop, used for a multitude of functions beyond food, such as textiles, paper, building supplies and rope. The Declaration of Independence was written on hemp paper. Today, most hemp is grown in Canada.

Interest in hemp cultivation is rising, partially because it’s very sustainable compared to other seed crops. Hemp is quick-growing, vigorous and resistant to disease and insects, requiring lower inputs of fertilizers, water and pesticides.

And, unlike many seed crops, the hemp stalk can be used for its rich fiber source in products like textiles and building supplies, such as pressboard.

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OR TODAY | MARCH 2015

Another reason hemp is on the rise is because of its unique nutrient profile. Hemp seeds provide 10 grams (g) of protein per ounce, as well as 10 g of heart-healthy, plantbased omega-3 and -6 fats, 3 g of fiber, and is a rich source of iron, thiamin, magnesium, zinc and manganese.

Hemp oil, which is cold-pressed and unrefined, has a fat profile similar to the seed, containing only 1 g of saturated fat per tablespoon; most of the fat content is the healthy kind, such as monounsaturated and polyunsaturated, with an impressive 2 g of omega-3 fatty acids per serving. When hemp is pressed into oil, powder, or “butter,” a unique emerald green color is released, signaling its rich chlorophyll compounds.

While the research on hemp is still in the early stages, there’s a lot to love WWW.ORTODAY.COM

NUTRITION

Hemp seeds provide 10 grams (g) of protein per ounce, as well as 10 g of heart-healthy, plant-based omega-3 and -6 fats, 3 g of ďŹ ber, and is a rich source of iron, thiamin, magnesium, zinc and manganese. about the nutritional value of this plant food. You can purchase hulled hemp seeds (some manufacturers call them hemp hearts), coldpressed hemp oil, hemp plant-based milk, hemp butter (ground hemp seeds,) and hemp powder (the milled protein fraction of hemp

seeds) at many natural food stores.

Sprinkle hemp seeds over cereal and yogurt, stir them into homemade granola, toss them into salads, and mix them into baked goods. Use hemp oil in place of extra virgin olive oil in pesto, salad dressings, and pasta as a finishing oil (do not

cook with this delicate oil; its smoking point is 350 degrees F.) Mix hemp powder and hemp milk into smoothies to increase their protein and nutrient value. And use hemp butter in place of peanut butter on sandwiches, toast and in baking.

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MARCH 2015 | OR TODAY

67

OUT OF THE OR RECIPE

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OR TODAY | MARCH 2015

BY SARA KATE GILLINGHAM

WWW.ORTODAY.COM

RECIPE

MEXICAN CHICKEN SOUP T

his is the soup my one-fourth Mexican mother used to make all the time, and for that reason alone it is authentic to me. Yes, go to Mexico and you will have a pretty different soup, but this is the way she fed me as a child, and so it is how I make it today. It has a lot to do with using up leftovers.

MEXICAN CHICKEN SOUP Serves 4 to 6.

1 3 1/2 4 1/4 • 4 2 1

• 1/4 1 1/2

If you don’t have a sweet potato, a yellow or red potato will work fine if that’s what you have on hand. Potatoes came into the soup in the first place because of leftovers. As for the tomatoes, if they’re not in season, try whole canned tomatoes, diced into smaller pieces. The building blocks for this dish are the chicken and chicken stock, lime, cilantro and tortilla; beyond that, you can experiment. Use the best stock possible – I like to use homemade.

1/2 cup shredded jack cheese, optional

medium sweet potato, cubed into bite-sized pieces (peeling optional) tablespoons cooking oil medium onion, sliced thin cloves garlic, minced teaspoon ground cumin Salt and black pepper cups chicken broth cups shredded cooked chicken cup chopped tomatoes (cherry tomatoes sliced in half, or larger tomatoes cubed) Juice of 1/2 lime cup chopped cilantro (stems and leaves), plus more leaves for garnish corn tortilla, cut in half, then in 1/4-inch strips whole avocado, cubed

WWW.ORTODAY.COM

In a 3-quart pot or larger, bring 6 cups of water to a boil over high heat. Add the potatoes and simmer, covered, for 5 to 7 minutes, until the potatoes are easily pierced with a knife. Drain and set aside.

In a large stock pot over medium heat, warm 2 tablespoons oil, add the onion and saute until soft, about 10 minutes. Add garlic, cumin, salt and pepper, and saute another minute.

Add the chicken stock and bring to a simmer. Add the shredded chicken, tomatoes, lime juice, potatoes and cilantro. Turn off the heat and cover.

In a small skillet over medium heat, warm the remaining 1 tablespoon oil. Add the tortilla strips and let them crisp, tossing around

often, about 5 minutes or until golden. Sprinkle with salt.

To serve, ladle the soup into bowls, top with cilantro leaves, cubed avocado, shredded cheese and a handful of tortilla strips.

RECIPE NOTES

Chicken breasts can be substituted for the thighs, though I find thighs hold up better over the long cooking and breasts tend to fall into shreds. Still delicious, though!

For a little of that smoky tandoori flavor, try using smoked paprika and roasted tomatoes. • Sara Kate Gillingham is founding editor of TheKitchn.com, a nationally known blog for people who love food and home cooking. Submit any comments or questions to kitchn@ apartmenttherapy.com.

MARCH 2015 | OR TODAY

69

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OR TODAY | MARCH 2015

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MARCH 2015 | OR TODAY

71

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • MARCH •

wild blueberries OR Today is great to share with co-workers.

Snap a photo of a co-worker reading a copy of OR Today and you could win FREE lunch for your department. Email your photo along with your name, title and contact information to Social@MDPublishing.com. Every entry will win a $5 gift card, but remember that the most creative photo wins a pizza party!

THE WINNER GETS LUNCH FOR THE ENTIRE TEAM!

win a gift card!

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OR TODAY | MARCH 2015

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EACH SUBMISSION WINS AN OR TODAY PRIZE PACK

Win Lunch!

WILD BLUEBERRIES COMBAT EFFECTS OF A HIGH-FAT DIET

Eating wild blueberries (bilberries) diminishes the adverse effects of a high-fat diet, according to a recent study at the University of Eastern Finland. For the first time, bilberries were shown to have beneficial effects on blood pressure and nutrition-derived inflammatory responses. Low-grade inflammation and elevated blood pressure are often associated with obesity-related diseases. The study focused on the health effects of bilberries on mice that were fed high-fat diet for a period of three months. Some of the mice were fed either 5 percent or 10 percent of freeze-dried bilberries in the diet. The researchers assessed the effects of the diets by looking at inflammatory cell and cytokine levels, systolic blood pressure, glucose tolerance, insulin sensitivity and weight gain. Mice on the high-fat diet experienced significant weight gain and detrimental changes in glucose and lipid metabolism, inflammation factors and blood pressure.

Bilberries diminished the pro-inflammatory effects of the high-fat diet, indicated by an altered cytokine profile and a reduced relative prevalence of inflammation supporting T-cells.

Bilberries also prevented elevated blood pressure caused by the high-fat diet.

The original article was published in PLOS ONE, and it is openly accessible at http://dx.plos.org/10.1371/journal.pone.0114790

WWW.ORTODAY.COM

PIN BOARD

BITE INTO A HEALTHY LIFESTYLE There is no one food, drink, pill or machine that is the key to achieving optimal health.

A person’s overall daily routine is what is most important. That is why, as part of National Nutrition Month 2015, the Academy of Nutrition and Dietetics urges everyone to "Bite into a Healthy Lifestyle."

March is Nation Nutrition Monthal .

Each March, the Academy encourages Americans to return to the basics of healthful eating through National Nutrition Month. This year’s theme encourages consumers to adopt a healthy lifestyle that is focused on consuming fewer calories, making informed food choices and getting daily exercise in order to achieve

"OUR JO B AS NU RSES IS TO C U S H IO N SORROW T AND CEL HE E THE JOY , EVERYD BRATE AY, W WE ARE 'JUST D HILE OING OUR JO BS.' " - Chr

and maintain a healthy weight, reduce the risk of

istine B elle, RN , BSN

chronic disease and promote overall health.

Find out more at www.eatright.org

TRY THESE SIMPLE STEPS TO BEAT RISING FOOD COSTS

The Kiplinger Agriculture Letter expects food prices across the board to increase 2.5 percent in 2015. However, there are ways to keep the cost of groceries under control. Follow these steps to keep your food bills in check: Stock up during sales. It's always a good money-saving strategy to stock up when nonperishable items and food that can be frozen go on sale. This strategy can pay off even more if prices on items you regularly buy are expected to rise.

Buy the store brand. You can save a lot by buying the house brand, so reconsider your loyalty to name brands.

Become a coupon maven. Some people take couponing to extremes, but You don't have to devote your entire weekend to clipping coupons to save at the supermarket. Many stores make it easy to find coupons on their website and will load them directly to your loyalty card (which you should get if you don't already have one).

Look for alternatives. Oranges aren't the only source of vitamin C. Foods such as kale, broccoli and Brussels sprouts also are rich in vitamin C and other vitamins found in fresh fruits.

Don't be afraid to haggle. Ask a store manager for discounts on items near their "sell by" date. The expiration date you see on a product is the manufacturer's estimate for freshness, not the drop-dead date by which the product must be used.

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For more helpful tips, visit ortoday.com/food-costs/.

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MARCH 2015 | OR TODAY

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INDEX ALPHABETICAL AAAHC…………………………………………………………………16 AIV, Inc.…………………………………………………………………13 Bemis Health Care……………………………………………… 5 Bio-Medical Equipment Service Co.…………… 32 Bryton Corporation…………………………………… 54, 63 C Change Surgical……………………………………………… 4 Cincinnati Sub-Zero………………………………………… 26 Clorox Professional Products………………………14-15 Cygnus Medical………………………………………………… 33 David Scott Company…………………………………… 54 Didage Sales Company, Inc.…………………………… 24 Eizo, Inc………………………………………………………………… 9

Encompass Group…………………………………………… 23 Enthermics Medical Systems, Inc.………………… 55 Flagship Surgical, LLC…………………………………… 47 GelPro……………………………………………………………………16 Government Liquidation…………………………………IBC Healthmark Industries…………………………………… 42 Innovative Medical Products, Inc………………… BC Innovative Research Lab, Inc………………………… 70 Jet Medical Electronics…………………………………… 63 MAC Medical……………………………………………………… 43 MD Technologies……………………………………………… 65 MedWrench………………………………………………… 70-71

Pacific Medical LLC………………………………………… 64 Palmero Health Care……………………………………… 32 Polar Products……………………………………………………71 Ruhof Corporation……………………………… 2-3, 44-46 Sage Services…………………………………………………… 24 Sharn Anesthesia…………………………………………………71 SMD Wynne Corp.…………………………………………… 23 Suburban Surgical Company, Inc.………………… 67 Summit Medical Inc.…………………………………………… 6 Surgical Power……………………………………………………61 TBJ, Inc.……………………………………………………………… 22 Tru-D…………………………………………………………………… 55

MedWrench………………………………………………… 70-71 Summit Medical Inc.…………………………………………… 6 Surgical Power……………………………………………………61

RADIOLOGY Eizo, Inc………………………………………………………………… 9

INDEX CATEGORICAL ACCREDITATION AAAHC…………………………………………………………………16 ANESTHESIA David Scott Company…………………………………… 54 Innovative Research Lab, Inc………………………… 70 SMD Wynne Corp.…………………………………………… 23 Sharn Anesthesia…………………………………………………71 APPAREL Healthmark Industries…………………………………… 42 ASSOCIATIONS AAAHC…………………………………………………………………16 AUCTIONS Government Liquidation…………………………………IBC MedWrench………………………………………………… 70-71 BIOMEDICAL Innovative Research Lab, Inc………………………… 70 BEDS Innovative Medical Products, Inc………………… BC CARDIAC SURGERY C Change Surgical……………………………………………… 4 CARTS Suburban Surgical Company, Inc.………………… 67 CABLES/LEADS Sage Services…………………………………………………… 24 CLEANING SUPPLIES Cygnus Medical………………………………………………… 33 Ruhof Corporation……………………………… 2-3, 44-46 CLAMPS Innovative Medical Products, Inc………………… BC DISPOSABLES Flagship Surgical, LLC…………………………………… 47 Government Liquidation…………………………………IBC Sage Services…………………………………………………… 24 ENDOSCOPY Government Liquidation…………………………………IBC Innovative Research Lab, Inc………………………… 70 MD Technologies……………………………………………… 65 Ruhof Corporation……………………………… 2-3, 44-46 Summit Medical Inc.…………………………………………… 6 TBJ, Inc.……………………………………………………………… 22 FALL PREVENTION Encompass Group…………………………………………… 23 GEL PADS David Scott Company…………………………………… 54 Innovative Medical Products, Inc………………… BC MAC Medical……………………………………………………… 43 GENERAL Didage Sales Company, Inc.…………………………… 24 GelPro……………………………………………………………………16 Government Liquidation…………………………………IBC Innovative Research Lab, Inc………………………… 70

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OR TODAY | MARCH 2015

HAND/ARM POSITIONERS Innovative Medical Products, Inc………………… BC HIP SYSTEMS Innovative Medical Products, Inc………………… BC INFECTION CONTROL/PREVENTION Bemis Health Care……………………………………………… 5 Clorox Professional Products………………………14-15 Cygnus Medical………………………………………………… 33 Encompass Group…………………………………………… 23 Government Liquidation…………………………………IBC Palmero Health Care……………………………………… 32 Ruhof Corporation……………………………… 2-3, 44-46 SMD Wynne Corp.…………………………………………… 23 INFUSION PUMPS AIV, Inc.…………………………………………………………………13 INSTRUMENTS Government Liquidation…………………………………IBC INTERNET RESOURCES MedWrench………………………………………………… 70-71 KNEE SYSTEMS Innovative Medical Products, Inc………………… BC LAB TBJ, Inc.……………………………………………………………… 56 LEG POSITIONERS Innovative Medical Products, Inc………………… BC MONITORS Eizo, Inc………………………………………………………………… 9 Jet Medical Electronics…………………………………… 63 OR TABLES/ ACCESSORIES Bryton Corporation…………………………………… 54, 63 Innovative Medical Products, Inc………………… BC ORTHOPEDIC Surgical Power……………………………………………………61 PATIENT AIDS Innovative Medical Products, Inc………………… BC PATIENT MONITORING Bio-Medical Equipment Service Co.…………… 32 Encompass Group…………………………………………… 23 Pacific Medical LLC………………………………………… 64 POSITIONING AIDS Innovative Medical Products, Inc………………… BC POSITIONERS/IMMOBILIZERS David Scott Company…………………………………… 54 Innovative Medical Products, Inc………………… BC PROCESSING TBJ, Inc.……………………………………………………………… 22

REPAIR SERVICES AIV, Inc.…………………………………………………………………13 Bio-Medical Equipment Service Co.…………… 32 Pacific Medical LLC………………………………………… 64 SHOULDER RECONSTRUCTION Innovative Medical Products, Inc………………… BC SIDE RAIL SOCKETS Innovative Medical Products, Inc………………… BC SOCIAL MEDIA MedWrench………………………………………………… 70-71 STERILIZATION Clorox Professional Products………………………14-15 Summit Medical Inc.…………………………………………… 6 TBJ, Inc.……………………………………………………………… 22 SURGEON COOLING Polar Products……………………………………………………71 SURGICAL AAAHC…………………………………………………………………16 Clorox Professional Products………………………14-15 David Scott Company…………………………………… 54 Eizo, Inc………………………………………………………………… 9 Flagship Surgical, LLC…………………………………… 47 MAC Medical……………………………………………………… 43 MD Technologies……………………………………………… 65 SMD Wynne Corp.…………………………………………… 23 Summit Medical Inc.…………………………………………… 6 Surgical Power……………………………………………………61 SURGICAL SUPPLIES Cincinnati Sub-Zero………………………………………… 26 Cygnus Medical………………………………………………… 33 David Scott Company…………………………………… 54 Government Liquidation…………………………………IBC Ruhof Corporation……………………………… 2-3, 44-46 SURPLUS MEDICAL Government Liquidation…………………………………IBC SUPPORTS Innovative Medical Products, Inc………………… BC TEMPERATURE MANAGEMENT C Change Surgical……………………………………………… 4 ULTRASOUND AIV, Inc.…………………………………………………………………13 VIDEO Eizo, Inc………………………………………………………………… 9 WARMERS Enthermics Medical Systems, Inc.………………… 55 WASTE MANAGEMENT Bemis Health Care……………………………………………… 5

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