OR Today - November 2015

PRODUCT SHOWROOM

DISINFECTION ROBOTS PAGE 26

TAKE GOOD CARE

INDUSTRY INSIGHTS

HEALTH

CLOROX EXPERT ADVICE PAGE 17

NURSES • SURGICAL TECHS • NURSE MANAGERS

STRESS RELIEF PAGE 56

NOVEMBER 2015

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C O N T I N U O U S

patient monitoring

READ OUR CORPORATE PROFILE ON PAGES 42-51

ScopeValet™ ValveSafe™ enables compliance with the new ANSI/AAMI ST91: 2015 Guidelines for flexible and semi-rigid endoscope processing: During and after cleaning... “all detachable valves should be kept together with the same endoscope as a unique set…to prevent cross-infection and enable full traceability.”

• Addresses the international guidelines’ recommendations (British Society of Gastroenterology; European Society of Gastrointestinal Endoscopy) • Single-use product which aids in the reduction of cross-contamination • “Smart-Click” technology ensures cage cannot be closed again once it has been used • Large enough for multiple valves, including cleaning valves • Plastic construction to prevent rust and any microbiological growth • Has 4 Integrated openings for air/water cleaning adaptor chain • Large openings, to allow cleaning solutions through

Safe and effective valve storage ensuring valves remain as part of a unique set with their parent endoscope thoughout the cleaning process

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While infected scopes pose a huge problem for medical facilities HAIs can be acquired anywhere… a robotic arm, surgical instrument, or even a computer keyboard. Ruhof’s ATP Complete® Hand-Held Contamination Monitoring System – with medical-grade Test® Swab and Test® Instrusponge™ – makes it possible to measure any surface in your facility for microbial contamination, helping to lower the risk of HAIs to patients and staff.

With ATP Complete® you can: • Identify problem areas with easy to use, reliable results IN JUST 15 SECONDS • Track ATP hygiene monitoring results with user-friendly database Monitoring Software • Utilize outcomes to identify contamination sources and develop improved cleaning protocols • Assure patient and staff safety as HAIs are reduced in the workplace.

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1-800-537-8463 www.ruhof.com 393 Sagamore Avenue, Mineola, NY 11501 Tel: 516-294-5888 Fax: 516-248-6456 1 Stated in the 2008 CDC/Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Disinfection and Sterilization in Healthcare Facilities

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CONTENTS

features

OR TODAY | November 2015

42

46

CORPORATE PROFILE: INNOVATIVE MEDICAL PRODUCTS

“Innovative Medical Products” is not a marketing moniker, but rather an indicator of IMP’s purpose and commitment in bringing new ideas to market – innovations that provide savings of time and cost to hospitals, add accuracy and support to the surgeon’s hands and contribute to positive patient outcomes. IMP is focused on providing innovative products inspired by industry professionals.

Renee Pink’s career in Army back in 1988. technician, 50and liked it so

CONTINUOUS PATIENT MONITORING The stories of patients who have died due to respiratory depression after their surgeries are heartbreaking. Over the past decade, a surprisingly high number of hospital patients have suffered complications due to undetected respiratory depression after receiving opioids. This has given rise to a movement to increase the usage of continuous patient monitoring to reduce these post-operative events.

SPOTLIGHT ON: RENEE PINK

Renee Pink's quest to provide patient care can't be stopped. While working as a transplant technician — and against the advice of her supervisors and colleagues — Pink enrolled in nursing school. She recalls a sense of destiny at the move; a feeling that she said was undiminished when she finally graduated nursing school and told her manager that she wanted to join the nursing staff in the operating room.

OR Today (Vol. 15, Issue #9) November 2015 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and 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. © 2015

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November 2015 | OR TODAY

7

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

34

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

EDITOR

10

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT Jonathan Riley Yareia Frazier Jessica Laurain

ACCOUNT EXECUTIVES

Mike Venezia | mike@mdpublishing.com Jayme McKelvey | jayme@mdpublishing.com

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

62

Andrew Parker | andrew@mdpublishing.com

ACCOUNTING Kim Callahan

WEB SERVICES Betsy Popinga Taylor Martin

IN THE OR 22 25 26 34

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 56 58 61 62 64

Health Fitness Nutrition Recipe Pinboard

66 Index

8

OR TODAY | November 2015

MD PUBLISHING | OR TODAY MAGAZINE 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 | Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

PROUD SUPPORTERS OF

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INDUSTRY INSIGHTS NEWS & NOTES

KARL STORZ C-HUB II CONTROL UNIT NAMED AN INNOVATION OF THE YEAR BY SLS

Endoscopy-America Inc. has announced that the Karl Storz C-Hub II Control Unit was recognized as a 2015 Innovation of the Year by the Society of Laparoendoscopic Surgeons (SLS). Recipients of this year’s honors were announced during Minimally Invasive Surgery Week, SLS Annual Meeting & Endo Expo in New York City.

The Karl Storz C-Hub II Control Unit represents a cost-effective yet comprehensive solution that offers true plug-and-play functionality in integrated ORs as well as in office environments. The unit links C-MAC Airway Management components with external monitors as well as with existing computer systems for real-time viewing, video transfers, documentation and more. Additionally, the unit enables simultaneous viewing of the intubation and surgical endoscopic procedures, 10

OR TODAY | November 2015

which helps streamline workflow.

Designed for integration in larger installations, the C-Hub II unit offers control of white balance at the touch of a button. A video editor function is used to display, record and further process endoscopic images. Connections can be made to existing systems, using USB 2.0, HDMI and S-Video connections. A wireless signal reaches over 30 feet between boom- or tower-mounted transmitters and a receiverequipped monitor for convenient video transfers.

Added monitors need only be equipped with an additional receiver unit.

The C-HUB II provides an interface for video image routing among various devices, including medical and commercial video monitors, OR1 integrated operating rooms, and other systems. •

STAFF REPORTS

FASCIAL CLOSURE SYSTEM SELECTED AS AN INNOVATION OF THE YEAR Teleflex Inc. was recognized for the selection of the new Weck EFx Shield Fascial Closure System as one of the 2015 Innovations of the Year at Minimally Invasive Surgery Week Annual Meeting & Endo Expo 2015.

The Society of Laparoendoscopic Surgeons (SLS) recognized the most innovative products of the past year that have a multidisciplinary application in minimally invasive surgery. Innovations of the Year were announced in September at SLS’ Minimally Invasive Surgery Week Annual Meeting and Endo Expo.

Weck EFx Fascial Closure Products from Teleflex allow surgeons to provide fast, safe closure of laparoscopic port sites with a range of options that suit their procedural and institutional needs.

The new Weck EFx Shield Fascial Closure System is the only shielded port closure device, providing enhanced sharps protection for safe, uniform, and consistent fascial closure, and is designed with a unique shielded wing for enhanced sharps protection, intuitive wing deployment and an innovative fascial closure technique with unassisted suture retrieval “Teleflex is honored that the Weck EFx Shield System has been chosen by the SLS as a 2015 Innovation of the Year,” said John Tushar, President & General Manager, Teleflex Surgical.

“The EFx Shield System is a prime example of our unwavering commitment to the pursuit of surgical innovation and the Teleflex mission to help improve the health and quality of people’s lives.” • WWW.ORTODAY.COM

NEWS & NOTES

MOLEX DELIVERS ISO 13485-COMPLIANT SURGICAL CABLES Molex LLC operates an ISO 146441-1:1999 Class 8-certified clean room, satisfying strict particulate contamination levels specified by ISO-compliant requirements. Located in Thailand, the facility has less than 100,000 particulates (≥0.5µm) per cubic foot of air and manufactures a variety of ISO 13485-compliant medical cables and surgical cables used in operating theaters, hospitals, laboratories and clinics. The micro-organism-controlled environment keeps room pressure, temperature, humidity and contamination levels within the limits required in the standard.

“Our ISO-compliant Class 100,000 clean room facility allows us to provide device designers with cable assemblies that meet the international standards and regulatory requirements for medical devices used on or within patients,” said Seann Kwan, product marketing manager, Molex.

Each clean room is equipped with High-Efficiency Particulate Air (HEPA) filters to prevent the spread of airborne and viral organisms.

They also feature a positive pressure design that keeps unfiltered air out of the room while air showers remove particulates from workers and products before they enter. The

audit clean room maintenance process includes a micro-organisms count to ensure compliance of cleanliness and bio-burden levels.

The medical-grade, surgical and non-surgical cables are used in a wide variety of applications including ablation, arthroscopy, coblation, cosmetic, dental, electro-surgery, endoscopy, gastro, laparoscopy, lasers, ophthalmic, power tools, surgical catheters, robotics and video endoscopy. • FOR INFORMATION, visit www.molex.com/link/ cleanroomgrademedicalcables.html.

NEOSURGICAL REPORTS COMMERCIAL MILESTONE neoSurgical Inc. has announced that the company’s neoClose system for port site closure after Laparoscopic surgery has been used 2,000 times in hospitals across the U.S. Northwestern Memorial-Prentice Hospital in Chicago is the newest addition to neoSurgical’s growing U.S. hospital customer base.

Two recently published clinical studies have shown that trocar site hernia (TSH) is highly prevalent in port site closures post-Lap surgery.

TSH can lead to significant morbidity, often requiring surgical intervention, frequently as emergency. “neoClose offers surgeons a new alternative designed to reduce the risk of post-Lap-surgery herniation at the port site,” said Magdy P. Milad, M.D., the Albert B. Gerbie Professor and Chief of Gynecology and Gynecologic Surgery at Northwestern Memorial Hospital, Chicago, and the

WWW.ORTODAY.COM

Vice-Chair of Education in the Department of Obstetrics and Gynecology at Northwestern Medicine.

Laparoscopic abdominal surgery requires a hole or “port site” in the abdomen. The port site must be closed, of course, after Lap surgery. While Lap surgery itself is minimally invasive, herniation, or protrusion of abdominal tissue through the port site after closure (commonly referred to as trocar site hernia, or TSH, among doctors), can lead to morbidity due to small bowel strangulation, for example, or nerve and vessel entrapment, resulting in infection, bleeding and pain.

The standard for port site closure has been Closed Loop Suture. Now, there’s neoClose. neoClose works by the use of a Vector X closure, approximating the tissue together and tying into place for a secure closure with up to 75 percent less tension compared to standard closed loop suture. •

November 2015 | OR TODAY

11

INDUSTRY INSIGHTS NEWS & NOTES

TRI-PULL SECURE SHOULDER SOLUTION PROVIDES ROTATION CONTROL

The Tri-Pull Secure Shoulder Solution from Innovative Sports Medicine, a division of Innovative Medical Products Inc., employs three proven systems to confidently secure, distract and ensure precise rotation control of the shoulder during surgical procedures for sports-related injuries, without compromising the sterile field. The Tri-Pull solution includes ISM’s Reznik Universal Shoulder Positioner, De Mayo RoTractor, and Phase 4 Gel Splint.

The Reznik Universal Shoulder Positioner provides controlled shoulder distraction with three planes of adjustment for maximum flexibility. For additional protection, the positioner’s patented vertical safety stops eliminate concerns about the equipment slumping or falling onto the patient during surgery.

The De Mayo RoTractor adapter delivers complete patient control of 12

OR TODAY | November 2015

the shoulder in the sterile field, holding the arm securely in place in varying degrees of rotation. The De Mayo RoTractor provides the surgeon not only better access to the surgical site but also the ability to “dial” in the rotation and lock it in place while maintaining distraction without utilizing an assistant.

The easy-to-apply, non-irritating Phase 4 Gel Splint is designed with a natural wrist contour for increased comfort while maintaining patient anatomy and improving patient safety. The splint’s three positioning holes work with any company’s pole-style shoulder positioner that utilizes hooks. In addition, these holes align perfectly with the De Mayo RoTractor adapter, allowing it to rotate and securely position the patient’s arm.

These three ISM systems also work independently and can be used with many manufacturers’ positioning products. •

CLEANPATCH LAUNCHES SMALL CIRCLE PATCH Surface Medical Inc. has expanded its CleanPatch product offering with the introduction of a smaller size.

SMI now offers a 5-centimeter (2-inch) circular CleanPatch designed to repair punctures and the earliest points of damage. This new offering features the same durability and performance as the 9-centimeter (3.5-inch) and 9 x 15 centimeter (3.5 x 6 inch) CleanPatch products.

“CleanPatch has been implemented in more than 360 health care facilities in nine countries, and we are continually asked for a smaller size to repair punctures,” said Tony Abboud, Vice President of Business Development at SMI. “Following discussions with our current customers, we selected a circular patch for this newest product offering because it will safely and effectively repair the sides and edges of mattresses and stretchers – two areas that are frequently damaged.”

The new small circular CleanPatch is offered in a box of 30 with a free implementation kit. • VISIT www.cleanpatch.us for information.

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c i n c i n n a t i

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Gelli-Roll® & Norm-O-Temp® The Norm-O-Temp® and Gelli-Roll® combined offer a whole body warming system that can be used in pre-op, the Operating Room, recovery, or the Emergency Department for conductive warming.

The Gelli-Roll® is a reusable water blanket that provides patient warming and comfort. It allows for the caregiver to have complete access and is easy to clean with disinfectants.

“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.”

— Charles E. Smith M.D., MetroHealth Medical Center ASA Poster, November 2009

www.cszmedical.com Phone: 513-772-8810 Toll Free: 800-989-7373 Fax: 513-772-9119

INDUSTRY INSIGHTS AAAHC UPDATE

BY JACK EGNATINSKY, M.D.

VERIFICATION, AUTHENTICATION, DOCUMENTING, DISTRIBUTING, REPORTING What do these all mean – especially to your AAAHC surveyor?

Y

ou’ve seen all these terms used in the AAAHC Standards and probably noted a number of deficiencies scored in the Standards where they occur.

What do AAAHC accreditation surveyors (like myself) mean by these terms and what do we look for? Since the Standards and Survey Process committee has not issued any guidelines, I am giving you my own approach as an active surveyor. I am not going to copy the Standards word for word here so you may want to pull out your AAAHC Accreditation Handbook and look at Standards 4.G, 6.I. 9-10, and 12.1.C.3 and 12.1.D. Let’s start by looking at 6-I which has requirements for entries into a clinical record. Sub-standard 9 calls for “verification of contents by health care professionals,” and 10 calls for “signature of, or authentication by, the health care professional on the clinical record entry.”

14

OR TODAY | November 2015

So what do I look for? I take them together, see what your clinical records policies call for, and then look to see that entries are signed and dated.

Inserting the time as well would be nice, but unless your policies call for this, it is not reason for a deficiency as I review your records. Many records contain an assortment of lab results – X-ray reports, EKGs and other test results.

Presumably, if these reports are in the record, the attending physician and/or the anesthesiologist thought the underlying tests were important enough to obtain. Therefore, I look to see some sort of verification that these have been reviewed. Most often, verification is by initials or signatures of the admitting physician and often by those of the anesthesiologist, too. In others, I look to see that the anesthesiologist has addressed these in his/her pre-anesthesia assessment. Sometimes, we see a sheet with a note by the surgeon/proceduralist and/or the anesthesia provider that the outside test results have been reviewed.

Any of these methods are acceptable to me; but, on occasions, I don’t see any of the above. Which raises the question: If the tests are not important enough

for the physicians to verify that they have reviewed them, then why are they including them in the clinical record?

Where the deficiencies often arise crosswalks to 4.G and 12.1.C.3 and 12.1.D. CLIA waived or other tests ordered on the day of surgery, and results from tests that come in on the day of surgery, are often incorporated into the completed records. While the nurses or techs may record these results in the nursing notes, or in some other designated location in the record, the Standards require that the results be distributed “to and reviewed by the ordering physician or another privileged provider.” Often this review is not documented. The same applies to test results received after the day of surgery such as culture reports and pathology reports. Remember, we generally review completed charts (by your definition of what is meant by “completed”) so these entries should be in there, and verification of review should be present.

I am often asked what is meant by “authentication” as it appears in 6.I.10.

It’s a good question since authentication implies proving or documenting that something is genuine. As I interWWW.ORTODAY.COM

AAAHC UPDATE

Once the report is sent in for staff processing, it cannot be changed.

Your best opportunity to have a term or a decision explained, or to challenge a finding, is during the survey while you are having a faceto-face conversation. pret this on the surveys I perform, the term “authentication” applies to reports coming from sources outside of the center. I am not expecting your center or the physicians to authenticate that what is done in the lab, X-ray unit, etc. is as represented in the report. However, I do expect that that you or the physicians have reviewed the report; and if there is a question about its authenticity this can be looked at further.

I hope this helps you understand what your surveyors are likely to look for and if you disagree with their findings, please make that known and explain your reasoning while they are still on-site. Once the report is sent in for staff processing, it cannot be changed. Your best opportunity to

have a term or a decision explained, or to challenge a finding, is during the survey while you are having a face-toface conversation.

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 also on the board of the Accreditation Association for Hospital and Health Systems (AAHHS) and is a representative of Acreditas Global, the international arm of AAAHC. He remains extremely active as a Medical Director for AAAHC, in addition to being an AAAHC accreditation surveyor, in the U.S. and internationally.

In 1979 the Steelers won the Super Bowl.

Saturday Night Fever was the album of the year. And AAAHC began accrediting ambulatory health care organizations.

YEARS STRONG

We’ve been raising the bar on ambulatory care through accreditation for 35 years. The secret of our success? Our peer review. AAAHC surveyors are physicians, nurses, anesthesiologists, medical directors and administrators. Which is why organizations routinely heap praise on us for our consultative and educational survey process.

And why we are the leader in ambulatory accreditation.

If you would like to know more about AAAHC accreditation, call us at 847-853-6060. Or email us at info@aaahc.org.

Or you can visit our web site at www.aaahc.org.

Improving Health Care Quality through Accreditation

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November 2015 | OR TODAY

15

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INDUSTRY INSIGHTS CLOROX ADVICE

BY KATHERINE VELEZ, PHD, SCIENTIST, CLOROX HEALTHCARE

ULTRAVIOLET-C IN THE OR INCORPORATING EMERGING TECHNOLOGY FOR INFECTION PREVENTION PROTOCOLS

M

any facilities are interested in using emerging technologies such as ultraviolet (UV-C) light emitting devices as part of the nationwide effort to reduce hospitalacquired infections (HAIs). This is in part due to the inherent limitations of manual cleaning; although manual cleaning and disinfection of hospital surfaces is a critical step in limiting the spread of pathogens that cause HAIs, studies have demonstrated that less than 50 percent of hospital room surfaces are adequately cleaned and disinfected, leaving facilities and patients vulnerable to potentially dangerous pathogens.1 For facilities that choose to turn to UV-C to supplement their manual disinfection protocols, there are many UV-C device options available to choose from, which is why it’s important for facilities to do their research to find the device that will best fit their specific infection control needs.

WHY USE UV-C? In the fast-paced hospital environment, terminal cleaning and disinfecting on environmental surfaces is often suboptimal. UV-C treatment technologies are a great way to supplement manual environmental surface cleaning and disinfection with Environmental Protection WWW.ORTODAY.COM

rooms, this includes one placement (or run cycle) on each side of the patient bed, and one placement inside the patient bathroom. A similar protocol is recommended for operating rooms following end of day terminal cleaning.

KATHERINE VELEZ, PHD, SCIENTIST, CLOROX HEALTHCARE

Agency (EPA)-registered disinfectants. Manual disinfection is essential for removing soils and killing pathogens on environmental surfaces, while UV-C devices offer an extra layer of protection by inactivating microorganisms in high-risk settings or hard to reach areas that may have been missed by manual cleaning, such as bed rails, doorknobs and handles, as well as areas that may be difficult to clean manually, such as walls, light fixtures, windows and floors.

Every device is different, but for the Clorox Healthcare™ OptimumUV Enlight™ System, the recommended protocol for most standard size hospital rooms is three separate 5-minute cycles. For standard patient

CHOOSING THE RIGHT UV-C DEVICE Key considerations for purchasers selecting a UV-C device include kill claims for the most common health care pathogens, exposure times, safety and ease of use. Purchasers should ask vendors about other factors such as training and support offered by the manufacturer, as well as costs to determine the best solutions for their facility. Ultimately, facilities should select the UV-C device that gives them assurance they are getting the antimicrobial efficacy they require, while also maximizing their investment.

The Clorox Healthcare™ Optimum-UV Enlight™ System provides the ideal balance of performance, quality, user-friendly design, safety and affordability. This system has been proven in laboratory microefficacy testing to kill more than 30 HAI-causing pathogens in 5 minutes at 8 feet from the device, including a 4 log reduction of C. difficile spores and a greater than 5 log reduction of over 20 pathogens, including MRSA, VRE, and CRE.2 Robust usability and safety features, such as an intuitive touchscreen operating system and infrared November 2015 | OR TODAY

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motion sensors to prevent operation if people are present, help enable facility-wide adoption of this UV-C technology. Clorox Healthcare also partners with facilities to provide PROOF APPROVED CHANGES NEEDED comprehensive training, workfl ow support, and technical support to CLIENT SIGN–OFF: enhance device implementation.

PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT Clorox Healthcare uniquely offers a LOGO PHONE NUMBER WEBSITE ADDRESS broad portfolio that includes both UV-C technology and a range of EPA-registered manual surface TRIM 4.5” disinfectants to provide a comprehensive solution for disinfection.

UV-C technology offers facilities a PUBLICATION unique way to supplement manual MEDICAL DEALER TECHNATION ORTODAY surface disinfection protocols as part of broader infection control meaBUYERS GUIDE OTHER sures aimed at reducing HAIs and MONTHfacilities improving patient safety; should use the considerations discussed here to decide J F which M A M J J A S O N D Refer a biomed to MedWrench technology is right for them. and you could win a DESIGNER: JL

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REFERENCES (1) Weber, D. J.; Anderson, D.; Rutala, W. A. Curr. Opin. Infect. Dis. 2013, 26, 338–344. (2) Based on third-party laboratory micro-efficacy testing.

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INDUSTRY INSIGHTS ASC UPDATE

BY WILLIAM PRENTICE

ASCS INVEST MORE IN EMPLOYEE BENEFITS, PAY SLIGHTLY HIGHER THAN IN 2012

R

The benefit that the largest percentage of ASCs began offering for the first time between 2012 and 2015 was tuition: 52 percent of ASCs now offer some form of tuition support compared to 28 percent in 2012. Two other benefits that saw significant increases were domestic partner health insurance and retirement benefits. The percentage of ASCs offering domestic partner health grew by 19 percent to 53 percent, and the percentage offering retirement benefits increased by 18 percent to 94 percent of the ASCs. As a median, benefits now account for nearly 15 percent of an ASC’s total compensation costs.

Salaries that increased the most since 2012 are for materials managers (up 9 percent), directors of nursing (up 6 percent) and administrator and business office managers 20

OR TODAY | November 2015

SALARY AND BENEFITS SURVEY MATERIALS MANAGER - BONUS CRITERIA

bonus based on outcomes (19%) AVAILABLE SELECTIONS

esults are in, and analysis of ASCA’s 2015 ASC Salary and Benefits Survey report shows that most ASC salaries grew modestly since ASCA conducted its ASC compensation survey in 2012. The information also shows that ASCs are investing more in individual benefits than in 2012, and while more ASC employees are receiving bonuses than before, the amounts of the individual bonuses that ASCs paid previously have gone down.

bonus based on net income (19%)

bonus based on other (25%)

bonus based on performance (34%)

position not eligible for bonus (37%)

0

10

20

30

40

PERCENTAGE

(up 5 percent). In 2015, 84 percent of ASCs reported paying their administrator a bonus, 74 percent said that they paid one to the head of their nursing staff and 73 percent indicated that they paid one to their business office manager. Those numbers are up from 69 percent, 60 percent and 61 percent in 2012. Also in 2015, a majority, or 63 percent, of materials managers received a bonus compared to 47 percent in 2012.

This year’s survey also suggests that many ASCs have begun to recognize the value of the certification programs their staff complete.

For example, 14 percent of ASCs now require their administrators to hold the Certified Administrator Surgery Center (CASC) credential, and in the ASCs that do, the median salary for that position is 19 percent higher

than in other ASCs. Also, in the ASCs that indicated that they employ surgical technologists, 43 percent said that they pay their certified surgical technologists more.

More than 95 percent of the ASCs that responded to the survey indicated that they have physicians in their ownership mix. In addition, 19 percent indicated that they had a corporate partner and 25 percent indicated that a hospital owned at least part of their ASC. Multi-specialty ASCs made up 59 percent of the mix. The median length of time the ASCs reported being in business was 12 years, the median number of full-time employees was 19 and the median number of cases reported annually was 3,707.

ASCA’s 2015 ASC Salary and Benefits Survey is an entirely WWW.ORTODAY.COM

ASC UPDATE

SALARY AND BENEFITS SURVEY EMPLOYEE TUITION REIMBURSEMENT/CONTINUING ED IS AVAILABLE

YES

YES (52%)

NO

NO (48%)

online tool that collected data on 20 ASC job positions, employee benefits and ASC demographics.

Nearly 850 ASCs participated.

Like the survey, the final report

is also available online. ASCs that completed more than 50 percent of the survey can access the report for free. Others can purchase the online report at www.ascassocia-

tion.org/salarysurvey. Dynamic comparison, filtering and reporting features built into the online tool allow users to perform their own analysis of the data.

This report is recommended to all ASCs working to develop compensation packages that will attract and retain top talent. ASCA will conduct the survey again in 2017 to build on the data in this report and identify any new trends that develop over time. If you have any questions about how to access or use this new resource, please contact Brian Stevenson at 703-636-0673.

WILLIAM PRENTICE is the chief executive officer of the Ambulatory Surgery Center Association.

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November 2015 | OR TODAY

21

IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

Q

TOTAL JOINT INFECTIONS Are any facilities seeing more total joint infections with the use of the Bear Hugger versus other types of warming devices? This seems to be a hot topic in the media.

A: Not us.

A: No.

A: We have not so far.

A: I have not noted such trending with our total joint patients.

A: No increase or change in SSI with and without forced air warming. There are some studies out there that support that.

A: No, we have not.

A: No.

Q

LABELING PEEL PACKS Should peel packs be labeled? When sending new employees for items, they sometimes are not completely knowledgeable about what they are looking for, and labeling peel packs can be very beneficial.

A: We label the bin for identification.

A: It is appropriate to label peel packs on the end of the

Q 22

LEEP Should N-95 masks be worn on all LEEP procedures?

OR TODAY | November 2015

pouch and not on the pouch itself. This is probably only necessary for seldom used items or items that look similar, but are not inter-

changeable in their use.

A: We label the peel packs.

A: We do not use them.

A: We wear special LASER masks.

A: Yes. According to AORN guidelines for Laser Safety, V.c. page 144: Personnel should wear respiratory protection (i.e., fit-tested surgical N95 filtering face piece respirator or high-filtration surgical mask) during procedures that generate surgical smoke as secondary protection against residual plume that has escaped capture by local exhaust ventilation. Local exhaust ventilation is the first line of protection from surgical smoke.

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SUITE TALK

Q

PRE-CLEAN Is it necessary to pre-clean all instruments at point of use? Should this be done in the suite, in the hall, or just in the decontamination room?

A: We just had The Joint A: The scrub should be A: I take that to mean at the Commission review. The keeping instruments as clean point of use. Endo is done surveyor was an infectious as possible in the field. They directly within the suite. disease physician. He should have some type of Dried debris is more difficult that we needNEEDED to use pre-klenz solution to put on to remove. Then, it is transPROOF APPROVEDstatedCHANGES enzymatic spray and spray the instruments if they are ported without gross conboth sides of the instrugoing to be setting for a while tamination.

CLIENT SIGN–OFF: ments before they leave the without being cleaned.

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November 2015 | OR TODAY

23

IN THE OR MARKET ANALYSIS

STAFF REPORT

MARKET ANALYSIS

Disinfection Robot Market Continues to Grow

T

he market for disinfection robots is expected to grow from $30 million in 2014 to $80 million by 2017, according to published reports. In recent years, hospitals and other health care facilities have turned to robots, or portable enhanced environmental disinfection systems, that feature ultraviolet-C (UV-C) light or hydrogen peroxide vapor (HPV) to complement infection control protocols already in place to battle multi-drugresistant organisms.

The growth of the market can be attributed to the ongoing fight against hospital-acquired infections (HAIs). Many health care facilities are turning to “robots” to help combat Clostridium difficile (C. diff ), methicillin-resistant Staphylococcus aureus (MRSA) and more as pathogens mutate to resist antibiotics and disinfectants.

According to the U.S. Centers for Disease Control and Prevention, a survey of acute care hospitals found 1 in 25 hospital patients has at least 1 HAI on any given day and that 75,000 deaths per year are due to HAIs. The thoroughness of terminal cleaning of patient rooms

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in acute care hospitals is one area of focus to reduce HAIs and improve patient care.

These robots help fight HAIs without additional labor costs.

While disinfection robots remain fairly new, the two sources they use

UV disinfection finds its uses in diversified areas, including surface disinfection in health care facilities.

However, water treatment leads the market, accounting for almost 60 percent of the total market share, as it is a volume-driven application (in

Introducing these technologies could have large positive implications for infection prevention practices and capital and operational budgets. for fighting infections are not.

UV-C light has been used to decontaminate drinking water and air handling systems for quite some time, and UV-C and HPV have both been used in clean room environments by the pharmaceutical industry for years.

According to a report by Allied Market Research titled “UV Disinfection Equipment Market Size, Industry Analysis, Trends, Growth, and Forecast, 2013-2020,” the global UV disinfection equipment market has a potential to reach $2.8 billion by 2020, registering a compound annual growth rate of 15.3 percent during 20142020.

The growth of the health care and chemical industry is creating tremendous opportunities for the UV disinfection equipment market.

terms of number of UV equipment utilized).

The ECRI Institute, realizing the growing use of these devices, included disinfection robots on its 2015 C-Suite Watch List along with Google Glass and telehealth among other hot topics.

“Introducing these technologies could have large positive implications for infection prevention practices and capital and operational budgets. In addition, administrators could see a return on investment due to fewer staff-contracted infections and loss of work time. Implementing disinfection robotics might not only improve patient health outcomes, but also bring about significant savings and cost avoidance for health care systems,” according to The ECRI Institute’s 2015 C-Suite Watch List.

November 2015 | OR TODAY

25

IN THE OR PRODUCT SHOWROOM

BIOQUELL BQ-50 Bioquell is pleased to announce the latest advancement in automated room decontamination with the introduction of the BQ-50. Utilizing Bioquell’s Hydrogen Peroxide (HP) Vapor, the BQ-50 is able to fully decontaminate every exposed surface in an enclosed area, from wall to wall and ceiling to floor. As Bioquell’s fourth-generation technology, the system is smaller, lighter, and operates faster than ever before.

It is even easier to use, requiring only the press of a single button to start the system, making it fully automated. The BQ-50 makes the decontamination process user-friendly and can be easily maneuvered throughout the facility.

Importantly, the new design continues Bioquell’s use of HP Vapor, which has an extensive and unparalleled scientific evidence base. •

26

OR TODAY | November 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

CLOROX HEALTHCARE™ OPTIMUM-UV ENLIGHT™ SYSTEM Combining manual surface disinfection with UV technology ensures thorough coverage, especially on areas that may be missed during manual cleaning. The new Clorox Healthcare™ Optimum-UV Enlight™ System kills 31 total pathogens in five minutes at a distance of eight feet, including a 4-log reduction of Clostridium difficile (C. difficile) spores and a greater than 5-log reduction of more than 20 pathogens such as MRSA, VRE and CRE. The Optimum-UV Enlight™ System combines powerful UV technology with advanced data collection and reporting capabilities, clinically proven efficacy and affordability to enable facility-wide adoption, including the OR. •

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November 2015 | OR TODAY

27

IN THE OR PRODUCT SHOWROOM

INDIGO-CLEAN CONTINUOUS ENVIRONMENTAL DISINFECTION TECHNOLOGY A new tool in health care disinfection is Indigo-Clean™, a light fixture that uses Continuous Environmental Disinfection technology instead of UV to continuously kill harmful bacteria linked to hospital acquired infections (HAIs). Indigo-Clean™ uses visible light, specifically 405 nanometers (nm), which is absorbed by porphyrin molecules within the bacteria. This produces a chemical reaction that kills the bacteria from the inside, similar to the effects of household bleach. Indigo-Clean™ operates continuously and requires no operator, kills bacteria in the air and on hard and soft surfaces, and complies with all internationally recognized standards for patient safety. The Indigo-Clean™ Clinical Partners Program is open to health care facilities that want to objectively evaluate the technology and share the results with peers. • FOR ADDITIONAL INFORMATION, visit www.Indigo-Clean.com.

28

OR TODAY | November 2015

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PRODUCT FOCUS

XENEX GERM-ZAPPING ROBOT™ The Xenex Germ-Zapping Robot™ is the only Full Spectrum™ room disinfection technology proven, in multiple peer-reviewed studies, to reduce HAI rates. Hospitals using Xenex robots have published 14 peer-reviewed studies, including five outcome studies showing greater than 50 percent decreases in MRSA, C.diff and VRE infection rates. Designed for speed, effectiveness and ease of use, the robot destroys viruses, bacteria and bacterial spores in five-minute disinfection cycles. Unlike other UV products that use bulbs containing toxic mercury to produce low-intensity UV light, Xenex is the only technology that uses high-intensity Full Spectrum™ pulsed xenon UV light to disinfect. •

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November 2015 | OR TODAY

29

IN THE OR PRODUCT SHOWROOM

TRU-D SMARTUVC Tru-D SmartUVC is the only portable UV disinfection system that can deliver an automated measured dose of UV-C to consistently disinfect an entire room from a single position, ensuring 99.99 percent pathogen reduction in direct and indirect shadowed areas and eliminating the threat of human error in the disinfection process. As the UV disinfection device of choice for the $2 million Centers for Disease Control-funded study, “The Benefits of Enhanced Terminal Room Disinfection” by the Duke University Prevention Epicenter Program, hospital leaders invest in more than the technology – it’s an investment in every patient who enters the operating room. Validated by more than 12 independent studies, Tru-D’s combined automated measured dosing capabilities and real-time usage-tracking feature, iTru-D, make Tru-D the most precise and advanced automated UV disinfection system available. •

30

OR TODAY | November 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

STERIS PATHOGON UV DISINFECTION SYSTEM The PATHOGON UV Disinfection System from STERIS provides assurance and sense of security that the room has been terminally cleaned to the highest standard of care and is ready for the next case. There is often a lack of confidence among OR staff that the operating room suite has been cleaned as well as it should have been. Knowing that PATHOGON was used in the room gives them confidence that a redundant or overkill step, if you will, has been used. PATHOGON UV reduces the risk of infection and cross contamination in the OR for patients and operating room staff. It delivers a calculated dose of germicidal UV-C energy in as little as 4 minutes to kill pathogens on environmental surfaces and has been shown to deliver a 3-4 log reduction of C-Diff spores and 5-7 log reduction of bacteria and viruses. The system employs a wireless controller that makes it easy to initiate and monitor cycles from outside the room and automatically tracks cycle data and usage. It uses redundant heat/motion sensors to protect staff against accidental exposure.

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November 2015 | OR TODAY

31

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IN THE OR CONTINUING EDUCATION 711

34

OR TODAY | November 2015

BY SARA A. LOWE, RN, MSN, CPNP, APNP, AE-C

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CONTINUING EDUCATION 711

NO WAY AROUND IT:

Rounding Means Satisfied Patients and Nurses

A

lice is a new nurse employee on a busy medical/surgical unit at General Hospital. During her first week, she noticed how frequently she heard call lights beeping. The unit was noisy from all the call lights, and the nurses seemed to be constantly scurrying around in and out of patient rooms. She asked Anne, her preceptor, why they weren’t doing hourly rounds. Anne said she was unfamiliar with hourly rounding. Alice explained that where she had worked before, nurses had rounded hourly on their patients. As a result, the unit was quiet, patients weren’t ringing their call lights, the number of patient falls had been reduced by half, and nurses had more time to get their work done since they weren’t constantly interrupted to go in and out of patient rooms. Anne was intrigued by what Alice was telling her and wanted to learn more about rounding and whether it would work on their unit at General Hospital.

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 program is to provide nurses and nurse leaders with an understanding of hourly rounding’s purpose and process and offer tips for implementation success. After studying the information presented here, you will be able to: • Define purposeful hourly rounding • Discuss the different types of rounding: introductory rounds, initial rounds and hourly rounds and the key behaviors in each • Explain how to measure the success of hourly rounding in the clinical setting

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Hourly rounding is a systematic, proactive, nurse-driven evidencebased process designed to anticipate and address needs of hospital patients.1-4 Rounding has been shown to increase patient satisfaction with their hospital experience as a result of regular attention from nurses. In addition, research indicates that on inpatient units where rounding has been “hardwired,” patient falls have decreased by 50%, skin breakdown has been reduced by 14%, and the number of patient calls via call lights has dropped by 38%.1,2,3,4 The concept of hourly rounding was developed in the late 1980s at a medical center in Birmingham, Ala. That hospital introduced the role of a unit “hostess,” who rounded on every patient four times each shift.

The hostess answered call lights within five minutes and addressed all patient requests that did not require a licensed staff member. Tasks that the hostess took care of included adjusting room temperatures and providing patients with juice, water or pillows. The change brought about by the hostess was dramatic: Within two weeks there was a noticeable decline in patient and

physician complaints together with many positive comments about the hostess from nurses. Nurses appreciated having someone available to answer call bells quickly, and patients felt that their needs were being met promptly.5 Hourly rounding developed from these roots.

PATIENT SATISFACTION One of the key drivers of hourly rounding is patient satisfaction. The unit hostess role described above indicates that patient satisfaction can be affected by things such as prompt response to call lights and attention to other patient needs and concerns.

Patient satisfaction can be defined as “the consumer’s fulfillment response; the degree to which the level of fulfillment is pleasant or unpleasant.”6 One author suggests that “satisfaction is a short-term attitude that is encounter specific.” He adds that “service quality is often judged by patients based on their perceptions of performance relative to expectations.”7 These perceptions about a patient’s hospital experience are measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey. The November 2015 | OR TODAY

35

IN THE OR CONTINUING EDUCATION 711 HCAHPS survey measures experiences of patients during their hospital stays and is used by hospitals throughout the United States.8 Hospital patients often need help with basic tasks, such as using the restroom, eating, bathing and ambulating. Nurses’ responsiveness to their needs is a key factor patients often consider when making judgments about the quality of their care. Other factors that can influence opinions about satisfaction can include patient and family perceptions of things like prompt response to call lights, timely assistance to the restroom, timeliness and appropriateness of pain control, friendliness of the nurses and effective exchange of information with nurses.

When a patient’s need for assistance isn’t met in a timely fashion, it can result in patient falls and increased pain, as well as complaints from patients and families.1-3,4,9,10 It should be noted that the HCAHPS survey includes questions about pain control and assistance to the restroom.8 As noted above, patients often measure their satisfaction with hospital care based on factors such as staff responsiveness to their needs and prompt answering of the call bell. The call bell is a “lifeline” for a hospital patient.10 It is how the patient summons the nurse for assistance or information.

Patients expect that when they push the call bell, the nurse will come promptly. But busy caregivers may find it time-consuming to answer call bells.

Also, every time a nurse tells a patient, “Call me if you need anything,” she or he seems to be giving up control of her time to the patient.10 Because of the expectations of patients for assistance and attention as well as the need for nurses to have some control over their activities, it became important to find a way to satisfy both patients and nurses while meeting the legitimate needs of both. Rounding fills this need in the inpatient setting. Rounding allows the 36

OR TODAY | November 2015

THE PS OF ROUNDING1,11-15 nurse to focus on the needs of each patient so that each patient gets the full attention of the nurse. During the round, the nurse will address all patient needs, including pain, restroom, comfort and position, information, treatments, meds and other requests so that when the round is complete, all of the patient needs have been met.1 PURPOSEFUL HOURLY ROUNDING Hourly rounding means visiting patients every hour to proactively take care of their needs, with rounding modified to every two hours overnight.1 Often the word “purposeful” is used along with hourly rounding to indicate that rounding requires specific actions and words, or scripting, on the part of the nurse who is rounding. Rounding is different from just checking to see if a patient needs anything. Instead, rounding is purposeful. By asking the patient about specific things during each round, nurses can anticipate patient needs instead of reacting to patient needs by waiting for the patient to use the call bell.1-3,4,11-15 The tasks of rounding are organized using the letter P. The three basic Ps of rounding are pain, potty and position, which are the three basic needs common to most patients. These 3 Ps are universal and used in most hospitals that use hourly rounding as their patient care model. Other Ps can be added, based on the preferences of each hospital.11,12 Other Ps for rounding include “pump, periphery, plan of the day, possessions.” Using words beginning with P makes the tasks of rounding easy to remember.

When rounding, it is best to limit the number of Ps so that it is easier for staff to remember the tasks associated with rounding. Most hospitals choose four or five Ps as their focus for rounds and incorporate all patient care tasks, including med passes and treatments, into those Ps.11-15

BASIC PS OF ROUNDING • PAIN: Address patient’s pain at every round; use scale of 1-10; document medication given and when next dose is due on inroom communication board. Explain pain med, adverse effects, dose. Tell patient “I will round on you every hour to make sure your pain is under control.”

• POTTY: Offer patient assistance with restroom needs. Caution not to get out of bed alone. Ask, “Do you need to use the restroom now?

May I help you to the restroom?”

• POSITION: Assess patient position and reposition as needed for comfort. Assist into or out of bed, into or out of chair, turn. Ask, “Is there anything I can do to make you more comfortable?”

OTHER PS THAT CAN BE USED • PUMP: Check IV and other pumps to ensure that everything is working correctly so that alarms do not go off.

• PERIPHERY: Assess patient room: tidy up, clear clutter, straighten bed, fluff pillows, remove used linen. Ensure that telephone, call light, TV control and wastebasket are within reach.

• PLAN: Review patient agenda or plan of care with patient.

Update on tests, treatments; discuss needs at home; plan for discharge. Ask patient, “What is the most important thing I can do for you today?” and update the communication board.

• POSSESSIONS: Make sure the patient’s belongings are within reach. Make sure that items such as dentures and hearing aids have labeled containers for safekeeping when patient isn’t using these items. Secure patient valuables.

• PARTING: Before leaving room ask the patient, “Is there anything else I can do for you before I leave? I have the time.”

Explain that you will be back again in an hour to round on them and that during the night you will round on them every two hours, even if they are sleeping. Document the round on the rounding log in the room.

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CONTINUING EDUCATION 711

TYPES OF ROUNDING There are three types of rounds during each shift: introductory (which can include bedside shift report), initial and hourly. Let’s examine each type.

The introductory round is just what it says, a round to introduce the oncoming nurse by the outgoing nurse. The process allows the oncoming nurse to be “managed up” by her colleague who is leaving and increases the patient’s confidence in the oncoming nurse. Managing up means that the outgoing nurse introduces the oncoming nurse by highlighting the nurse’s strengths.

An example of this is: “Hello, Mrs. Jones, I’m going home now, but I wanted to introduce Kelly, who will be taking care of you today. She has worked here for three years and is an excellent nurse, one of our best. She

will take very good care of you today.” A statement like this from the outgoing nurse sets up the oncoming nurse as competent and lets patients feel they are in good hands.11,15 The introductory round can be included as part of the bedside shift report or can take the form of the outgoing and incoming nurse visiting each patient together at change of shift for introductions and a quick check of the patient’s well-being. As part of the introductory round, the outgoing and oncoming nurse visit all their patients together at shift change and give a shift change report. The outgoing nurse can then leave, and the oncoming nurse can begin his or her initial rounds.11,12,15 The initial round is the first hourly round of each shift, and it is done after the outgoing and oncoming nurses complete the introductory

rounds. The initial round includes all of the dialogue and actions that are part of a regular hourly round with the addition of two important elements. First, the initial round should include an explanation to the patient of what hourly rounding is.

This way, the patient understands rounding and knows that it is purposeful. Second, during this initial round that the nurse should ask each patient, “What is the Most Important Thing that I can do for you today?” The MIT may be something as simple as making a phone call to check on the status of a patient’s pet or checking with the physician to see if the patient can have regular instead of decaf coffee.

Asking for the MIT shows patients that their priorities are important and will be addressed along with their medical treatment. The MIT is

TYPES OF ROUNDING1,11,14,15 TYPE OF ROUND

Different Behaviors

INTRODUCTORY ROUND

• Outgoing and oncoming nurses go to each patient room together.

• Outgoing nurse introduces oncoming nurse and “manages up.”

• Nurses conduct shift report at bedside.

• Oncoming nurse closes round by saying, “I’ll be back to round on you as soon as I’ve met all of my other patients.”

INITIAL ROUND

HOURLY ROUND

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Commonalities

Ask about Ps Conduct environmental scan

• Washes/foams hands on entry to room • Introduction — explains hourly rounding to patient • Asks patient, “What’s the most important thing I can do for you today?

Ask about Ps Environmental scan Parting Mark off round on inroom rounding log

• Night-shift rounds (2300) — explain to patients that you will round every two hours through the night • You will come into the room to check that they are safe but will not awaken them.

Same until 10 p.m., then modified for overnight hours (2300 to 0600). Resume regular hourly rounding schedule at 0600.

November 2015 | OR TODAY

37

IN THE OR CONTINUING EDUCATION 711

usually written on the patient’s communication board so that the nurse can focus on ensuring that the MIT is carried out. Each oncoming nurse should ask about the MIT as part of the initial round, as the patient’s MIT likely will change shift to shift.11-15 The regular hourly round is done every hour for the remainder of the shift. The hourly round is performed in the same way at most hospitals although the Ps used may vary. The hourly round is performed every hour addressing the Ps from 0600 to 2200. At night, the nurse can set up the overnight expectation for rounding by telling the patient that she will round every two hours from 2200 until 0600. She will quietly come into rooms and check that patients are safe, but will not waken them if they are sleeping. She will sign the rounding log at each round so the patient can see that the round happened during the night.

Rounds return to every hour beginning at 0600.11-15 COMMUNICATION An important part of every round is nurse-patient communication. One way to encourage this is with a communication board. At many hospitals where rounding is practiced, a glass dry-erase communication board is installed in patient rooms to help with communication.

Typically these wall-mounted boards, often called white boards, contain basic information for the patient, including date, room number, room telephone number and names and phone numbers of nurse, nurse tech and nurse manager. A possible discharge date is also often included. Other information on white boards can include pain level, 38

OR TODAY | November 2015

meds for pain and the schedule of the next dose, the MIT and information about the plan for the day, including tests and treatments.

Information on these boards is updated at the start of each shift and communicated by the nurse to the patient so that the patient understands what is going to happen each day, who his or her care team is and what the goals for pain control are.15 Another communication tool often used with rounding is the in-room rounding log. This log is often paper and is posted on the wall inside the room. The log has spaces for each hour where the nurse can write his or her initials to note that the round was completed. These in-room rounding logs let patients know that rounding has occurred even if they were asleep.11-15 ROUNDING PROCESS AND SCRIPTING Hourly rounding is a formal process that requires key actions and words during each round. It is important to use key words at key times. For example, when entering a room for a round, the nurse should say, “I am here to do my hourly round” and explain hourly rounding and the Ps to the patient. When finishing the round, the nurse should say, “Is there anything else I can do for you before I leave? I have the time.” Then, when the nurse is ready to leave the room, he or she should say, “I’ll be back in an hour to round on you.” During the initial round, a key phrase the nurse should use is “What’s the most important thing I can do for you today?” These key words at key times help set up expectations for the round. Patients know that the nurse is there to do an hourly round and can expect that the

nurse will address the Ps. By telling the patient what the Ps are, the nurse is letting them know that their basic needs are important and will be addressed every hour.11-15 Nurses should also round using the concept of “nursing out loud,” or NOL. “Nursing out loud” means talking as you perform the round.

For example, “I’m pulling the curtain for your privacy.” Or “Let me check your pitcher to be sure you have enough water and ice.” By talking through what they are doing, nurses let the patient know what they are doing and why, which allows for better communication between patient and nurse.15 Rounding helps nurses organize patient care so that all patient needs in areas of pain, restroom, position, information, room orderliness and patient requests can be addressed during the round. Once all these things are done for the patient during the round, the nurse can move on to round on the next patient and know that the patient is comfortable. Patients also know that the nurse will be in to round on them on a regular schedule, so they are less likely to use the call light.1-3,4,11-15 INTO ACTION Implementation of purposeful hourly rounding can be difficult. You must have the nursing leadership team’s support since you will need its help in getting rounding started on inpatient units. At the beginning of implementation, nurses may tend to view hourly rounding as more work for them instead of as a way of reorganizing their work and making their time in a patient’s room more purposeful. Also nurses often don’t understand that regular tasks, such as medication passing, can be WWW.ORTODAY.COM

CONTINUING EDUCATION 711

integrated into the hourly rounding process, not done outside the round.

Careful communication about the benefits of rounding for both nurses and patients should take place to help nurses understand the why of rounding. Communicating the why is essential in getting hourly rounding established on a patient care unit.

Nurses want to do what’s best for their patients, and when they understand the benefits, such as a reduction in falls and skin breakdown, as well as time savings for them, they are more likely to willingly adopt the practice.2,3-4,11-15 Communicating the why and benefits to the nurse, such as reducing the interruptions of call lights, answers the “what’s in it for me?” question. Nurse leaders should clearly explain to nurses that purposeful hourly rounding seeks to reduce patient calls because nurses are anticipating patient needs and being proactive in addressing them.1-4,12-15 Staff training will be needed to demonstrate what rounding looks and sounds like. The training skills labs will need to be repeated quarterly until rounding is fully established on each unit. As noted above, part of rounding training includes scripting, or providing specific words that staff are to use when rounding. Rounding will need to be validated on each unit daily to ensure that staff are not only rounding, but doing it correctly.1,2,8-12 ROUNDING VERIFICATION As rounding is being implemented, it is essential to verify that hourly rounding is being done purposefully and correctly. Nurse leaders can validate that nurses are rounding effectively through nurse leader WWW.ORTODAY.COM

rounding. Nurse leader rounding is done on every patient every day by the nurse manager. One of the key purposes of nurse leader rounding is for the nurse leader to visit each patient daily and ask whether the nursing staff are effectively addressing the tasks of rounding (pain, potty, position). Nurse leaders round using a rounding log that lists patients’ names and room numbers. The log includes columns with questions the nurse leader can ask patients about rounding behaviors, such as pain control, toileting, personal comfort, hygiene and call bell use.14,15 Answers to these questions can provide the nurse leader with information about how each nurse is practicing rounding and where coaching may be needed to improve rounding practice. The nurse leader also assesses the appearance of the patient room during the round. After nurse leader rounding is completed, the nurse leader can follow up with nurses and coach them as needed on their rounding based on the feedback from patients. Nurses who are rounding well can be praised. Nurse leader rounding is not done to “catch” nurses not performing hourly rounding, but rather to affirm that hourly rounding is being done in a purposeful way and is effectively addressing patient needs.14,15 Successful implementation of hourly rounding can be assessed by looking at scores on patient satisfaction surveys, such as HCAHPS.8 A nonstandard HCAHPS survey question, “Did the nurse visit you every hour?” is designed to provide information from a patient about whether rounding took place during his or her hospital stay. Some hospitals choose to add the above nonstandard question to their HCAHP survey

to directly measure rounding. When used on the survey, this question is worded as above. This question is noted as nonstandard because it is not part of the required HCAHPS survey but an option that can be added.8 Tracking the “yes” responses will provide information about the implementation of rounding on a hospital unit and in the hospital overall. As rounding becomes hardwired on a unit, the number of “yes” answers to this questions should increase. Scores of 90% or more on “yes” responses on this HCAHPS question indicate that hourly rounding is being performed effectively on a patient care unit.11,15 ROUNDING OUTCOMES Studies have shown that when purposeful hourly rounding is effectively implemented, the frequency of patient call lights should decrease by as much as 65%, patient falls by 65% and pressure ulcers and skin breakdown to almost none.1-4,11-15 Similarly, patient satisfaction at hospitals and on units with hourly rounding usually improves dramatically. Hospitals where hourly rounding is fully implemented have reported that their patient satisfaction scores have increased as much as 30 to 40 points and the increase has been maintained over time. Nurses also report satisfaction with rounding since they aren’t interrupted so often with call bells. Reduction in nurse fatigue has also been reported because nurses aren’t running around as much answering call bells. Staff overtime has also been reduced at some hospitals with rounding since nurses can better organize their work and manage their time.1-4,11-15 While the implementation of hourly rounding can be difficult at November 2015 | OR TODAY

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IN THE OR

CLINICAL VIGNETTE You have been hearing a lot about hourly rounding and the positive effect it has on clinical outcomes at other hospitals in the area. You are the nurse executive who has been assigned by the chief nursing officer the task of implementing hourly rounding at your hospital. You have been told that you need to have a plan for rounding implementation ready for approval in one month.

1

What is an important first step in planning for hourly rounding?

A. Decide what rounding Ps you will use at your hospital B. Explain rounding to nurse managers and get their buy-in C. Tell everyone they must start rounding immediately D. Get the support of the nursing leadership team for the initiative

2

Which is NOT a documented outcome of rounding?

A. A reduction in patient falls B. A reduction in patient call lights C. A reduction in patient bed sores D. A reduction in infiltrated IVs

3

Nurses tend to view rounding as “one more flavor of the month.”

To overcome this perception you need to: A. Clearly communicate to nurses the benefits of rounding for nurses and patients B. Mandate from the top that this is what is going to be done C. Tell nurses that they MUST round, no excuses D. Threaten to take disciplinary action against nurses who don’t round

4

first, once it is fully hardwired, the benefits to both nurses and patients are well documented.

Today’s nurses must be aware of the importance of hourly rounding given the proven impact of this nurse-driven intervention on patient satisfaction.

LYNN DEITRICK, RN, PHD, is a nurse-anthropologist who has worked in the field of patient satisfaction and patient experience for more than 13 years. She has published more than 25 articles in peer-reviewed journals on topics including call bells, patient satisfaction and hourly rounding, and has presented on these topics at numerous professional conferences.

REFERENCES

1. Meade CM, Bursell AL, When discussing rounding with nursing leadership, you get objections to scripting and using key words at key times. You tell the team that the reasons for scripting are all of the points below EXCEPT: A. Rounding is a purposeful process and must be done the same way all the time.

B. Scripting ensures that certain key concepts of rounding are communicated consistently to patients.

C. Scripting helps nurses make sure they don’t forget any of the steps of rounding.

D. It doesn’t matter what the nurses say as long as they get the rounding done using the Ps.

Ketelsen L. Effects of nursing rounds on patients’ call light use, satisfaction and safety. Am J Nurs.

2006;106(9):58-70.

2. Deitrick L, Baker K, Paxton H, Flores M, Swavely D. Hourly rounding: challenges with implementation of an evidence-based process. J Nurs Care Qual.

2012;27(1):13-19. doi:10.1097/

4. Correct answer: D — Key words at key times are essential to the success of rounding.

Without scripting, rounding can become too casual, and some of the key components of the process, such as MIT, may be lost if said in a different way.

3. Correct answer: A — Nurses need to understand the WHY for their patients as well as the “what’s in it for me.” Once nurses understand that rounding will have benefits for them during the workday, they are more likely to cooperate in the implementation process.

2. Correct answer: D — A reduction in infiltrated IVs has not been documented in the literature.

1. Correct answer: D — You must have the support of the nursing leadership team to get started since you will need its help in getting rounding started on inpatient units.

40 OR TODAY | November 2015

NCQ.0b013e318227d7dd.

3. Rondinelli J, Ecker M, Crawford C, Seelinger A, Omery A. Hourly rounding: a multisite description of structures, processes & outcomes. JONA. 2012:42(6):326-332.

4. Olrich T, Kalman M, Nigolian C. Hourly roundWWW.ORTODAY.COM

HOW TO EARN CONTINUING EDUCATION CREDIT

ing: a replication study. MedSurgNurs.

2012;21(1):23-36.

5. Sheedy S. Responding to patients: the

1. Read the Continuing Education article.

2. Go online to ce.nurse.com to take the test for $12.

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

unit hostess. J Nurs Admin. 1989;19(4):31-33.

6. Oliver, RL. Satisfaction: A Behavioral Perspective on the Consumer. New York, NY: McGraw-Hill Cos;1997:28.

7. Taylor, SA. Distinguishing service quality from patient satisfaction in developing healthcare marketing strategies. Hosp Health Services Adm. 1994;39(2):232.

8. HCAHPS. HCAHPS Web site. http://www. hcahpsonline.org. Accessed March 27, 2014.

9. Deitrick L, Capuano TA, Paxton SS, Stern G, Dunleavy J, Miller WL. Becoming a leader in patient satisfaction: changing the culture of care in an academic community hospital.

Health Mark Q. 2006; 23(3):31-57.

10. Deitrick L, Bokovoy J, Stern G, Panik A. Dance of the call bells: using ethnography

DEADLINE Courses must be completed by 6/09/2016.

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.

to evaluate patient satisfaction with quality of care. J Nurs Care Qual. 2006;21(4):316324.

11. Studer Group. Hourly Rounding Guide.

Patient Care Strategies: Achieving Nursing

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

and Patient Care Excellence. Gulf Breeze, FL: Fire Starter Publishing; 2006.

12. Proactive patient rounding reduces call light use and falls, eliminates pressure ulcers and enhances patient and staff satisfaction.

Agency for Healthcare Research and Quality Web site. http://www.innovations.ahrq.gov/ content.aspx?id=2504. Updated July 6, 2011.

Accessed March 27, 2014.

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).

13. Ford B. Hourly rounding: a strategy to improve patient satisfaction scores. Medsurg Nurs. 2010;19(3):188-191.

14. Best practice: making hourly rounding purposeful. Association for Patient Experience Web site. http://www.patient-

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

Prices subject to change.

experience.org/Education-Research/ArticleArchive/Best-Practice-Making-HourlyRounding-Purposeful.aspx. Published April 11, 2011. Accessed March 27, 2014.

15. Studer Q, Robinson BC, Cook, K. The HCAHPS Handbook: Hardwire Your Hospi-

QUESTIONS Questions or for a complete listing of our courses Phone: 800-866-0919 Email: ce@nurse.com

tal for Pay-for-Performance Success. Gulf Breeze, FL: FireStarter Publishing; 2010.

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…

CORPORATE PROFILE …

What’s in a name?

A Shakespearean character seems to think not much: “A rose by any other name would smell as sweet.”

But this isn’t the case with Innovative Medical Products Inc.® “Innovative Medical Products” is not a generic label or simply a marketing moniker, but rather a real indicator of IMP’s purpose and commitment in bringing new ideas to market – innovations that provide savings of time and cost to hospitals, add accuracy and support to the surgeon’s hands and contribute to positive patient outcomes.

IMP is focused on developing and marketing innovative products to 42

OR TODAY | November 2015

benefit and improve efficiency in the operating room and hospital clinics where patient stability and positioning are required. IMP innovations are inspired by clinicians’ feedback, as well as by listening to a full range of industry professionals including insights from its own engineers and sales and marketing teams.

In addition to these research and development efforts, advancements in minimally invasive surgical

procedures and navigation through computer-assisted orthopedic surgery have also brought about IMP’s innovative partnerships with world-renowned surgeons committed to improving patient outcomes and surgical techniques.

One of these partnerships – with Dr. Edward De Mayo – has generated a wide range of innovations in patient positioning systems for orthopedic surgery including the De Mayo Knee Positioner®, De Mayo Hip Positioner®, De Mayo Universal Distractor®, and De Mayo Ankle Distractor™.

As the partnership with Dr. De Mayo continues to grow, three new positioning solutions have been added to IMP’s repertoire of innovative products: the De Mayo V2 E™ Knee Positioner, De Mayo Universal Comfort Finger Trap™, and De Mayo Ankle Distractor™ Accessory ‘Ladder.’

DE MAYO V2 E™ KNEE POSITIONER: MAKES KNEE SURGERY EASIER AND SAFER THAN EVER The De Mayo V2 E™ Knee Positioner is designed with both the surgeon and patient in mind. IMP’s new, innovative positioner has the option to extend off the end of the OR table and allows a direct line of sight to the surgical site in knee surgeries.

Surgeons no longer have to lean over the OR table when performing WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

IMP’S NEW, INNOVATIVE POSITIONER HAS THE OPTION TO EXTEND OFF THE END OF THE OR TABLE AND ALLOWS A DIRECT LINE OF SIGHT TO THE SURGICAL SITE IN KNEE SURGERIES.

THE DE MAYO UNIVERSAL COMFORT FINGER TRAP™ IS NOT ONLY EASIER AND MORE EFFICIENT TO USE BUT ALSO PROVIDES MAXIMUM COMFORT FOR THOSE UNDERGOING WRIST OR FOREARM PROCEDURES – TWO POSITIVE OUTCOMES FOR BOTH DOCTOR AND PATIENT.

procedures. The V2 E™ uses a sterile extension arm that extends the knee positioner base plate off the end of the table, enabling the surgeon to stand between the patient’s legs where the surgeon can look straight down onto the surgical site. The IMP solution is especially useful for surgeons performing unicompartmental replacements where the surgical site is on the inside of the patient’s knee. The De Mayo V2 E™ can also be used in the Standard option on top of the OR table.

The IMP solution has improved patient safety with new features to the knee positioner’s locking mechanisms. The system’s carriage and clamping systems have been fitted with a sliding bar that preWWW.ORTODAY.COM

vents a patient’s knee/leg from tilting out, regardless of patient height or weight. Patients stay solidly in place during the entire surgical procedure, while still allowing the surgeon to adjust the rotation and angle of the knee.

The V2 E™ Knee Positioner also comes with an optional new handle on the carriage for ease of locking the boot.

Besides these innovative benefits for the surgeon, the De Mayo V2 E™ Knee Positioner increases patient safety, while making it easier for OR staff and the Sterile Processing Department to handle and clean the IMP components.

The De Mayo V2 E™ Knee Positioner has also been made lighter,

without decreasing its positioning strength. Hospital staff can easily disassemble the system’s carriage for ease of cleaning, as well as easily replace the plastic Teflon pad used to slide the carriage back and forth on the positioner.

DE MAYO UNIVERSAL COMFORT FINGER TRAP™: THE ONLY STERILE, ONE-SIZE-FITSALL, FINGER TRAP Aiming to create innovative solutions in every patient-positioning category, Innovative Medical Products has produced the only sterile finger trap in a universal size. The IMP finger trap is also the only one that can distribute the traction load over two fingers with one strap, improving November 2015 | OR TODAY

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UNLIKE SOME OTHER ANKLE DISTRACTORS, THE DESIGN OF THE IMP ANKLE DISTRACTOR AND ACCESSORY HELPS TO PREVENT PATIENTS FROM SLIDING OFF THE OPERATING TABLE.

holding power while preventing possible injury to patients. These innovative features make the De Mayo Universal Comfort Finger Trap™ more cost effective than other traps, cutting down on inventory and saving time for surgeons and OR staff by offering a sterile, single-use, one-size-fits-all solution.

The key to the patented IMP finger trap innovation is the material used – a hook and loop mesh material with a strap that easily stretches over two fingers while completely locking the strap securely into place. The IMP finger trap is designed for wrist and forearm procedures in the OR, ER and orthopedic clinics. Plus, it comes with an optional V-plate that can be attached to a typical IV pole to hold the trap.

The De Mayo Universal Comfort Finger Trap™ is not only easier and more efficient to use but also provides maximum comfort for those undergoing wrist or forearm procedures – two positive outcomes for both doctor and patient.

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OR TODAY | November 2015

DE MAYO ANKLE DISTRACTOR™ ‘LADDER’ ACCESSORY: ALLOWS AN ALTERNATIVE TECHNIQUE IN ANKLE ARTHROSCOPIES For surgeons who require arthroscopic ankle procedures from a posterior approach or who need to use an alternative surgical technique because of a patient’s anatomy, Innovative Medical Products has designed the De Mayo Ankle Distractor™ ‘ladder’ accessory.

The IMP attachment fits the end of the De Mayo Ankle Distractor™ frame and consists of six rungs or levels of elevation from which the ankle strap can be attached – the higher the rung or position allows for more distraction of the ankle. Unlike some other ankle distractors, the design of the IMP ankle distractor and accessory helps to prevent patients from sliding off the operating table.

The De Mayo Ankle Distractor™ accessory is one more example of how Innovative Medical Products

strives to provide universal solutions in every patient-positioning category.

CONCLUSION Innovative Medical Products continues to search out clinical feedback and to conduct research on ways to improve its existing positioning products and developing new products – all with the purpose of creating viable solutions using new technologies in orthopedic surgery that are more efficient, more cost effective and improve patient outcomes. But IMP does not seek new solutions just for the sake of “newness.” Rather, the company, founded more than 30 years ago, searches only for solutions that really benefit both surgeon and patient.

That is truly “innovative” about its products. In other words, “Innovative Medical Products Inc.®” is not just a name.

FOR MORE INFORMATION, please visit www.innovativemedical.com WWW.ORTODAY.COM

New Technique for Femoral Distraction

Introducing the De Mayo Universal Distractor 速 Improved placement, access and an unobstructed view of the operative site.

Finally an external distractor outside the surgical site. The new, patented De Mayo Universal Distractor速 delivers finite joint distraction without obstructing your field of vision, tying up a pair of hands or placing lamina spreaders. You get finite distraction and reduced procedure time for Unicompartmental, MIS Techniques, Arthroscopies, ACL and TKA surgeries. To see all the advantages, visit www.impmedical.com or call 800-467-4944 today. And get positioned for success.

The operative word in patient positioning.

Eliminate visual & physical obstructions in the operative site Clear field of vision allows easier, trouble-free access

Patent-pending patient protector pad protects the popliteal area

Works with the De Mayo Knee Positioner速 that features a single locking lever for precise control of flexion/extension, tilt & rotation

Nothing to obstruct the operative site

Tension release lever to fine-tune spacing or disengage distraction Broad distribution of pressure with sterile protector pad that will not rotate or roll

Hand control for finite adjustment of distraction De Mayo Knee Positioner : US Patent No. 7,380,299 Single Lever Clamp : US Patent No. 7,003,827 De Mayo Universal Distractor : US Patent No. 8,048,082 B1

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November 2015 | OR TODAY

息 2013 IMP

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WHEN HOSPITALS INVEST IN

C O N T I N U O U S P A T I E N T M O N I T O R I N G

T E C H N O L O G Y FOR PATIENTS ON OPIOIDS, THIS RESULTS IN

FEWER ADVERSE PATIENT OUTCOMES, FEWER ICU TRANSFERS, SHORTER LENGTHS OF STAY IN THE HOSPITAL, AND LOWER OVERALL COSTS.

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OR TODAY | November 2015

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C O N T I N U O U S

patient monitoring

BY DON SADLER

Of particular note is the National Coalition to Promote Continuous Monitoring of Patients on Opioids. This organization was formed by the AAMI Foundation’s Healthcare Technology Safety Institute to promote the case that patient safety demands continuous post-operative monitoring.

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C O N T I N U O U S

patient monitoring

HEARTBREAKING STORIES The stories of patients who have died due to respiratory depression after their surgeries are heartbreaking. They include a healthy 15-year-old boy and a healthy 11-year-old girl, both of whom underwent elective surgeries to correct chest deformities; an 18-year-old woman admitted to the hospital with a severe sore throat; and a man who had routine shoulder surgery.

Meanwhile, a state trooper who went into respirator depression in the middle of the night after neck surgery was only saved because a nurse happened to walk past his room and noticed he wasn’t breathing. None of these patients on opioid pain medication after surgery was being electronically monitored.

The state trooper, who was without oxygen for six minutes, was one of the lucky patients who suffer respiratory depression post-surgery and survive. Approximately 70 percent of these patients cannot be resuscitated.

“It’s clear that patients receiving opioids for pain management after surgery need continuous monitoring because they sometimes don’t react well to the medication and have a respiration event,” says Janet Dillione, the CEO of Cardiopulmonary Corp., which provides extensible platforms for medical device connectivity, alarm management and clinical surveillance.

Dillione points out that “inadequate monitoring for respiratory depression in patients taking opioids” was listed as number 9 in the ECRI Institute’s Top 10 Patient Safety Concerns for 2014.

“Increased use of opioids (for pain management) raises the 48

OR TODAY | November 2015

possibility of adverse events,” states the ECRI Institute. Opioids are considered a high-alert medication. The most serious adverse effect of opioids is respiratory depression, which is often preceded by sedation.”

“Several event reports submitted to the ECRI Institute PSO suggest that patients receiving opioids are not being adequately assessed and monitored for respiratory depression,” The ECRI Institute continues.

Monitoring is especially critical during the first 24 hours after a patient is given opioids post-operatively, the ECRI Institute adds.

During this time, it recommends that nursing staff carefully assess the patient’s tolerance for the drug as it reaches its peak effect, especially if the patient has never received opioids before.

“The first 24 hours puts the patient at greatest risk for oversedation,” states Stephanie Uses, Pharm.D., M.J., J.D., patient safety analyst at ECRI Institute PSO. A study published in the Journal of Nursing Administration demonstrated significant benefits for patients and nurses when continuous patient monitoring is performed in the hospital. Such monitoring provides an early alert to nurses about potential medical problems so they can intervene in a more timely way, the study concluded.

The timeliness of a continuous patient monitoring early warning system improves early recognition of patient distress, according to the study. In addition, other studies have demonstrated that continuous patient monitoring can reduce patient fall rates by between 40 and 90 percent.

TECHNOLOGY SOLUTIONS The AAMI Foundation’s Health-

care Technology Safety Institute believes that there are technology solutions available that can provide continuous patient monitoring and thus help save lives. This is one of the reasons it launched the National Coalition to Promote Continuous Monitoring of Patients on Opioids last November.

The Coalition points out that there is evidence to support not only positive patient outcomes, but that there’s also a strong financial justification for continuous patient monitoring.

It has demonstrated that when hospitals invest in continuous patient monitoring technology for patients on opioids, this results in fewer adverse patient outcomes, fewer ICU transfers, shorter lengths of stay in the hospital, and lower overall costs. The technology can pay for itself within six to 18 months, according to the Coalition.

Cardiopulmonary Corp’s.

Bernoulli Enterprise platform is one technology solution that extends continuous patient monitoring not just to post-operative patients on opioids, but throughout the hospital to improve clinician response and patient safety. Dillione says the platform is especially beneficial in high-acuity areas like the OR, post-anesthesia and the ICU. The platform does more than just pass along alarm information, Dillione adds.

“It intelligently evaluates data from medical devices the way a physician or nurse would and provides real-time information that can be used at the point of care,” she says.

However, the Coalition believes that technology alone is not enough WWW.ORTODAY.COM

to solve this problem. Hospitals also need to consider such factors as clinician, nurse and patient education and the huge culture shift that must occur within hospitals. For example, nurses, clinicians and even patients might object to using continuous monitoring equipment due to the high volume of false alarms they might set off or possible discomfort of the equipment.

The patient benefits of using technology solutions for continuous patient monitoring are fairly obvious. But hospitals can reap tremendous benefits by using the data captured by these solutions, says Chris Bloodworth, Director of Product Strategy, Clinical Solutions, at MEDHOST. “The question is, what are hospitals doing with the information that’s generated from continuous patient monitoring technology,” she says. “The key is to integrate the output that’s generated from the technology into their electronic health records (EHR). This can help hospitals demonstrate Meaningful Use as required by the EHR Incentive program, which was part of the American Recovery and Reinvestment Act (ARRA).”

Dillione agrees with Bloodworth.

“There’s a tremendous amount of data that’s being generated by the monitoring technology that needs to be part of the patient record,” she says. “This data needs to be viewed across the entire continuum of patient care.”

MONITORING IN THE OR Lisa Spruce, RN, CNS-CP, CNOR, ACNS, ACNP, Director, Evidence-Based Perioperative Practice for the Association of periOperative Registered Nurses WWW.ORTODAY.COM

(AORN), stresses the importance of continuous patient monitoring within the operating room itself.

“This is what AORN’s evidencebased practice guidelines have been designed to ensure,” she says.

“The guidelines contribute to continuous patient monitoring in the OR. However, they are only as good as the people who use them.”

To help OR personnel keep AORN’s evidence-based practice guidelines top-of-mind, AORN

“The key is to integrate the output that’s generated from the technology into their electronic health records (EHR).

This can help hospitals demonstrate Meaningful Use as required by the EHR Incentive program, which was part of the American Recovery and Reinvestment Act (ARRA).” — Chris Bloodworth will soon be releasing myAORNguidelines. This is an iPad-based tool that lets OR managers see how OR personnel are doing with regard to following the evidencebased practice guidelines.

Spruce says myAORNguidelines will start by monitoring four important guidelines where there is the greatest potential for errors and breakdowns: hand hygiene, preoperative skin antisepsis, cleaning and care of surgical instruments, and sterilization.

“Continuous monitoring in the OR goes beyond just monitoring

the patient’s vital signs,” says Spruce. “OR personnel need to be monitoring the entire room. This requires an ‘OR consciousness’ to always be vigilant and on-guard, especially for a breach in sterile technique.”

In addition, hospitals need to have policies in place to make sure that the evidence-based practice guidelines are being followed by all OR personnel at all times, Spruce adds.

“OR personnel can never let their guard down, not even for a second,” she says.

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ALWAYS ADVANCING Renee Pink Never Stops in Quest for Patient Care

Renee Pink’s career in health care Army back in 1988. Stationed in technician, and liked it so much she t 50

OR TODAY | November 2015

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Spotlight On: Renee Pin k

By Matt Skoufalos

R

enee Pink’s career in health care began with a turn in the U.S. Army back in 1988. Stationed in Germany , Pink became a surgical techni cian, and liked it so much she took up the career in civilian life, too. After she returned to the United States, where she was married, Pink landed a position at the University of California San Diego (UCSD). She loved the work; “couldn’t believe they we re paying me to do the job,” but knew she wanted more.

“The nurses that ran the OR, I trie d to do what they were doing,” she said. “It was just embedded in me to do right for the patient.”

So, while working as a transplant technician — and against the advice of her sup ervisors and colleagues — Pink enrolled in nur sing school.

She recalls a sense of destiny at the move; a feeling that she said was undiminishe d when she finally graduated nursing school and told her manager that she wanted to join the nursing staff in the operating room.

e began with a turn in the U.S. Germany, Pink became a surgical took up the career in civilian life, too WWW.ORTODAY.COM

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Renee Pink’s career in health care be back in 1988. Stationed in Germany and liked it so much she took up the ca “They don’t like new grads in the OR,” Pink said. “They say you have to go to the floor, but I had it. I was already there.”

However, “my manager at the time was not buying into it,” she said.

Pink was told she would be doing a disservice to herself and to her career by going from a technician position to being an OR nurse; that she would be mortgaging her future for a youthful whim.

But the transplant nurses rallied around Pink and signed a petition on her behalf … and she found herself in her manager’s office once more.

“She said, ‘I’m sick of

hearing your name. I’m going to send you to the OR class against my wishes,’ ” Pink recalled. “I said, ‘Thank you for giving me the opportunity.’ ” At the time, Pink said, it would otherwise have been impossible for her to be recommended to the OR training program, which she described as an ad hoc curriculum developed jointly by a group of local hospitals as an effort to combat a regional shortage of nurses trained in OR-specific skills. Pink was the only surgical technician enrolled in the program. She was also a mother to two children, newly divorced, and

continued to work full-time throughout the class.

“You either had to be an OR technician by trade who went to nursing school, or you had to have been an OR nurse that was out of the field for maybe five or six years and using it as a refresher course,” Pink said. “No one had transitioned from a tech to a nurse at UCSD.” “That was 15 years ago,” she said. “I’m finishing my master’s degree now.”

When she finally got the chance to work the job for which she’d fought so hard, Pink said she blossomed. She embraced her role as a patient champion, and eventually rose

Renee Pink is seen during OR briefings that are performed in preop with both the donor's and recipient’s team – including anesthesia providers, surgical techs, surgeons, pharmacy and the patients.

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egan with a turn in the U.S. Army y, Pink became a surgical technician, areer in civilian life, too. to become a clinical coordinator for transplantation and vascular services in her hospital. Ever the self-starter, Pink took it upon herself to improve processes in her department that she noticed as lacking, first initiating conversations with her peers and superiors, then starting to outline protocol revisions and, finally, calling regular team

synchronized to more effectively connect the recipients and donors throughout the procedures — a suggestion, she noted, that would be more closely aligned with the goals of the hospital to be a familycentered institution.

“The families were disconnected,” Pink said. “We had a healthy donor in the room taking out a kidney. The

One of the more revolutionary notions Pink had was to shift the focus of kidney donations at UCSD to being recipient-driven instead of donor-driven.

meetings to discuss ways to refine the group approach.

Eventually, she said, even the doctors started looking forward to them.

“I started organizing meetings with the surgeons, with pharmacy, with anesthesia, to collaborate with disciplines that would aid in transplant,” she said. “I would set up a PowerPoint presentation: ‘This is what we’re doing today; these are the problems that I’ve noticed.’ ” One of the more revolutionary notions Pink had was to shift the focus of kidney donations at UCSD to being recipient-driven instead of donor-driven. She questioned whether the processes around transplantation could be

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recipient was still in pre-op; they had just drawn his labs.

Now we’re taking out this kidney, and we have to put this patient on dialysis. Why don’t we do the labs together, do the pre-op together, bring the families together?”

Pink found an advocate for her ideas in a doctor on her surgical team, and then she had the support she needed to pitch the idea to the director of nursing. With that buy-in, the rest all fell into place. But Pink still had to contend with questions as to why she was the one agitating for so much to change.

“At the time, they considered me the baby nurse because I went from tech to nurse,” she said. “The little

nurse’s voice was heard.”

Pink eventually codified her approach to patient services around a transplant procedure in a handbook she created herself. Today, she said, her fellow nurses swear by it, and told her that when she was away on vacation, its procedures helped them stay true to form. She appreciates the praise, but to be sure, her own internal motivations have helped her get along quite fine without it.

“This is something that I have been doing and I don’t consider it a job,” Pink said.

“If it’s your vision, you really have to stay true to it. People may knock you at first, but if you stay true, they will eventually follow.”

November 2015 | OR TODAY

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November 2015 | OR TODAY

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OUT OF THE OR HEALTH

BY HOLLY PEVZNER

CHECK OUT 5 FOODS FOR STRESS RELIEF

W

hile we may feel better in the short-term after that hot-fudge brownie sundae, healthy foods are better choices when you’re feeling stressed out. Stress can take a toll on your body’s natural defenses, but eating these foods can offer relief:

1

Nuts Stress depletes our B vitamin stores, and snacking on nuts helps replenish them. The potassium in nuts is also key. Penn State researchers found that a couple servings of potassium-packed pistachios a day can lower blood pressure and reduce the strain stress puts on the heart.

This warm an d comfor helps your br ting breakfast food also ain generate serotonin.

2

Oatmeal This warm and comforting breakfast food also helps your brain generate serotonin, which soothes stress. Complex carbs like oatmeal are also digested more slowly than refined carbs, which can spike blood sugar, messing with moods and stress.

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HEALTH

While oranges get all of the vitamin C hype, red peppers have about twice as much!

3

Salmon In one study, people who took a daily omega-3 supplement (containing DHA and EPA, found in salmon) for 12 weeks reduced their anxiety by 20 percent compared to the placebo group. You won’t get the same mood boost from the type of omega-3s (ALA) in flax, walnuts and soy, though, so shoot for about two servings a week of wild Alaskan salmon or other oily fish, and/or talk to your doctor about DHA supplements.

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5

ers inach and red pepp Combine salmon, sp . for a delicious salad

Red peppers While oranges get all of the vitamin C hype, red peppers have about twice as much (95 vs.

50 mg per 1/2-cup serving). In one study, people who took high doses of C before engaging in stress-inducing activities had lower blood pressure and recovered faster from the cortisol surge than those who got a placebo.

4

Spinach This leafy green veggie is rich in stress-busting magnesium. Magnesium helps regulate the stress hormone cortisol as well as blood pressure. And since magnesium gets flushed out of the body when you’re stressed, it’s crucial to get enough.

November 2015 | OR TODAY

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OUT OF THE OR FITNESS

BY MARILYNN PRESTON

IF YOU WANT TO RAISE A HEALTHY KID, STOP KIDDING YOURSELF

P

eople leading active, healthy lifestyles may be great parents, but let’s not kid ourselves: Raising a vibrant, engaged child these days isn’t a piece of cake.

Are cola drinks making them fat?

(Yes.) Are smartphones taking a toll on their developing brains? (Yes, again.)

And why did schools cancel gym and end recess when every shred of research shows that’s exactly what kids need in order to learn better, stay alert and handle stress? (Oops. A huge mistake.)

The more we learn about the challenges kids are facing, the more I’m motivated to re-issue the Theoretical University of Wellness’s first five Golden Rules of parenting, a guide to the trying task of guiding your child’s hood.

1

EAT REAL FOOD You are the most important teacher your child has. If you eat well, so will they ... eventually. Some

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OR TODAY | November 2015

will rebel, of course, and bury Oreos in their backpacks, but all the research shows that parents are vital role models for their kids. So dig down and walk the talk: Read labels, learn to cook, limit sugar, and serve up a lot of plants, not things that were made in plants. Kiddy see, kiddy do.

2

TAKE ACTION It’s never too late to clean up your act, not to mention your pantry. Declare your house to be a processed-food free zone – neon magic markers are made for this – and engage your kids in the game of getting rid of stuff with ingredients they can’t pronounce. For extra credit, start your kids growing some food: Small pots of delicious things like cherry tomatoes can cultivate healthy changes in eating habits. As you’re roasting your kale chips, explain to them that most foods and drinks in school vending machines are “the enemy.” You don’t have to name names – though Coke and Monsanto scream out for recognition – but let your little ones know that

this new “real food” policy is irreversible, with one exception, described below.

3

HONOR THE 80-20 RULE No one’s perfect, and striving for perfection is what gives us headaches, back aches and sleepless nights. So as part of your real food kitchen makeover, set aside a corner shelf for your family’s special treats.

(I can find my blue corn tortilla chips in the dark.) It’s all part of the brilliant and simple 80-20 Rule: 80 percent of the time you eat real food – vegetables, fruits, nuts, beans, whole grains, healthy fats and fish, limited high-quality meats – and 20 percent of the time, you’re freelancing into forbidden territory.

The funny thing is, after years of eating in a balanced, nourishing way, your body stops craving junk. Wait.

You’ll see. So will your kids.

4

HELP YOUR CHILD FIND HER SPORT There’s a sport for every child.

Your job is to guide yours to the one that feels like fun and brings out the WWW.ORTODAY.COM

FITNESS

best in them. Soccer can do that, but so might Aikido. If your kid isn’t wild about the traditional school sports, encourage him and especially her to explore a long list of alternatives, including wall climbing, Irish dancing and, of course, yoga.

Be a cheerleader for their participation, and don’t force them to be competitive. In general, children play to have fun. Adults play to win. One of the biggest wins you can experience is to raise kids who are playful and active all their lives, young people who feel good about their bodies, their strengths, and understand what team spirit is all about.

5

HAVE A STRATEGY FOR STRESS Kids have stressful lives. We all do, but when you’re young, you need parental guidance to help you notice when stress is making you cranky or tired, and what to do about it. Again, role modeling is key. If your kids see you shouting, angry, drowning your stress in a gin and tonic the size of a flower vase, they won’t have a clue how to deal with their own difficult moments. Having that stress talk with your kids is just as important as the sex talk. Try taking family instruction in meditation or mindfulness, including breathing exercises. Learning to come back to the moment – to calm our anxieties, to still our busy minds – really is child’s play.

MARILYNN PRESTON Is a healthy lifestyle expert, well-being coach and Emmy-winning producer. She is the creator of Energy Express, the longest-running syndicated fitness column in the country. She has a website, marilynnpreston.com, and welcomes reader questions, which can be sent to MyEnergyExpress@aol.com.

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GI

(800) 521-6224 healthmark@hmark.com

www.HealthmarkGI.com Healthmark and our GI products help the Endoscopy center manage the reprocessing of their scopes. We do this through monitoring of cleaning (cleaning verification products), tools to improve cleaning (cleaning products) and finally products to organize and track the steps in reprocessing (accessories, including labels).

Cleaning Verification

Cleaning Products

Reprocessing Accessories

November 2015 | OR TODAY

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BE SURE THAT ROBOTIC ARM...

NUTRITION

...IS A-OKAY! Confirm the proper cleaning of surgical robotic arms with RoboticArmCheck™. These miracles of modern medicine have a limited use life. Improper cleaning can lead to the build-up of bioburden inside of the instrument - representing not only a potential source of cross-contamination to patients, but perhaps shortening the useful life of the instrument itself. The RoboticArmCheck™ is an easy to use and interpret method for testing these instruments, providing a result in less than 30 seconds. Sample the inside of the robotic arm with the provided swab, and expose the swab to a simple reagent test. A color change to green/blue indicates that blood remains in the lumen of the instrument, requiring recleaning.

60 OR TODAY | November 2015

No color change indicates the instrument was effectively cleaned and is ready for the next step in reprocessing.

Do you want to be sure that robotic arm is A-Okay?

Join us at CRAZY4CLEAN.com. There you can share your experiences with thousands of colleagues and learn more about the science behind the RoboticArmCheck™.

Be in the Know: HealthmarketDigest.com

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OUT OF THE OR NUTRITION

Y

BY CLARE TONE, M.S., R.D.

YOU CAN LEARN TO LIKE LESS SALT

ou already know that too much salt can raise the risk for cardiovascular disease through its effect of raising blood pressure. Unfortunately, many of our favorite foods – canned soups, rice mixes, pasta sauces – are loaded with salt, though low-sodium versions are available. But is it possible to change your taste preference to foods with less salt? Recent research indicates it’s possible, though it may take some patience.

EARLY SALT EXPOSURE Exposure to salt – even at an early age – may influence your preference for salty foods. Infants exposed to foods containing salt prior to six months of age had a greater preference for a salt solution, compared to infants who did not have early exposure to salty foods, according to a 2012 study of 61 infants (American Journal of Clinical Nutrition.)

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This preference for salty taste persisted into preschool, where children in the early salt exposure group as infants were more likely to lick salt from the surface of foods.

REPEAT EXPOSURE However, sensory experiences can influence the acceptance of less palatable flavors, for both children and adults, through repeated exposure. Scientists call this the “mere exposure” effect. Experimental studies from the 1980s show that young children required 6 to 15 taste exposures before accepting a new food or flavor. And recent research shows that adults, too, require repeat exposures to new tastes – in this case, low-sodium versions of familiar foods – before they accept them.

Researchers examined the acceptance of low-salt soup among 37 adults (Food Quality and Preference, May 2012.) Participants were given either no-added-salt soup, or the same soup with 280 milligrams of sodium per serving. After almost daily exposure for eight days, the

no-added-salt group showed increased liking for the soup by the third exposure.

In a June 2014 study published in the same journal, acceptance of low-sodium tomato juice was investigated among 83 subjects over 16 weeks. Researchers measured a shift in preference for lower salt in tomato juice after repeat exposure, concluding that salt preference can be altered by exposure alone, even in study subjects who consumed a high-sodium diet.

GOOD NEWS Since preference for less salty foods may literally be an acquired taste, strategies for lowering salt in your diet should include repeat exposures to low-salt food items. Though it may take numerous exposures before you prefer the new taste, it seems that it is possible to start enjoying the taste of lower salt foods. And that’s a healthy preference to encourage.

– Environmental Nutrition November 2015 | OR TODAY

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OUT OF THE OR RECIPE

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OR TODAY | November 2015

BY CATHY POLLAK, ENTRﾃ右

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RECIPE

ON-THE-GO BREAKFAST, COMING RIGHT UP

I

have been making this sandwich again and again and decided it’s probably time to share them with all of you.

Heck, just look at them ... what’s not to love?

Just this morning I shoved one into the hands of my eldest son as he was running out the door. Turns out, it’s perfect school bus food too. Lucky him. The ingredients are simple and you probably already have most of them at home.

There is rarely a day that goes by that I don’t enjoy an avocado with one of my meals or as a snack. They truly are nature’s butter and require nothing to make them an amazing and healthy treat. Avocados are one of the few fruits that provide good fats in our diet (3 grams of mono and 0.5 grams polyunsaturated fat per 1-ounce serving) and are heart healthy.

And don’t be afraid to buy extra avocados and keep them in your fridge.

I store mine in the crisper drawer, and they keep for weeks. This means I always have a ripe avocado to use when I’m ready ... which is daily. After you scramble your eggs, place them on top of your toasted bagels and sprinkle with shredded cheese. It will melt nicely on top of the hot eggs.

The whole bacon, egg and avocado trifecta is an amazing combination. I can’t think of a better way to start my day. However, I must admit these little sandwiches are not just limited to breakfast. They make the perfect lunch and dinner too.

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CHEESY EGG, AVOCADO AND BACON BREAKFAST SANDWICH Serves: 2 to 3

INGREDIENTS: 1 1/2 - 2 2 to 3 mini bagels, 4 3 TO 4 1/3 1 •

toasted with butter large eggs, scrambled (seasoned with salt & pepper to taste) slices crispy cooked bacon cup shredded extra sharp cheddar cheese California avocado, halved and pitted juice of one lime

Once bagels are toasted and eggs are scrambled, remove the avocado from its skin and smash together with the juice of one lime. (This adds a tangy flavor and keeps the avocado from turning brown.)

Place scrambled eggs on the bottom halves of the toasted bagels and sprinkle with cheddar cheese. Place smashed avocado on top of the cheese and top with bacon slices and the other half of the bagel. Serve immediately.

CATHY POLLAK runs her own

vineyard and winery in the Willamette Valley of Oregon.

She shares her love of food and wine at www.noblepig.com.

One for the Table is Amy Ephron’s online magazine that specializes in food, politics and love. www.oneforthetable.com.

November 2015 | OR TODAY

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OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • NOVEMBER • What are you thankful for this Thanksgiving season? OR Today wants to know. Email us what you are thankful for at work along and include a photo. Each person who sends in an entry will receive a $5 gift card. One lucky winner will receive a $50 pizza gift card so they can treat their department to a snack. Email your entry to Social@MDPublishing.com and remember to include a photo! •

THE WINNER GETS A $50 PIZZA GIFT CARD

{

{

EACH SUBMISSION WINS AN OR TODAY PRIZE PACK

Eat Smart

LABELS HELP KIDS MAKE HEALTHFUL CHOICES To help kids make healthful dietary choices, the U.S. Food and Drug Administration (FDA) encourages kids to Read the Label! The Nutrition Facts Label is a simple tool available on food and beverage packages. It lets kids know exactly what they’re eating and helps them choose and compare snacks and other foods.

The earlier kids start using the Nutrition Facts Label, the sooner they’ll be making choices that keep them feeling great and on the path to long-term good health!

Kids can start using the Nutrition Facts Label today to compare foods and make smart snack choices. By knowing a food’s serving size, calories, and nutrients – they can take charge of managing their own healthful diet!

FDA is proposing to update the Nutrition Facts Label for packaged foods. • FOR MORE INFORMATION on the proposed changes to the Nutrition Facts Label, visit: http://www.fda.gov/Food/GuidanceRegulation/ GuidanceDocumentsRegulatoryInformation/ LabelingNutrition/ucm385663.htm

Win Lunch!

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PIN BOARD

OR TODAY SEPTEMBER

CONTEST ENTRIES • OR TODAY LIVE! •

Attendees had a blast at the OR Today Live! Surgical Conference in Las Vegas! We have submitted photos to prove it. Thank you to Danielle Hostler and Jenny Delk-Fikes for emailing photos. It's not too late to share your photos. Email them to Editor John Wallace at editor@mdpublishing.com.

Viva Las Vegas

"Pick me, pick me!!

Great conference."

- Danielle Hostler, RN, CNOR

Bowling Divas!

"We had so much fun!

Thank you!"

- Jenny Delk-Fikes

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November 2015 | OR TODAY

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INDEX ALPHABETICAL AAAHC……………………………………………………… 15 ASC Association…………………………………… 32 C Change Surgical…………………………………… 9 Check List Boards………………………………… 23 Cincinnati Sub-Zero………………………………… 13 Clorox Professional Products…………………16 Curbell Medical Products, Inc.……………… 5 Dabir Surfaces……………………………………… 59

Enthermics Medical Systems, Inc.…………19 GelPro………………………………………………………… 21 Healthmark Industries……………………59, 60 Innovative Medical Products, Inc… 42-45, BC Jet Medical Electronics……………………………18 MD Technologies…………………………………… 55 MedWrench………………………………………………18 Pacific Medical LLC………………………………… 4

Palmero Health Care……………………………… 6 Paragon Service…………………………………… 33 Ruhof Corporation………………………………… 2-3 Sage Services Group…………………………… 55 SIPS Consults, Corp.……………………………… 55 Surgical Power……………………………………… 32 Tru-D………………………………………………………… 24 USOC………………………………………………………IBC

GENERAL GelPro………………………………………………………………21 MedWrench………………………………………………… 18 Surgical Power…………………………………………… 32

POSITIONING AIDS Innovative Medical Products, Inc…………………………………… 42-45, BC

INDEX CATEGORICAL ASSOCIATIONS ASC Association………………………………………… 32 ACCREDITATION AAAHC………………………………………………………… 15 ANESTHESIA Check List Boards……………………………………… 23 Paragon Service………………………………………… 33 APPAREL Healthmark Industries……………………… 59, 60 ASSOCIATIONS AAAHC………………………………………………………… 15 AUCTIONS MedWrench………………………………………………… 18 BEDS Innovative Medical Products, Inc…………………………………… 42-45, BC CARDIAC SURGERY C Change Surgical………………………………………… 9 CABLES/LEADS Sage Services Group………………………………… 55 CLEANING SUPPLIES Ruhof Corporation………………………………………2-3 CLAMPS Innovative Medical Products, Inc…………………………………… 42-45, BC DISPOSABLES Sage Services Group………………………………… 55 Pacific Medical LLC……………………………………… 4 USOC………………………………………………………… IBC ENDOSCOPY MD Technologies………………………………………… 55 Ruhof Corporation………………………………………2-3 SIPS Consults, Corp.…………………………………… 55 GEL PADS GelPro………………………………………………………………21 Innovative Medical Products, Inc…………………………………… 42-45, BC

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OR TODAY | November 2015

HAND/ARM POSITIONERS Innovative Medical Products, Inc…………………………………… 42-45, BC HIP SYSTEMS Innovative Medical Products, Inc…………………………………… 42-45, BC INFECTION CONTROL/PREVENTION Clorox Professional Products…………………… 16 Palmero Health Care…………………………………… 6 Ruhof Corporation………………………………………2-3 Tru-D……………………………………………………………… 24 INTERNET RESOURCES MedWrench………………………………………………… 18 KNEE SYSTEMS Innovative Medical Products, Inc…………………………………… 42-45, BC LEG POSITIONERS Innovative Medical Products, Inc…………………………………… 42-45, BC MONITORS Jet Medical Electronics……………………………… 18 OR TABLES/ ACCESSORIES Dabir Surfaces…………………………………………… 59 Innovative Medical Products, Inc…………………………………… 42-45, BC ORTHOPEDIC Surgical Power…………………………………………… 32 OTHER SIPS Consults, Corp.…………………………………… 55 PATIENT AIDS Innovative Medical Products, Inc…………………………………… 42-45, BC PATIENT MONITORING Curbell Medical Products, Inc.…………………… 5 Pacific Medical LLC……………………………………… 4 USOC………………………………………………………… IBC

POSITIONERS/IMMOBILIZERS Innovative Medical Products, Inc…………………………………… 42-45, BC REPAIR SERVICES Pacific Medical LLC……………………………………… 4 USOC………………………………………………………… IBC SHOULDER RECONSTRUCTION Innovative Medical Products, Inc…………………………………… 42-45, BC SIDE RAIL SOCKETS Innovative Medical Products, Inc…………………………………… 42-45, BC SOCIAL MEDIA MedWrench………………………………………………… 18 STERILIZATION Clorox Professional Products…………………… 16 SIPS Consults, Corp.…………………………………… 55 Tru-D……………………………………………………………… 24 SURGICAL AAAHC…………………………………………………………

Check List Boards………………………………………

MD Technologies…………………………………………

Surgical Power……………………………………………

15 23 55 32

SURGICAL INSTRUMENT/ACCESSORIES Clorox Professional Products…………………… 16 SURGICAL SUPPLIES Cincinnati Sub-Zero…………………………………… 13 Ruhof Corporation………………………………………2-3 SUPPORTS Innovative Medical Products, Inc…………………………………… 42-45, BC TEMPERATURE MANAGEMENT C Change Surgical………………………………………… 9 Cincinnati Sub-Zero…………………………………… 13 WARMERS Enthermics Medical Systems, Inc.…………… 19

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New Technique for Femoral Distraction

Introducing the De Mayo Universal Distractor 速 Improved placement, access and an unobstructed view of the operative site.

Finally an external distractor outside the surgical site. The new, patented De Mayo Universal Distractor速 delivers finite joint distraction without obstructing your field of vision, tying up a pair of hands or placing lamina spreaders. You get finite distraction and reduced procedure time for Unicompartmental, MIS Techniques, Arthroscopies, ACL and TKA surgeries. To see all the advantages, visit www.impmedical.com or call 800-467-4944 today. And get positioned for success.

The operative word in patient positioning.

Eliminate visual & physical obstructions in the operative site Clear field of vision allows easier, trouble-free access

Patent-pending patient protector pad protects the popliteal area

Works with the De Mayo Knee Positioner速 that features a single locking lever for precise control of flexion/extension, tilt & rotation

Nothing to obstruct the operative site

Tension release lever to fine-tune spacing or disengage distraction Broad distribution of pressure with sterile protector pad that will not rotate or roll

Hand control for finite adjustment of distraction De Mayo Knee Positioner : US Patent No. 7,380,299 Single Lever Clamp : US Patent No. 7,003,827 De Mayo Universal Distractor : US Patent No. 8,048,082 B1

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息 2013 IMP

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