Professional Documents
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Aligning practice with policy to improve patient care
Volume 5, Issue 4
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THE OR CONNECTION
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8
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The Patient Handout Forms & Tools
OR Connection
Aligning practice with policy to improve patient care
Aspirin
Avoid aspirin or over-the-counter medications containing aspirin for a week to 10 days after
Never miss an issue of The OR Connection! surgery. Aspirin interferes with blood clotting and makes it easier for bruises to form near
the incision.
Subscriptions are free and signing up is a snap!
Sun Exposure
Subscribing to The OR Connection guarantees that you’ll To subscribe, simply go to www.medline.com/orconnection. As an incision heals, the new skin that forms over the cut is very sensitive to sunlight and
continue to receive this info-packed magazine and won’t miss You will need to provide: will burn more easily than normal skin and lead to worse scarring. Keep the incision area
out on our industry updates and articles addressing on-the- Your name covered from direct sun exposure for three to nine months in order to prevent burning and
job issues and tips on caring for yourself! Facility and position severe scarring.
Mailing address
E-mail address General Hygiene
Infection is the most common complication of surgical procedures. It is important, therefore,
to minimize the risk of an infection when caring for your incision at home.
We also welcome any suggestions you might have on how we can continue to improve
The OR Connection! Love the content? Want to see something new? Just let us know!
Observe the following precautions:
• Wash your hands carefully after using the toilet and after touching or handling trash;
pets and pet
Content Key equipment; dirty laundry and anything else that is dirty or has been used outdoors
We've coded the articles and information in this magazine to indicate which patient care • Ask family members, close friends, and others to wash their hands before contact
initiatives they pertain to. Throughout the publication, when you see these icons you'll with you
know immediately that the subject matter on that page relates to one or more of the • Avoid contact with family members and others who are sick or recovering from a
following national initiatives: contagious illness
• IHI's Improvement Map • Stop smoking (smoking slows down the healing process)
• Joint Commission 2009 National Patient Safety Goals
• Surgical Care Improvement Project (SCIP)
We've tried to include content that clarifies the initiatives or gives you ideas and tools Adapted from www.surgeryencyclopedia.com/Fi-La/Incision-Care.html
for implementing their recommendations. For a summary of each of the initiatives,
see pages 10 and 11.
About Medline
Medline, headquartered in Mundelein, IL, manufactures and distributes more than Meeting the highest level of national and international quality standards, Medline is FDA
100,000 products to hospitals, extended care facilities, surgery centers, home care QSR compliant and ISO 13485 registered. Medline serves on major industry quality
dealers and agencies and other markets. Medline has more than 800 dedicated committees to develop guidelines and standards for medical product use including
sales representatives nationwide to support its broad product line and cost manage- the FDA Midwest Steering Committee, AAMI Sterilization and Packaging Committee
ment services. and various ASTM committees. For more information on Medline, visit our Web site,
www.medline.com.
©2010 Medline Industries, Inc. The OR Connection is published by Medline Industries, Inc. One Medline Place, Mundelein, IL 60060. 1-800-MEDLINE.
Another New Year is here! It’s a great time to reminisce, to make our New Year’s resolu-
tions and set our goals for 2011. Do you ever just stop and think about what was happening
this time last year or even five years ago? Do you think about what you were doing then?
Have you changed responsibilities, or maybe even careers? Did you get married, have a child,
become a grandparent, move, have to deal with a tragic situation … And when you think back,
do you ever say, “I can’t believe I’ve come this far.” Because if you haven’t, you should!
You should recognize and celebrate your achievements. I know, I know, at some point you have to get back to work
Those milestones are what will continue to inspire you and and deal with reality and everyday pressures. But it is
push you to be your very best. And, when you are at your easier to do when you make time for yourself and your
best and do your best, everyone wins…especially the family. I realize it’s hard to do everything, know every-
patients you are caring for. So, for 2011, I hope you will thing, remember everything…that is why in this issue of
take care of yourself. You are so important to your patients. The OR Connection, you are going to learn more than you
Sometimes it takes being a patient or the family member probably ever wanted to know about checklists. On the
of a patient to really appreciate all that you do. I’ve been cover isn’t just another handsome face. It is Dr. Peter
there, and so have many, many of the people I work with. Pronovost, a well-known advocate of patient safety,
We all thank you. quality and the infamous checklist. On page 20, he tells
his own personal story about his father and how it has
To set the tone for 2011, you might want to start reading on inspired him to champion a culture of safety. Whether your
page 84, “8 Principles for Achieving Inner Peace.” There is checklist is healthcare-related or a checklist for travel or a
nothing better than an inspirational article like this one to social event, it is easy to forget the simplest things when
get those New Year’s resolutions and goals flowing. High- our minds are buzzing. We should embrace and adopt
light the article, take notes, think about the message…and checklists and encourage others to do likewise. If one
then figure out what YOU are going to do to make 2011 the life is saved or one error is avoided, it’s worth it, don’t
best ever!! Once you’ve put your plan together, look again you think?
at the pictures of the pink glove dancers. Take note of the
This edition is packed full of stories and ideas you can use
hospitals involved, look at the people’s faces, feel their joy.
in your profession as well as in your personal life. You are
Breathe in all those positive vibes. Then set the magazine
the face of health care. Thank you for making a difference
aside and do something for yourself, something that makes
in so many people’s lives. And don’t forget. Step one is
you feel good. Surprise a co-worker with a smile, ask them
making sure you take care of YOU.
about their holiday, get them a cup of coffee. Or, listen to
your child or your spouse talk about their day. Be there, in
the moment, and forget everything else that is distract-
Sue MacInnes, RD, LD
ing you and taking time away from living.
Editor
4 The OR Connection
And the winning pink glove ad is…
Yes, They’re Genuine.
Only Medline’s Pink Pearl™ gloves combine
aloe, nitrile and breast cancer awareness.
6 The OR Connection
A
pink glove survey
Q
It means unity, joy, excitement, a cause
“on the go” for all involved.
Shannon Sessoms, RN, BSN, CNOR
Southeast Missouri Hospital
Cape Girardeau, MO
Left to right:
Tina Hollis, Patrick
Montgomery and
Cindy Gibson.
Co-workers in the Those with cancer are not alone.
surgery department
at Northeast We are out there standing beside
Alabama Regional them and showing our support.
Medical Center in
Herflin, AL. Kathleen Ingraham
FirstHealth Moore Regional Hospital
Pinehurst, NC
the cause!
Wonderful healthcare providers, not
Helen Aylward, RN, BSN, L.Ac.
Maine Medical Center professional dancers, working hard to
Portland, ME spread the word about breast cancer
awareness.
It made me cry to see the teamwork that Mary Valley, RN, CNOR
went into making it. I’m a breast cancer Frisbie Memorial Hospital
Rochester, NH
survivor.
Carolyn Meyer, RN, BSN, CNOR
Joy for cancer survivors and hope
St. John Medical Center
Bartlesville, OK for more.
Carol Athey, RN, MSN, CNOR
Woodland Heights Medical Center
As a breast cancer survivor it means so Lufkin, TX
much to know that many people care and
want to show it - keep it up! It makes me smile.
Ellen Whitehead, RN, CNOR Debra Ann Caise, RN, BSN
Georgia Surgical Provena St. Mary’s Hospital
Acworth, GA St. Anne, IL
8 The OR Connection
As a breast cancer survivor,
every time I see the videos I cry
The dance demonstrates the joy of with gratitude that so many people
living while increasing awareness care and did something so fun
about breast cancer. and positive as a response. Thank
Paula Bishop, RN, MSN, CNOR you to everyone who participated.
Aultman Hospital And thank you to so-hip Portland
Canal Fulton, OH
for getting the ball rolling. And as a
lifetime rock and roller, dancer and
The closer we get to a cure! I lost a silly person, every time I see these
sister and have a sister who is a survivor folks dance and carry on, I laugh and I am infused with love of
going on 10 years now! Very close to life and humanity. Boy do they get their groove on!
my heart.
Lynetta Baldwin I was diagnosed with breast cancer in mid-2004. I had two
Advanced Surgical Care lumpectomies and two months of radiation, and have been
Creve Coeur, MO
free and clear ever since (as of October 2010). I had very
good care in Marin County, CA.
A hospital works as a unified unit to
complete its mission. I made some wonderful friends in my support group and
Colleen Witt, RN BSN became closer to many of the friends I already had. Besides
Roswell Park Cancer Institute
my support group, I have about ten women friends who
Buffalo, NY
have had breast cancer. I would never wish it on anyone as
A way to show support for breast a life experience (I don’t believe that things like this happen
to teach us a lesson, but rather that we use what happens
cancer survivors.
to us in a way that teaches us something), but I used it to
John Ratliff, BS, CST, FAST
York Technical College recommit myself to the best health and the best appreciation
Rock Hill, SC of life and friendships that I can muster, which is pretty dang
good. Every single day counts, as does every single person.
People getting involved to bring
awareness to breast cancer. In the pink,
Francine Falk-Allen
Darlene McCraney, RN San Rafael, CA
South Central Regional Medical Center
Laurel, MS
Hospitals sign up through IHI and can choose to implement some or all of the recommended interventions.
IHI provides how-to guides and tools for all participating hospitals.
The IHI Improvement Map covers the entire landscape of outstanding hospital care to help hospitals make sense of countless requirements
and focus on high-leverage changes to transform care. There are 70 processes grouped into three domains: leadership and management,
patient care and processes to support care.
Joint Commission-accredited organizations are evaluated for compliance with these goals. The Joint Commission offers
guidance to help organizations meet goal requirements.
Over the next year, the current National Patient Safety Goals (NPSGs) will undergo an extensive review process. As a result,
no new NPSGs will be developed for 2011; however, revisions to the NPSGs will be effective in 2011.
SCIP aims to reduce surgical complications in three target areas. Participating hospitals collect data on specific process and
outcome measures. The SCIP committee believes it could prevent 13,000 perioperative deaths and up to 300,000 surgical
complications annually (just in Medicare patients) by getting performance up to benchmark levels.
10 The OR Connection
Patient Safety
To learn more about the IHI Improvement Map and the 73 processes to transform hospital care, go to www.ihi.org/imap/tool
Visit www.qualitynet.org
APIC, CDC, Other Infection Control Organizations Death Rate Six Times Higher for Hospital Patients
Pledge to Eliminate HAIs1 with HAIs3
Action steps published in AJIC Adults who developed health care-associated infections
A number of professional healthcare organizations, (HAIs) due to medical or surgical care while in the hospital in
i n cluding the Association for Professionals in Infection 2007 had a death rate six times higher than patients without
Control and Epidemiology (APIC), the Society for Healthcare an HAI, according to the latest News and Numbers published
Epidemiology of America (SHEA), the Infectious Diseases by the Agency for Healthcare Research and Quality (AHRQ).
Society of America (IDSA), the Centers for Disease Control
and Prevention (CDC) and others have joined together to Patients with HAIs also had to stay in the hospital an
move toward the elimination of healthcare-associated infec- average of 19 days longer. On average, the cost of a hospital
tions (HAIs). They announced their plan in a white paper, stay of an adult patient who developed an HAI was about
“Moving Toward Elimination of Healthcare-Associated Infec- $43,000 more expensive than the stay of a patient without
tions: A Call to Action,” published in the November 2010 issue an HAI. AHRQ also discovered that:
of the American Journal of Infection Control (AJIC). • In 2007, about 45 percent of patients with HAIs
were 65 or older, 33 percent were 45 to 64 and 22
The group proposes to eliminate healthcare-associated percent were 18 to 44.
infections through a series of action steps, as outlined in the • Patients in the 45 to 64 age group had the highest
paper: rate of HAIs.
• Adherence to evidence-based practices • The top three diagnoses in hospitalized adult patients
• Aligning financial incentives who developed HAIs were septicemia (12 percent),
• Innovation and research adult respiratory failure (6 percent) and complications
• Gathering data for action from surgical procedures or medical treatment
(4 percent).
New Hampshire Hospital Initiative Aims to Eliminate
Harm to Patients by 20152 References
In a new effort to promote better and safer patient care, the 1. Cardo D, Dennehy PH, Halverson P, Fishman N, Kohn M, Murphy CL, et al.
Moving toward elimination of healthcare-associated infections: a call to action.
New Hampshire Hospital Association and Foundation for American Journal of Infection Control. 2010;31(11):1101-1105. Available at:
Healthy Communities recently began a new initiative to elim- http://www.journals.uchicago.edu/doi/pdf/10.1086/656912. Accessed October
25, 2010.
inate harm to patients by 2015.
2. New Hampshire’s hospitals commit to eliminate harm [news release].
Concord, NH: New Hampshire Hospital Association; September 27, 2010.
The definition of “harm,” according the New Hampshire www.nhha.org/WhatsNewFiles/EliminateHarm092710.pdf. Accessed October
25, 2010.
initiative, refers to an injury associated with medical care that 3. Health care-associated infections greatly increase the length and cost of
requires or prolongs hospitalization and/or results in perma- hospital stays. Agency for Healthcare Research and Quality website. October
2010 feature story. Available at: www.ahrq.gov/research/oct10/1010RA1.htm.
nent disability or death.
Accessed October 25, 2010.
12 The OR Connection
Medline Partners with The Joint
Commission to Help Solve
Healthcare Quality and Safety Issues
Medline Industries, Inc. has signed an agreement with the Joint “Medline is proud to support and share in the mission of solving
Commission Center for Transforming Healthcare to contribute healthcare’s most critical safety and quality problems,” said
financially to the Center’s Endowment Fund. The Center for Andy Mills, president of Medline. “Medline’s approach is to
Transforming Healthcare was developed to help solve health- ‘Make it hard for the healthcare worker to do the wrong thing.’
care’s most critical safety and quality problems. The Center is studying some of the most pressing issues
facing providers, bringing together teams of experts to design
In this effort, Medline is joining other leading healthcare and test practical solutions to healthcare’s everyday challenges.”
organizations in their commitment to eliminate preventable
complications and transform healthcare. Issues the Center is working on include Hand Hygiene,
Surgical Site Infections, Wrong Site Surgery and Hand-off
Communication.
14 The OR Connection
Special Feature
Keathley advocates improvement through fixing systems, Above (left to right): Medline
not by adding more resources. For example, whereas hospi- President Andy Mills, Deborah
tals often rely on intuition and personal judgment when man- Adler, Medline Chief Marketing
Officer, Sue MacInnes, RD, LD,
aging patient flow and locating empty beds, Keathley suggests Atul Gawande, MD, MPH,
that studying capacity patterns and related data leads to Medline COO Jim Abrams.
more efficient use of resources. He also encourages collabo-
ration among departments, viewing the hospital as a whole
rather than operating as individual silos.
“If money were no object, we would add more beds, add more
operating rooms, hire more nurses, and we could drive
occupancy back down to the ideal 85 percent,” Keathley Right: The Third Annual
said. “But I am telling you, that fantasy doesn’t exist.” Prevention Above All Conference
took place at the historic Hudson
Theatre in New York City.
Prevention Above All
Another solution to meeting the challenges of healthcare reform
lies in preventing costly medical errors and infections that are
indeed preventable. Sue MacInnes, Medline’s Chief Marketing Urinary Tract Infection (CAUTI) Foley Catheter Management
Officer and host of the Prevention Above All Conference, System to help prevent CAUTIs.
reviewed Medline’s growing offering of preventive strategies
for healthcare providers: These six strategies are targeted, focused and achievable evi-
dence-based solutions that are also practical. They fit with
The Gold Standard Surgical Safety Program to help prevent everyday processes and systems currently in place at most
operating room errors, the Hand Hygiene Compliance Pro- healthcare facilities.
gram, the Pressure Ulcer Prevention Program, Educational
Packaging, the ClearCount Surgical System to help prevent MacInnes emphasized, “Sometimes the simplest solutions
sponges from being left behind and the Catheter-Associated make the biggest difference.”
16 The OR Connection
What the Experts Are Saying ...
Caroline Fife, MD and Kevin W. Yankowsky, JD
Lawsuits, Technology and Wound Care: How Electronic
Health Records Change Your Legal Risks
“Any time a lawsuit is filed, you and your facility and your
practitioners lose. The only question is the question
of degree ... I would suggest and recommend that you
take a moment to focus on how, in addition to improving
your clinical care, you can take steps to absolutely mini-
mize your risk of ever being involved in the legal system; of
ever being sued in the first place.” - Kevin W. Yankowsky
Fife Yankowsky
Continued on page 19
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AORN: Spreading knowledge,
Practicing Advanced Medicine preventing complications
Within Outdated Systems
AORN Executive Director Linda
Atul Gawande, MD, a Harvard professor and author of several K. Groah, RN, MSN, CNOR,
books, including his most recent, The Checklist Manifesto, NEA-BC, FAAN, began her pres-
addressed the challenges of delivering highly advanced medical entation with these statistics: the
care within outdated systems. average department of surgery is
responsible for 40 to 60 percent
He pointed out that we’ve entered a complex medical world in of expenses, 70 percent of rev-
which we have 13,600 different diagnoses, 6,000 prescription enue and 50 percent of errors.
medications and more than 4,000 medical and surgical
procedures. To help reduce surgical errors, the Association of peri-
Operative Nurses (AORN) promotes safe surgical prac-
Compounding matters, we’ve inherited a structure from 50 tices and optimal patient outcomes by educating
years ago that didn’t have nearly so many diagnoses, drugs perioperative nurses and partnering with other profes-
and procedures. At that time, the doctor was considered an sional and governmental healthcare organizations.
artisan, and all you really needed was the physician’s brain,
along with an operating room, a few simple tools and some AORN collaborates on patient safety initiatives with a
skills behind that. number of major healthcare organizations, including
the Centers for Medicare & Medicaid Services (CMS),
“What we have today, though, is a volume and complexity of the Surgical Care Improvement Project (SCIP), the
medical discovery that has now exceeded our ability as World Health Organization (WHO), the Joint Commis-
individual specialized artisans to be able to deliver that care to sion, IPPS, Blue Cross and others. In fact, AORN
the right person, the right way, at the right time without waste worked closely with the WHO and Dr. Atul Gawande
of resources,” Dr. Gawande said. to ensure the perioperative nurse’s role was incorpo-
rated into the Surgical Safety Checklist.
The Checklist Manifesto: How to Get Things Right
Atul Gawande, MD, MPH As a leader in the perioperative arena, AORN has also
developed a number of its own initiatives for practical
We live in a world of great and application in the OR. Some of these include Periop-
increasing complexity, where even erative Standards and Recommended Practices, a
the most expert professionals strug- complete perioperative curriculum and various toolkits.
gle to master the tasks they face.
Longer training, ever more advanced “The Perioperative Standards really are the core of
technologies — neither seems to pre- AORN,” Groah said. “They represent the intellectual
vent grievous errors. But in a hopeful property of AORN.” Groah also emphasized that hun-
turn, acclaimed surgeon and writer dreds of hospitals and surgery centers across the
Atul Gawande finds a remedy in the country look to the Perioperative Standards as the
humblest and simplest of techniques: go-to guide for evidence-based surgical practices.
the checklist. New and revised standards go through up to three
rounds of revisions based on input from surgical pro-
fessionals and the general public.
A few years later, when I was a physician and after I’d done
Dr. Peter J. Pronovost, 45, is medical director of the Quality an additional Ph.D. on hospital safety, I met Sorrel King,
and Safety Research Group at Johns Hopkins Hospital in whose 18-month-old daughter, Josie, had died at Hopkins
Baltimore, which means he leads that institution’s quest for from infection and dehydration after a catheter insertion.
safer ways to care for its patients. He also travels the country,
advising hospitals on innovative safety measures. The Hudson The mother and the nurses had recognized that the little
Street Press has just released his book, “Safe Patients, Smart girl was in trouble. But some of the doctors charged with
Hospitals: How One Doctor’s Checklist Can Help Us Change her care wouldn’t listen. So you had a child die of dehy-
Health Care from the Inside Out,” written with Eric Vohr. An dration, a third world disease, at one of the best hospitals
edited version of a two-hour conversation follows.
in the world. Many people here were quite anguished about
it. And the soul-searching that followed made it possible
for me to do new safety research and push for changes.
20 The OR Connection
What exactly was wrong here? At Hopkins, we tested the checklist idea in the surgical
As at many hospitals, we had dysfunctional teamwork intensive care unit. It helped, though you still needed to do
because of an exceedingly hierarchal culture. When con- more to lower the infection rate. You needed to make sure
frontations occurred, the problem was rarely framed in that supplies — disinfectant, drapery, catheters — were
terms of what was best for the patient. It was: “I’m right. I’m near and handy. We observed that these items were stored
more senior than you. Don’t tell me what to do.” With the in eight different places within the hospital, and that was
thing that Josie King died from — an infection after a why, in emergencies, people often skipped steps. So we
catheter insertion, our rates were sky high: about 11 per gathered all the necessary materials and placed them
1,000, which, at the time, put us in the worst 10 percent in together on an accessible cart. We assigned someone to
the country. be in charge of the cart and to always make sure it was
stocked. We also instituted independent safeguards to
Catheters are inserted into the veins near the heart before make certain that the checklist was followed.
major surgery, in the I.C.U., for chemotherapy and for dial-
ysis. The C.D.C. estimates that 31,000 people a year die We said: “Doctors, we know you’re busy and sometimes
from bloodstream infections contracted at hospitals this forget to wash your hands. So nurses, you are to make
way. So I thought, “This can be stopped. Hospital infec- sure the doctors do it. And if they don’t, you are empow-
tions aren’t like a disease there’s no cure for.” I thought, ered to stop takeoff on a procedure.”
“Let’s try a checklist that standardizes what clinicians do
before catheterization.” It seemed to me that if you looked How did that fly?
for the most important safety measures and found some You would have thought I started World War III! The nurses
way to make them routine, it could change the picture. The said it wasn’t their job to monitor doctors; the doctors
checklist we developed was simple: wash your hands, said no nurse was going to stop takeoff. I said: “Doctors,
clean your skin with chlorhexidine, try to avoid placing we know we’re not perfect, and we can forget important
catheters in the groin, if you can, cover the patient and safety measures. And nurses, how could you permit a doc-
yourself while inserting the catheter, keep a sterile field, and tor to start if they haven’t washed their hands?” I told the
ask yourself every day if the benefits of catheterization nurses they could page me day or night, and I’d support
exceed the risks. them. Well, in four years’ time, we’ve gotten infection rates
down to almost zero in the I.C.U.
Wash your hands? Don’t doctors
automatically do that? We then took this to 100 intensive care units at 70 hospitals
National estimates are that we wash our hands 30 to 40 in Michigan. We measured their infection rates, imple-
percent of the time. Hospitals working on improving their mented the checklist, worked to get a more cooperative
safety records are up to 70 percent. Still, that means that culture so that nurses could speak up. And again, we got
30 percent of the time, people are not doing it. it down to a near zero. We’ve been encouraging hospitals
around the country to set up similar checklist systems.
22 The OR Connection
®
MEDLINE SURGICAL PACKS
THE HIGHEST QUALITY STANDARDS
“
Medline Surgical Packs – The Highest Quality Standards Over the 15 years that I’ve been using Medline
• Over 350 quality assurance specialists as the manufacturer of my surgical procedure
• Production-line inspections with picture-driven trays, quality complaints have effectively gone
build instructions
down to zero.”
• Specialized scales along the production line weigh
each pack to detect missing components Larry Creech, Senior Vice President, Carilion Clinic, Roanoke, VA
© 2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Patient Safety
Checking it Twice
Yes! Checklists do save lives
It’s been more than a decade since the Institute of Medicine (IOM) issued its
groundbreaking report, To Err is Human, outlining the poor state of patient safety in the United
States. And yet, progress toward reducing healthcare errors over the past ten years has been
“frustratingly slow,” say the authors of the report.1 Patients continue to die at a rate of 99,000
per year due to hospital-acquired infections alone, according to the latest estimate from the
Centers for Disease Control and Prevention.1
Needless to say, healthcare professionals have a long Dr. Pronovost introduced the checklist at Johns Hop-
way to go toward improving patient safety. There are, kins Hospital, asking staff to run through it each time
however, glimmers of hope, one of which comes in the they inserted a line. The central line infection rate soon
form of a checklist. decreased from 11 percent to zero.4
A checklist for the ICU Next, Dr. Pronovost implemented the ICU checklist and
Buried on page 171 of the thick To Err is Human report other related safety interventions at 103 hospitals across
is one sentence recommending that healthcare organi- Michigan, resulting in a 66 percent reduction in CR-
zations use checklists as a way to prevent errors by BSIs.6 In the first 15 months of the study, known as the
avoiding reliance on memory.2 But it was not until 2006, Keystone Initiative, the checklist is estimated to have
with the published results of a study headed by now saved 1,500 lives and $175 million in costs.4
renowned patient safety advocate Peter Pronovost, MD,
PhD, that the healthcare checklist came to the forefront The ICU checklist is simple; as experts recommend
as a proven way to prevent errors and save lives.3 healthcare checklists should be. It requires clinicians to
employ the following evidence-based practices when
Dr. Pronovost, a practicing anesthesiologist and critical placing central venous catheters: hand washing, using
care physician at Johns Hopkins in Baltimore, crafted full-barrier precautions during the insertion of the
his first checklist by listing on paper the steps necessary catheter, cleaning the patient’s skin with chlorhexidine,
to avoid catheter-related bloodstream infections (CR- avoiding the femoral site, if possible, and removing
BSIs).4 The steps were nothing new; just things that unnecessary catheters.6 To download a sample copy of
clinicians may not remember to do every time they place Dr. Pronovost’s ICU checklist, go to www.ihi.org/IHI/Pro-
a new central line. He and fellow researchers then grams/IHIOpenSchool/OnCallPeterPronovostCheck-
refined the list, making sure the steps corresponded with lists.htm.
items from the CDC guidelines for preventing CR-BSIs.5
Continued on page 27
24 The OR Connection
Aligning practice with policy to improve patient care 25
Finally!
A way to know
when the catheter
was placed
Reference
1 Saint S, Kaufman SR, Thompson M, Rogers MA, Chenoweth CE. A reminder reduces urinary catheterization in
hospitalized patients. Jt Comm J Quality Patient Saf. 2005; 31(8): 455-462
2 Patient Safety Quality Measures for the Surgical Care Improvement Project (SCIP). Health Services Advisory Group.
Available at: http://qualitymeasures.ahrq.gov/content.aspx?f=rss&id=16275. Accessed December 7, 2010.
3 Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009. Centers for Disease Control and Prevention.
Available at: http://www.cdc.gov/hicpac/cauti/001_cauti.html. Accessed December 7, 2010.
©2010 Medline Industries, Inc. Medline is a registered trademark and InserTag is a trademark of Medline Industries, Inc.
Checklists for safer surgery
Not long after the Keystone Initiative study came out,
the World Health Organization (WHO) Surgical Safety
Checklist gained recognition in 2009 with a study pub-
Four Es
for implementing a healthcare checklist5
lished in the New England Journal of Medicine describ-
Patient safety advocate Peter Pronovost, MD PhD,
ing how use of the checklist helped reduce patient
offers the following four steps to remember when
morbidity and complications.7
implementing a safety checklist at your own facility:
The WHO Surgical Safety Checklist was used at hospitals
around the world, resulting in a reduction in complication 1. Engage staff and physicians with stories and
rates from 11 percent to 7 percent. Death rates dropped baseline performance.
from 1.5 percent to 0.8 percent.7 2. Educate staff and physicians explicitly on what
needs to be done to carry out the checklist; walk
For a copy of the WHO Surgical Safety Checklist and
tips on how to use it, visit www.safesurg.org. through the checklist a few times to identify
any glitches
Another study, just published in October 2010 in the 3. Execute the checklist, making sure everyone is
Journal of the American Medical Association (JAMA),
committed to following it.
showed an 18 percent reduction in surgery deaths over
three years at 74 Veterans Affairs hospitals that used a 4. Evaluate how it’s working by analyzing
surgery checklist.8,9 collected data.
The Surgical Care and Outcomes Assessment Program He also recommends determining in advance the prod-
(SCOAP), has developed a surgical safety checklist as ucts and equipment needed to carry out the items on
well, which is being used by most hospitals and some the checklist, making sure all
freestanding surgery centers in the state of Washington. supplies are close at hand when
SCOAP links hospitals and surgeons with clinicians from clinicians go to implement the
across Washington to increase the use of best practices checklist.
in surgical care. The organization’s goal is to provide the
kind of surveillance of procedures and response to neg- For more tips, read Safe Patients,
ative outcomes that exists in the world of aviation.10 Smart Hospitals: How One Doc-
tor’s Checklist Can Help Us
To access a copy of the SCOAP Surgical Checklist, Change Health Care from the
including a version specifically for ambulatory surgery Inside Out by Peter Pronovost
centers, go to www.scoap.org/checklist. Copies of the and Eric Vohr.
SCOAP Surgical Checklists are also included in the
Forms & Tools section of this issue.
28 The OR Connection
®
STERILLIUM RUB: FAsTeR RUb TO GlOve
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. Sterillium is a registered trademark of Bode Chemie GmbH
Special Feature
Patient,
Heal
Thyself
After shorter hospital stays,
doctors raise demands
and time for recovery
By Laura Landro
30 The OR Connection
For Michael Noonan, knee surgery in April was practically a breeze —
an outpatient procedure that had the 41-year-old investment banker hobbling
home on crutches in a matter of hours after surgeon David Altchek replaced
his anterior cruciate ligament using small incisions.
But recovery was another matter. He needed the crutches The mean charge for outpatient surgery was $6,100 ver-
for three weeks, had 12 weeks of physical therapy three sus $39,000 for inpatient surgery in 2007, according to
times a week, then six weeks of exercises at home. He the most recent report on surgical costs from the federal
rented a strap-on ice compression device to reduce government. Insurance companies are also less likely to
swelling, and wore a brace for about five weeks. Though pay for stays at rehabilitation centers, places where surgi-
fully healed now, being responsible for so much of his own cal patients were often sent after hospital discharge to
rehabilitation, he says, “was like taking a new baby home recuperate.
for the first time—you don’t really feel like you’re licensed
to do it.” With patients going home so quickly, more are having to
grapple with complications on their own. Of all the com-
Surgery is easier and faster than ever before: Nearly 65% plications that occur in the 30 days after surgery, such as
of all surgeries don’t require an overnight hospital stay, infection and blood clots, almost half will surface after a
compared to 16% in 1980. Hospitals that once kept patient leaves the hospital, according to data from one mil-
patients for three weeks after some major operations now lion patients in a surgical quality improvement program
discharge them within a matter of days. But the body still sponsored by the American College of Surgeons.
heals at its own pace, and reduced time in hospital care
means patients are assuming more responsibility for their “The onus is really on patients to recognize if something is
own recovery—and more risks. Patients not only have to a problem,” says Clifford Ko, a colorectal surgeon at the
perform rehabilitation regimens at home, but they are more University of California, Los Angeles, and director of
often caring for their own incision wounds and dressings research and optimal patient care for the American College
and having to watch for signs of infections and blood clots. of Surgeons. “The recovery period is often as important as
They also may be managing drains, implanted IV ports and the procedure itself, and patients who don’t follow their
pumps, all of which can be difficult and stressful. discharge instructions could have longer recovery times,
greater risk of a complication, and potentially more pain.”
The move to speedier surgeries is largely the result of new
minimally invasive techniques, improvements in anesthesia
and cost-cutting by insurance companies and hospitals.
Surgical procedures now often use smaller incisions, cut
less muscle, and result in less blood loss. Newer anes-
thetics allow patients to regain consciousness quickly or
not go to sleep at all. Pain medications are more effective.
At the same time, concern about rising health care costs The Long Road to Recovery
has led to changes in Medicare and insurance plans that While most surgeries now require much shorter hospital
have encouraged the development of outpatient surgical stays than in years past, patients often face weeks or
centers and created financial incentives for hospitals to months of recovery on their own. The picture for some
shift less complex surgery to their own outpatient facilities. common procedures: Knee surgery patients, for example,
So, many types of surgeries previously performed in hos- are counseled to maintain their weight after surgery. But a
pitals with overnight stays are now being done on an out- recent study shows that most patients gain weight, which
patient basis: The number of freestanding surgery centers can jeopardize the health of the other knee. Depression,
grew from about 240 in 1983 to more than 5,000 now.
Continued on page 33
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84,000 patients who developed a surgical
site infection found that more than half
occurred after discharge
another common after-surgery occurrence, also can elevate the leg and perform specific movement exercises.
inhibit healing, if patients don’t seek treatment. Blood clots and subsequent pulmonary embolisms remain
the most common cause for emergency readmission and
Efforts are underway to improve follow-up for patients, par- death following joint replacement, according to the Ameri-
ticularly those who have surgery in doctor’s offices, which can Academy of Orthopaedic Surgeons.
don’t have the same regulation as outpatient surgery cen-
ters. The Institute for Safety in Office-Based Surgery has The American Academy of Orthopaedic Surgeons spon-
developed a checklist that includes assuring that discharge sors workshops to teach its members better communica-
instructions are provided and a plan for follow-up care is tions skills to help patients understand procedures and to
clear. “Patients need to be asked things like if there is red- stress the importance of follow-up care, such as providing
ness at the incision site, do you know what to do?” says clear written instructions and monitoring patients after sur-
Fred Shapiro, a Harvard anesthesiologist and president of gery. “We can have a perfect total knee replacement but
the group. (Redness at an incision site can be a sign of then have a poor outcome if we don’t convince surgeons
infection.) that explaining the post-operative care is in everyone’s best
interest,” says John Tongue, a Portland, Ore.-area ortho-
Infections that can occur after any surgery can lead to a pedic surgeon and clinical associate professor at Oregon
severe bloodstream infection that can be fatal. A study Health & Science University who teaches the workshops.
published in July in the Journal of Hospital Infection of Insurers have become stricter about paying for inpatient
84,000 patients who developed a surgical site infection rehabilitation programs where surgical patients were once
found that more than half occurred after discharge, transferred to recover. The move has been spurred partly
increasing the risks of an emergency room visit, readmis- by studies that show that cheaper at-home visits from ther-
sion to the hospital, and another surgery. apists are effective.
For months after a procedure, surgical patients are also at But Nina Reznick, a 63-year old patient who had both hips
high risk of developing blood clots which can travel to the replaced last July, says the home therapist her insurance
lung and cause death from a pulmonary embolism. After paid for did not have the equipment or time to really help,
joint replacement, for example, though the risk is greatest so she did extra exercises on her own. She believes that
within two to five days, a second peak development period effort enabled her to walk a week after surgery. “You are
occurs about 10 days after surgery when most patients really on your own, and you have to be very motivated,”
have been discharged from the hospital. In knee surgery she says.
patients, a clot can form in the calf if the patient fails to
Some doctors say that the changing demographics of their Andrew Minko, a 41-year-old patient of Dr. Altchek’s who
patients also can contribute to bumpy recoveries. Dr. plays tennis and surfs, has had two surgeries to repair
Altchek, who performs knee and rotator cuff surgery at the joints on his left shoulder and now needs surgery on his
Hospital for Special Surgery in New York, says that more right shoulder. Though he healed well, he admits he was
younger patients are opting to replace troublesome knees somewhat lax about doing his exercises at home and may
and hips so they can resume athletic activities such as ten- have rushed into some activities too quickly after the
nis and skiing; close to 42% of all knee replacements in previous procedures. For the upcoming surgery, he says,
2008 were for patients aged 45 to 65, compared to less “I will be more diligent about the recovery.”
than 35% in 2002, and studies show that waiting too long
once a joint starts to deteriorate before having surgery can Write to Laura Landro at laura.landro@wsj.com
make recovery more difficult.
Reprinted by permission of The Wall Street Journal, Copyright © 2010 Dow Jones & Company, Inc.
All Rights Reserved Worldwide. License number 2537291131129
34 The OR Connection
DASH® in use gently
retracting the small
intestine while
absorbing fluid
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. www.medline.com
Preventing
by Mary Ann Alexander-Magalee, MSN, RN, CNOR-BC injury protection devices, and use a one-handed recap-
ping technique, if no other alternatives exist.
Nearly 30% of the estimated 385,000 needle sticks and
other sharps-related injuries that occur each year happen The Occupational Safety and Health Administration
in the OR.1 The CDC’s recommended work practices that requires healthcare organizations to protect their workers
can help ensure safety can be simplified into three points: and have a written exposure control plan.3 Facilities must
Be prepared, be aware, and dispose with care.1 This arti- also observe local, state, and federal regulations on injury
cle describes what you can do to protect yourself from prevention.
sharps injury.
Common strategies for sharps injury prevention during a
Studies indicate that 6% to 16% of all percutaneous procedure include:
injuries for scrubbed personnel are self-inflicted during • Double gloving and monitoring gloves for punctures.2
hand-to-hand passing of suture needles, with the non- • Encouraging neutral or hands-free technique for
dominant hand being the most injured body part.2 This passing sharp items.2
often occurs during the loading or repositioning of suture • Giving verbal notification when passing a sharp item.
needles, loading or removing scalpel blades, suturing, tying • Loading suture needles using the suture packet to
sutures with the needle attached, and immediately before help mount the needle in the needle holder.
or after the sharp has been used and remains unattended • Using the appropriate instrument to help adjust or
on the operative field.2 unload the needle.
• Removing the needle before tying the suture, or using
For nonscrubbed personnel, the greatest risk of injury is control-release sutures.
during hand-off of used sharps or disposal of sharps. • Activating the safety feature of a safety-engineered
device immediately after use.2
Healthcare organizations and their employees are respon- • Using another available instrument or a magnet to pick
sible for actively participating in strategies to reduce per- up a sharp item that’s fallen on the floor. Discard the
cutaneous injuries. Wear personal protective equipment sharp immediately.
when indicated. Use needless systems or sharps with
36 The OR Connection
OR Issues
Introducing CE Courses
for Surgical Techs!
For the first time ever, Medline University introduces
surgical technologist courses at www.medlineuniversity.com
Join us on Twitter
Be the first to know when we add new courses and content.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
By Steve Harden
“This is just the tip of the iceberg,” he said, “introducing the Uni-
versal Protocol has not reduced the frequency of these events.”
2. To cure communication failures during the Universal Protocol, Dr. Stahel is absolutely spot on. The Universal Protocol is not
give as many folks as possible a “speaking part” in your Time going to protect your patients if your teams are not going to
Out process. Knowing that they have a speaking part and use the safety system correctly.
will have to verbally respond to a checklist item creates
mindfulness, focus on the process and participation. No About the author
one wants to be the person not prepared and gumming Steve Harden is Chairman of the Board and
up the works. CEO of LifeWings Partners LLC and co-founder
of Crew Training International, Inc. (CTI). He has
helped over 80 healthcare organizations in 28
3. Make sure your Time Out is a true “challenge and response” states implement the best safety practices from
checklist, requiring a real cross check with two or more sets aviation and other high reliability industries. He
of eyeballs confirming critical items—and not just a “tick is the author of Never Go to the Hospital Alone,
sheet” where one staff member independently puts a check published by BPS Books, and co-author of
in the box when they think an item has been completed. CRM: The Flight Plan for Lasting Change in Patient Safety, the
A “tick sheet” mentality is the number one reason we see definitive how-to text on implementing aviation-based safety tools in
for failing to complete the Time Out as required. health care, published by HCPro. LifeWings Partners is the industry
leader in using aviation safety, leadership, team building and human
factors tools to reduce patient-harming medical errors and improve
safety and quality.
40 The OR Connection
SAFER CATHETERIZATION
FOR KIDS
Pediatric
Catheter
Tray
Children’s
Introducing Medline’s new Activities
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latest addition to the innovative
ERASE CAUTI product line.
ra
Sometimes, you just need a buddy. Buddy
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e
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But it’s more than just fun. There’s published evidence Bud
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Bra
I’
A New
Guidebook
for Patient
Safety in
the OR
by Connie Yuska, RN, MS, CORLN
42 The OR Connection
Patient Safety
44 The OR Connection
SAFETY
DESERVES
ATTENTION
References:
1. Occupational Safety and Health Standards, Toxic and Hazardous Substances,
Bloodborne pathogens. Regulations (Standards - 29 CFR). Available at: http://
www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_
id=10051#1910.1030(d)(2)(i). Accessed October 13, 2010.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Safety-Splash and S.T.O.P are trademarks of Medline Industries, Inc.
h e y ’re
T ng
l u r k i
in ...
46 The OR Connection
Patient Safety
Well, the truth is pressure ulcers do occur in the ambulance — and lots of other places you
might not even think about, including the operating room (OR). In fact, the pressure ulcer
incidence rate as a result of surgery may be as high as 66 percent1 and 42 percent of all
hospital-acquired pressure ulcers are occurring in surgical patients.2
Continued on page 50
48 The OR Connection
50%
LESS
FRICTION
than the leading
competitor3
The heels are the most common site for facility-acquired pressure
ulcers in long-term care, and the second most common site over-
all.1 According to clinical experts, the most effective aspect of
pressure ulcer prevention for heels is pressure relief, also known
as offloading.1,2 Offloading is achieved with the use of pillows or
2 Strapping Methods
heel protection devices that relieve pressure by elevating the heel.
1
Fowler E, Scott-Williams S, McGuire JB. Practice recommendations for preventing heel pressure
ulcers. Ostomy Wound Management. 2008;54(10):42:48.
2
Langemo D, Thompson P, Hunter S, Hanson D, Anderson J. Heel pressure ulcers: stand guard.
Advances in Skin & Wound Care. 2008;21(6):282-292.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
AORN guidelines recommend using
pressure redistribution surfaces for
surgeries lasting longer than 2 1/2 hours.
Figure 1
long a surgery will take, a pressure redistribution surface Pressure ulcer risk in ancillary services
should be available in every operating room. There is also high risk for pressure ulcers in ancillary
services:
There are high-quality surfaces that self-adjust (Figure 1), • Radiology
provide a stable environment for the surgeon and OR staff • Renal dialysis
to work and conform to the patient’s body. Some of these • Cardiac and vascular procedure laboratories
surfaces contain the same type of visco or viscoelastic such as cath labs
memory foam many of us sleep on in our own bedrooms.
When evaluating various surfaces, ask the vendor about The problem is that until awareness is increased, we will
the warranty, weight limits, cleaning instructions and com- continue doing what we always did, and patients will con-
parative data such as pressure mapping. This will help you tinue to develop pressure ulcers.
make an educated decision regarding your purchase.
Patients undergoing lengthy radiology procedures have a
Important steps to take after surgery 53.8 percent incidence of pressure ulcers. Emergency de-
At the hand-off to the post-anesthesia care unit (PACU) it partments are another area of risk, with 40 percent of pa-
is advisable to: tients admitted through the emergency department at risk
• Clean and dry the patient’s skin for pressure ulcer development.11
• Conduct a post-op skin assessment, noting:
- Skin irritation The average emergency department patient waits six to
- Discoloration eight hours lying on a stretcher that usually consists of two
- Bruising to three inches of open-celled foam and an uncomfortable
- Swelling non-conformable cover that can contribute to the devel-
• Provide a thorough report including: opment of pressure ulcers.
- Results of pre-surgery risk factors and potential
new risks that developed during surgery This is especially important now that acute care facilities
- Results of threats and skin assessment performed are financially responsible for acquired pressure ulcers –
before, during and after surgery which can be quite costly. Many hospitals have instituted
- How long the surgery lasted (e.g., my own surgery a comprehensive program to prevent pressure ulcers
was scheduled for two hours and lasted almost across the continuum, including the OR, ED and ancillary
double that time) areas. Introducing a tool kit on average can reduce a facility’s
Continued on page 52
50 The OR Connection
Benefits Of A Great
Work Environment
By Greg Smith
LEGAL IMPLICATIONS
Source: workz.com
OF PRESSURE ULCERS
Medline Named One of Becker’s Join us for this webcast presentation as two
industry experts bring you critical infor-
100 Best Places to mation on how the utilization of the nursing
process and proper documentation are vital
Work in Healthcare components in maintaining the standard of
care and avoiding litigation.
52 The OR Connection
KEEP YOUR SURGICAL
PATIENTS DESERT DRY.
Medline’s Sahara® Super Absorbent OR table sheets
are designed with your patients’ skin integrity in mind. QuickSuite®
OR Clean Up Kit
The Braden Scale tells us that moisture is one of the
major risk factors for developing a pressure ulcer.1 We also
know that as many as 66 percent of all hospital-acquired
pressure ulcers come out of the operating room.2
©2010 Medline Industries, Inc. Medline, QuickSuite and Sahara are registered trademarks of Medline Industries, Inc.
The OR Goes Green
– the only TRULY eco-friendly surgical drape
Medline’s new patent-pending EcoDrape is the only Composition Comparison
eco-friendly surgical drape available today. Made of EcoDrape SMS
more than 96% wood pulp, EcoDrape will biodegrade Fibers More than 96% No wood
wood pulp pulp
in only two to five months in a landfill – polypropylene
Petrochemical 0% 100% PP
drapes take hundreds of years to break down. EcoDrape ingredients (plastics)
has all the same great features as other Medline Additives Bio-based Fluorine
drapes, including hook-and-loop line holders, large
reinforcement zones, and premium tape and incise
film flush to the fenestration. For a quick online video demonstration,
visit www.medline.com/ecodrape
Try the new EcoDrape and take your OR to the next
level of green!
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
EcoDrape and greensmart are trademarks of Medline Industries, Inc.
OR Issues
Medline Joins
Greening the Operating Room Initiative
Medline has joined a group of corporate sponsors to sup- • OR Kit Formulation
port Practice Greenhealth’s Greening the Operating Room • Waste Anesthetic Gas Scavenging Systems
(GOR) initiative. This initiative to green the nation’s oper- • Fluid Waste Management Systems
ating rooms was launched earlier in 2010 to reduce the • Energy Use/Lighting & Thermal Comfort
environmental footprint of operating rooms in U.S. hospi- • Regulated Medical Waste (RMW)
tals. Hospital operating rooms contribute between 20 and Minimization/Segregation
30 percent of the hospital’s total waste.1 • Substitution of Reusable Hard Cases for Blue
Sterile Wrap
Medline will join the collaborative effort of hospitals, man- • Recycling of Medical Plastics
ufacturers and related stakeholders to develop guidance • Laser Safety/Smoke Evacuation
documents for helping reduce the environmental impact of • Green Cleaning/Proper Disinfection in a
the nation’s operating rooms and potentially reduce cost, Surgical Setting
increase quality and improve worker or patient safety. The • Medical Equipment and Supplies Donation
following are the GOR areas for “green” interventions in the
operating room: To learn more about Practice Greenhealth’s Greening the
• Single-Use Device (SUD) Reprocessing OR initiative visit www.greeningtheor.org.
• Reusables v. Disposables: Gowns, Surgical Drapes,
Basins and Other Reusables
Reference
1. Esaki RK & Macario A. Wastage of supplies and drugs in the operating room. Medscape Anesthesiology. Posted October 21, 2009.
Available at. http://www.medscape.com/viewarticle/710513. Accessed October 22, 2010.
3 Checklists
on the Cleaning & Disinfection of
Endoscopic Equipment
by Lorri A. Downs RN, BSN, MS, CIC
According to the Association for Professionals in Infec- staff quickly and efficiently adhere to infection control
tion Control (APIC), many factors contribute to guidelines for reprocessing endoscopic equipment in
endoscopy-associated infection, including numerous the central sterile processing department, same-day
reports of outbreaks associated with equipment cleaning surgery arena and freestanding endoscopy clinics.
and disinfection. Infection prevention related to the use
of endoscopy equipment begins with educating and The following checklists for the cleaning and disinfec-
training practitioners and strict adherence to reprocess- tion of endoscopes were adapted from the Society of
ing protocols.1 Gastroenterology Nurses and Associates (SGNA) Stan-
dards of Infection Control in Reprocessing of Flexible
We know that in busy healthcare environments, check- Gastrointestinal Endoscopes.2 To see the guidelines in
lists can help reduce errors and improve adherence to their entirety, go to www.sgna.org.
critical steps. Below you will find three checklists to help
56 The OR Connection
Special Feature
1
Checklist 1:
Cleaning the Endoscope Immediately After
the Endoscopy Procedure
Use the following checklist after you have gathered the supplies listed above and put on your
personal protective equipment.
❏ Immediately wipe the insertion tube with a wet cloth or sponge soaked in freshly
prepared detergent solution. (Note: Do not reuse cloths or sponges between cases.)
❏ Place distal end of the endoscope in the detergent solution and suction the solution
through the channel. Alternate suctioning, detergent solution and air several times
until the solution is visibly clean. Finish with suctioning air.
❏ Flush or blow out air and water channels in accordance with the endoscope
manufacturer’s instructions.
❏ Flush the auxiliary water channel.
❏ Detach the endoscope from the light source and suction pump.
❏ Attach the protective video cap if using a video endoscope.
❏ Transport the endoscope to the reprocessing area in an enclosed container.
Use the following checklist after you have gathered the supplies listed above and put on your
personal protective equipment.
❏ Leak test the endoscope either manually or via computer testing following the
manufacturer’s instructions. If a leak is detected, follow the manufacturer’s
instructions.
❏ Fill the sink or a basin with a freshly prepared solution (for each endoscope) of water
and a medical grade, low-foaming, neutral pH detergent formulated for endoscopes
that may or may not contain enzymes.
❏ Immerse the endoscope.
❏ Wash all debris from the exterior of the endoscope by brushing and wiping the instrument
while submerged in the detergent solution.
❏ Keep the scope submerged to prevent splashing of contaminated fluid and aerosolization
of bioburden.
❏ Use a small soft brush to clean all removable parts, including inside and under the suction
valve, air/water valve, and biopsy port cover and openings. Brush all accessible channels,
the scope body, insertion tube and the umbilicus of the endoscope.
❏ After each passage of the brush, rinse the brush in the detergent solution, removing any
visible debris before retracting and reinserting it. Continue brushing until there is
no visible debris on the brush.
❏ Clean and high-level disinfect reusable brushes between cases.
❏ Attach manufacturer’s cleaning adapters for special endoscopic channels. Flush all
channels with detergent solution to remove debris. (Note: Automated pumps are available
for flushing endoscopes. Refer to the manufacturer’s instructions.)
❏ Soak the endoscope and its internal channels for the period of time specified on the label
of the detergent.
❏ Thoroughly rinse the endoscope and all removable parts with clean water to remove
residual debris and detergent.
❏ Purge water from all channels using forced air and dry the exterior of the scope with a
soft, lint-free cloth.
58 The OR Connection
3 Checklist 3:
High Level Disinfection/Sterilization for Endoscopes
in the Reprocessing Area
• Once the endoscope has been cleaned, it is ready for disinfectants and sterilants.
• Be sure to follow the manufacturer’s instructions for proper use of these chemicals.
• Test the chemical for the minimum effective concentration (MEC) according to the
label on the test strip container.
• Never use the MEC value to extend the “reuse” life claim on the product and never
use beyond the date specified on activation.
• Use product-specific test strips to check for the MEC and keep a log of the test results.
❏ Completely immerse the endoscope and all removable parts in a basin of high level
disinfectant/sterilant.
❏ Inject disinfectant into all channels of the endoscope until it can be seen exiting the
opposite end of each channel. Make sure no air pockets remain within the channels
❏ Do not coil the scope tightly and cover the basin to contain chemical vapors.
❏ Soak the endoscope in the high-level disinfectant/sterilant for the appropriate time and
temperature.
❏ Required to achieve high-level disinfection. Use a timer to verify soaking time.
❏ Purge all channels completely with air before removing the endoscope from the high-
level disinfectant/sterilant.
❏ Thoroughly rinse all surfaces and removable parts and flush all channels of the endoscope
and its removable parts with clean water and disinfectant per the manufacturer’s
recommendations.
❏ Purge all channels with air until dry and follow with 70% isopropyl alcohol (even if sterile
water is used to flush) to assist in drying the interior channel surfaces.
❏ Thoroughly rinse and dry all removable parts and do not store removable parts attached
to the endoscope when not in use.
❏ Dry the exterior of the endoscope with a soft, lint-free cloth.
❏ Thoroughly rinse the endoscope and all removable parts with clean water to remove
residual debris and detergent.
❏ Hang the endoscope vertically with the distal tip hanging freely in a clean, well-vented,
dust-free area.
References
1. Stricof RL. Endoscopy. In: Carrico R, ed. APIC Text of Infection Control and Epidemiology. 3rd ed. Washington, DC: Association for Professionals
in Infection Control and Epidemiology, Inc.; 2009.
2. Society of Gastroenterology Nurses and Associates, Inc. The Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes.
10-19. Available at: http://infectioncontrol.sgna.org/SGNAResources/tabid/55/Default.aspx#standards. Accessed November 10, 2010.
Surgical
Stuck Like ^ Glue
NEW USES AND IMPROVED OUTCOMES
Are your surgeons increasingly requesting surgical glue? If they advancements and the expanding caseloads for which these
aren’t asking for it yet, all indications are that surgical glue will technologies apply. While traditional wound closure products,
be a mainstay in operating rooms in the near future. Let’s including sutures and staples, still command a sizable portion
explore why use of surgical glue is becoming so prominent of the overall market, their rate of use compared to alternative
among surgeons. products is relatively flat, and in some cases declining, in
certain geographic regions. In contrast, the use of surgical
Current Market Snapshot sealants and glues is growing at an estimated 10 to 15 percent
Current research on the success of surgical sealants and glues per year.1
in clinical practice was published in October 2010 by Med-
Market Diligence, a provider of data and insight on advanced In August 2010, Outpatient Surgery conducted a poll asking
medical technologies. The report states that the advance- readers about their use of surgical glue and the results were as
ments in surgical sealants and glue technology are enabling follows:
these products to increasingly penetrate the existing markets
for sutures and staples, in addition to capturing a caseload of OUTPATIENT SURGERY MAGAZINE READER POLL2
new applications.1 A wide array of wound closure products is “In which types of cases do you use surgical
now in use by both general surgeons and surgeons special- glue instead of sutures?”
izing in gynecologic, orthopedic, gastrointestinal, neurology,
cosmetic, vascular and nearly all other surgical areas. ARTHROSCOPY . . . . . . . . . . . . . . . . . . .28%
ENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1%
Many aspects of prevailing surgical methods (from as recently GENERAL SURGERY . . . . . . . . . . .34%
as 10 years ago) have undergone major changes. The GYNECOLOGY . . . . . . . . . . . .11%
increased use of surgical sealants and glue is one such PLASTICS . . . . . . . . . . . . .26%
change and is primarily attributable to both new technological
Continued on page 64
62 The OR Connection
Stick with OctylSeal™
Flexible wound closure that’s easy on your budget
Introducing Medline’s OctylSeal high viscosity
tissue adhesive for closure of simple wounds
• Flexible structure moves with the skin, minimizing the Indications for use
chance of cracking Topical application only to hold closed easily approximated
• Acts as a barrier to microbial penetration as long as the edges of wounds from surgical incisions, including punc-
adhesive film remains intact tures from minimally invasive surgery and simple, thoroughly
• 40 percent more glue per container than most other cleansed trauma-induced lacerations. OctylSeal may be
tissue adhesives (0.7 grams versus 0.5 grams) used in conjunction with, but not in place of deep dermal
• Easy, versatile application – interchangeable tips (swab sutures. Available by prescription only.
and nozzle) included in every package; violet color for
easier identification on skin
• Metal tube instead of glass ampule means no risk of
broken glass entering the wound
To learn more about OctylSeal,
call 847-643-4526.
©2010 Medline Industries, Inc. Medline is a registered trademark and OctylSeal is a trademark of Medline Industries, Inc.
Table 1. Octyl versus butyl cyanoacrylates
Octyl Butyl
No need to refrigerate Needs refrigeration
Cures or polymerizes as a smooth Cures or polymerizes as a rough
surface and an even film surface
Sets up with a flexible “glue” line at Sets up with a brittle “glue” line at
the application site. the application site.
Since both types of cyanoacrylate adhesives have FDA 1. Reason for the surgery
approval,4 how does a surgeon select the preferred product? 2. Location of where and how the injury occurred
Many factors can play into the surgeon’s decision, though top- (if applicable)
ping the list seem to be the features and benefits of each type 3. Location of the wound
of adhesive that appeals to the surgeon, the product type the 4. Length of the surgical procedure
surgeon trained on, and the product brand that the hospital
stocks. Table 1 compares octyl and butyl cyanoacrylates and Surgical wound closure using a cyanoacylate is best suited for
shows the factors that may play into the clinicians preference wounds that are not subject to significant stress or flexion.
in product choice. Many surgeons follow this rule of thumb: if the skin requires
more than simple pulling together with forceps or fingers to
64 The OR Connection
Most surgeons find that surgical glues offer a fast,
simple and effective means of surgical wound closure
achieve approximation of the wound, then deeper sutures
and/or subcutaneous sutures should be used before the glue
is applied.5 Octyl cyanoacylates appear to work better on
areas of flexion as compared to butyl cyanoacylates, because
they set up with a flexible “glue line” and maintain their micro-
bial barrier.
The best results are obtained when the wound incision is clean
and dry with total hemostasis prior to the application of the
skin adhesive. Cyanoacrylate adhesives close the skin by
forming a polymerized layer across the top of the skin, creat-
ing a a bridge between the skin edges. Therefore, it is impor-
tant for best results to obtain edge-to-edge apposition while Trauma
the glue sets over the wound.
66 The OR Connection
CE Test Questions
3. Butyl cyanoacrylates cure or polymerize as a smooth 9. Glutaraldehyde glues are used in the repair of
surface. T F _________________.
a. Simple skin lacerations
4. Octyl cyanoacrylates require refrigeration. T F b. Aortic dissections
c. Massive head wounds
5. Cyanoacrylate adhesives first entered the clinical d. Laparoscopic surgical incisions
market in the 1960s. T F
10. Surgical adhesives derived from both human and
Multiple Choice animal blood products are called
6. Which of the following is one of the factors surgeons _____________________.
take into account when determining the appropriate a. Fibrin sealants
type of product to close a surgical incision? b. Collagen-based compounds
a. Patient’s age c. Cyanoacrylates
b. Skin temperature d. None of the above
c. Ability to approximate wound edges
d. None of the above
No resistance
Lack of leaching helps prevent the potential
To request a sample of BIOGUARD®
for resistant strain formation.
contact your Medline sales
representative or e-mail
ProductSupportPrimaryCare@medline.com
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. BIOGUARD is a registered
trademark of Derma Sciences, Inc. US Patent No. 7,045,673 and 7,709,694 and 7,790,217 and foreign counterparts.
NIMBUS technology is licensed by Quick-Med Technologies, Inc. NIMBUS is a registered trademark of Quick-Med
Technologies, Inc. Covidien is a registered trademark of Covidien.
Special Feature
product spotlight
INTRODUCING MEDLINE BIOGUARD® BARRIER DRESSINGS
Proven 99.999% bacterial reduction for your infection
control program
Time magazine Innovation Leader Dr. Greg Schultz developed the patented
technique for bonding p-DADMAC to the gauze dressings.1 A biochemist
with an interest in wound care, Dr. Schultz serves on the board of direc-
tors for the National Pressure Ulcer Advisory Panel (NPUAP)2 and on the Reference
1. S Morrissey. Epidemiology: forging the future:
editorial boards of several journals in the areas of ocular and skin wound microbe-busting bandages. Time. 2006; 167(12). Posted
March 12, 2006. Available at: www.time.com/time/maga-
healing.3
zine/article/0,9171,1172215,00.html.
Accessed November 9, 2010.
2. National Pressure Ulcer Advisory Panel Board of Directors
Medline BIOGUARD® dressings are intended for use with: 2010. Available at: www.npuap.org/about.htm.
• Exuding wounds Accessed November 9, 2010.
3. University of Florida website. Biochemistry and Molecular
• First and second degree burns Biology. Gregory Schultz, PhD. Available at:
• Surgical wounds www.med.ufl.edu/IDP/BMB/bmbfacultypages/gschultz.html.
Accessed November 9, 2010.
• Securing and preventing movement of a primary dressing 4. Data on file.
• Wound packing
Bioguard is a registered trademark of Derma Sciences, Inc.
The dressings are available in many sizes and types, including rolls,
sponges, packing strips, non-adherent pads and conforming bandages.
Contact your Medline representative for further details.
0
Methicillin-resistant Pseudomonas aeruginosa (PA) Vancomycin-resistant
Staphyloccus aureus (MRSA) Enterococcus faecium (VRE)
70 The OR Connection
BioCon™- 500
Bladder Scanner
Safely Measures
Bladder Volume
Minimize unnecessary catheterization
Research has shown that 80 percent of urinary tract
infections acquired at healthcare facilities are associated
with an indwelling urethral catheter.1 This type of infection
is known as CAUTI, or catheter-associated urinary tract
infection. What’s more, Medicare no longer reimburses
for treatment of CAUTI if it happens while a patient is
hospitalized, giving hospitals a major incentive to prevent it.
But how?
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
1 Real photography on the outside –
so you know exactly what’s inside
A photo on the package helps identify the
contents of the kit, serves as an educational
tool for the clinician and can be used to
discuss the procedure with the patient.
Also, the label opens up to a booklet
with step-by-step instructions and
helpful tipsfor the clinician.
VAP
3. Peptic ulcer disease prophylaxis
4. Deep vein thrombosis prophylaxis
5. Daily oral care with chlorhexidine
References
1. Kollef MH. What is ventilator-associated pneumonia and why is it
important? Respiratory Care. 2005;50(6):714-724. Available at:
www.rcjournal.com/contents/06.05/06.05.0714.pdf. Accessed
November 4, 2010.
2. Implement the Ventilator Bundle. Institute for Healthcare
Improvement (IHI) website. Available at: www.ihi.org/IHI/Topics/Criti-
calCare/IntensiveCare/Changes/ImplementtheVentilatorBundle.htm.
Accessed November 4, 2010.
74 The OR Connection
Patient Safety
1. Elevating the Head of the Bed 30 Degrees 3. Peptic Ulcer Disease Prophylaxis
• Implement a mechanism to ensure head-of-the-bed • Include peptic ulcer disease prophylaxis as part of
elevation, such as including this intervention on your ICU order admission set and ventilator order
nursing flow sheets and as a topic at set. Make application of prophylaxis the default
multidisciplinary rounds. value on the form.
• Create an environment where respiratory therapists • Include peptic ulcer disease prophylaxis as an item
work collaboratively with nursing to maintain for discussion on daily multidisciplinary rounds.
head-of-the-bed elevation. • Empower pharmacy to review orders for ICU
• Involve families in the process by educating them patients to ensure that some form of peptic ulcer
about the importance of head-of-the-bed elevation disease prophylaxis is in place at all times.
and encourage them to notify clinical personnel
when the bed does not appear to be in the 4. Deep Venous Thrombosis Prophylaxis
proper position. • Include deep venous prophylaxis as part of your
• Use visual cues to easily identify when the bed is ICU order admission set and ventilator order set.
in the proper position. Make application of prophylaxis the default value
• Include this intervention on order sets for initiation on the form.
and weaning of mechanical ventilation, delivery of • Include deep venous prophylaxis as an item for
tube feedings, and provision of oral care. discussion on daily multidisciplinary rounds.
• Empower pharmacy to review orders for ICU
2. Daily “Sedation Vacations” and Assessment patients to ensure that some form of deep venous
of Readiness to Extubate prophylaxis is in place at all times.
• Implement a protocol to lighten sedation daily at
an appropriate time to assess for neurological 5. Daily Oral Care with Chlorhexidine
readiness to extubate. Include precautions to • Educate registered nurses (RNs) about the rationale
prevent self-extubation such as increased supporting good oral hygiene and its potential
monitoring and vigilance during the trial. benefit in reducing ventilator-associated pneumonia.
• Include a “sedation vacation” strategy in your overall • Develop a comprehensive oral care process that
plan to wean the patient from the ventilator; if you includes the use of 0.12% chlorhexidine oral rinse.
have a weaning protocol, add “sedation vacation” • Schedule chlorhexidine as a medication, which then
to that strategy. provides a reminder for the RN and triggers oral
• Assess that compliance daily during care process delivery.
multidisciplinary rounds.
Source: www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Changes/Implement-
• Consider implementation of a sedation scale
theVentilatorBundle.htm
(e.g., the Riker Scale) to avoid oversedation.
Strong
built-in IV
pole hanger
IHI Checklist
of activities
to help
reduce VAP
Compliance
at a glance –
clearly labeled
and sequenced
in the order
they should
be used
Thumb grip
for easy
dispensing
VAPrevent is a comprehensive oral care system modeled after the guidelines of
the Institute for Healthcare Improvement (IHI) Ventilator Bundle. It’s designed to
address ventilator-associated pneumonia (VAP)—the second most common
healthcare-associated infection1, affecting up to 40 percent of ventilator patients.2
The VAPrevent System brings you the three Ps to better oral care: the right products
combined with a comprehensive educational program at a value-added price.
Product
Only Medline features these three options for oral care: IHI-recommended
chlorhexidine gluconate (CHG), the alcohol-free moisturizing of Biotene®,
or the proven antisepsis of hydrogen peroxide. Color-coded packaging
allows for quick identification, thorough caregiver education and simple
compliance. The system is designed to dispense each kit one-at-a-time
in the right order at the right time.
Record
start time,
date and
patient
information
Easy
identification
of oral care Suction Toothbrush
frequency & Catheter Kit
Program
Products are only as beneficial as knowing how to use them appropriately.
Clear visual That’s why we also developed the Medline VAP Program, which helps build
identification your staff’s knowledge and clinical skills with educational modules for novice
of kit and experienced clinicians, as well as an online interactive competency for oral
components
care. We help you implement the program, and then provide you with 90-
day reports to help you track your incidence of VAP.
Price
All this – and a lower price! The cost of the VAPrevent System is five to 10
percent lower than competitors, who offer less comprehensive systems.
References
1 Bingham M, Ashley J, De Jong M, Swift C. Implementing a unit-level intervention to reduce the probability
of ventilator-associated pneumonia. Nursing Research. 2010; 59(1): S40-S47.
2 Trouillet J, Chastre J, Vuagnat A, Joly-Guillou M, Combaux D, Dombret M, et al. Ventilator-associated
pneumonia cased by potentially drug-resistant bacteria. Am J Respir Crit Care Med. 1998. 157(2):531-539.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Caring for Yourself
78 The OR Connection
Prevention Tips
Get vaccinated against flu. According to the Centers for
Disease Control and Prevention (CDC):
• More than 200,000 people in the United States are
hospitalized from flu-related complications each year,
including 20,000 children younger than age 5.
• Flu-associated deaths number in the thousands each
year. Between 1976 and 2006, the estimated number of
flu-related deaths every year ranged from about 3,000
to about 49,000.
Tips for Avoiding
Flu vaccine, available as a shot or a nasal spray, remains the
best way to prevent and control influenza. The best time to get WINTER BUGS:
a flu vaccination is from October through November, although
getting it in December and January is not too late. A new flu • Get vaccinated against flu
shot is needed every year because the predominant flu viruses
change every year.
• Wash your hands often
• Limit exposure to infected people
All people 6 months of age and older should be vaccinated.
However, you should talk to your health care professional
• Keep stress in check
before getting vaccinated if you • Eat right
• have certain allergies, especially to eggs
• have an illness, such as pneumonia • Sleep right
• have a high fever • Exercise
• are pregnant
Flu vaccination for health care workers is urged because During last flu season, two different vaccines were needed; one
unvaccinated workers can be a primary cause of outbreaks in to prevent seasonal influenza and another to protect against
health care settings. Certain people are more at risk for devel- the 2009 H1N1 flu virus. This year’s seasonal flu vaccine pro-
oping complications from flu; they should be immunized as tects against three strains of influenza, including the 2009
soon as vaccine is available. These groups include: H1N1 flu virus.
• people 65 and older
• residents of nursing homes or other places that house Also, a vaccine specifically for people 65 years and older is
people with chronic medical conditions such as diabetes, available this year. Called Fluzone High-Dose, this vaccine
asthma, and heart disease induces a stronger immune response and is intended to better
• adults and children with heart or lung disorders, protect the elderly against seasonal influenza.
including asthma
• adults and children who have required regular medical This vaccine—which was approved by FDA in 2009—was
follow-up or hospitalization during the preceding year developed because the immune system typically becomes
because of chronic metabolic diseases (including diabetes), weaker with age, leaving people at increased risk of seasonal
kidney dysfunction, a weakened immune system, or flu-related complications which may lead to hospitalization
disorders caused by abnormalities of hemoglobin and death.
(a protein in red blood cells that carries oxygen)
• young people ages 6 months to 18 years receiving long-term Wash your hands often. Teach children to do the same. Both
aspirin therapy, and who as a result might be at risk for colds and flu can be passed through coughing, sneezing, and
developing Reye’s syndrome after being infected with contaminated surfaces, including the hands.
influenza (See aspirin information in the section “Taking
OTC Products.”) Note that only one vaccine is needed CDC recommends regular washing of your hands with warm,
for the 2010-2011 influenza season. soapy water for about 15 seconds.
1. Wash your hands often with soap 2. Get vaccinated against the flu. 3. Choose over-the-counter medicines
and warm water. that treat only your specific symptoms.
FDA says that while soap and water are undoubtedly the first Here are other steps to consider:
choice for hand hygiene, alcohol-based hand rubs may be • First, call your doctor. This will ensure that the best course
used if soap and water are not available. However, the agency of treatment can be started early.
cautions against using the alcohol-based rubs when hands are • If you are sick, try not to make others sick too. Limit your
visibly dirty. This is because organic material such as dirt exposure to other people. Also, cover your mouth with a
or blood can inactivate the alcohol, rendering it unable to tissue when you cough or sneeze, and throw used tissues
kill bacteria. into the trash immediately.
• Stay hydrated and rested. Fluids can help loosen mucus
Try to limit exposure to infected people. Keep infants away and make you feel better, especially if you have a fever.
from crowds for the first few months of life. This is especially Avoid alcohol and caffeinated products. These may
important for premature babies who may have underlying dehydrate you.
abnormalities such as lung or heart disease. • Know your medicine options. If you choose to use medicine,
there are over-the-counter (OTC) options that can help
Practice healthy habits. relieve the symptoms of colds and flu.
• Eat a balanced diet.
• Get enough sleep. If you want to unclog a stuffy nose, then nasal decongestants
• Exercise. It can help the immune system may help. Cough suppressants quiet coughs; expectorants
better fight off the germs that cause illness. loosen mucus so you can cough it up; antihistamines help stop
• Do your best to keep stress in check. a runny nose and sneezing; and pain relievers can ease fever,
headaches, and minor aches.
Also, people who use tobacco or who are exposed to
secondhand smoke are more prone to respiratory illnesses and In addition, there are prescription antiviral medications
more severe complications than nonsmokers. approved by FDA that are indicated for treating the flu. Talk to
your health care professional to find out what will work best
Already Sick? for you.
Usually, colds and flu simply have to be allowed to run their
course. You can try to relieve symptoms without taking medi- Taking OTC Products
cine. Gargling with salt water may relieve a sore throat. And a Be wary of unproven treatments. It’s best to use treatments
cool-mist humidifier may help relieve stuffy noses. that have been approved by FDA. Many people believe that
products with certain ingredients—vitamin C or Echinacea, for
example—can treat winter illnesses.
Continued on page 82
80 The OR Connection
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82 The OR Connection
Medline Suction
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Medline advanced
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the OR
8 Principles
For Achieving Inner Peace
by Wolf J. Rinke, PhD, RD, CSP
Travel alerts, seemingly never ending natural and manmade 2. Think empowering thoughts
disasters, cranky patients bugging you…stress accelerat- As a man thinkest, so he becomes, says
ing at logarithmic speed! We certainly live in a very unsettling the Bible. And yet most of the time we
and stressful time. A time where achieving inner piece are totally inattentive to our thoughts.
seems totally out of reach. And yet I have found that you It’s almost like they run amok—totally
can attain it by relentlessly practicing the eight principles out of control—doing their own thing. To
that follow. achieve inner peace requires us to first
become aware of our thoughts—instead
1. Be honest of just letting them ruminate at the sub-
BP, politicians, clergy … do I need to conscious level. Second we must ask ourselves: is this a
say more? But before you get too smug, thought that empowers me and makes me stronger, or does
better look at the face in the mirror. it make me feel mad, bad or sad? And third we must be-
Study after study has shown that most come aware that at any one nanosecond our minds can
people lie. We inflate our resumes, hold only one thought. It can be a positive thought that gives
fudge our accomplishments and exag- us inner peace and improves our quality of life, or it can be
gerate even inconsequential events. a negative thought that does just the opposite. It’s so sim-
And when we lie there is no trust, and ple, yet difficult, to develop this powerful new awareness
without trust you can’t have solid relationships, without and transform it into a habit.
relationships there is no love, and without love you won’t
have inner peace. Call me old-fashioned; I believe there is 3. Take advantage of the
no excuse for lying … none. There is not even a good rea- abundance all around you
son for exaggerating. Because if you do, you will have to When we are struggling and having trou-
talk from the head, always checking your memory to make ble making ends meet, it is really difficult
sure you are consistent. And who can keep track of that, to see the abundance. What we see
when most of us have trouble remembering where we put instead—almost oppressively—is scarcity.
our car keys. Only by getting in the habit of always telling I know firsthand. Having been born right
the truth—especially if it is at your own expense—will you be after World War II in Germany, with my
able to talk form the heart and that will set you free. This in parents losing all their earthly posses-
turn will enhance your leadership skills because people sions—yes, everything—we had less than scarcity, we had
follow people they can trust. And it will put you on the fast desperation. Finding enough food and shelter to keep us
track in any endeavor. It will also enrich your personal rela- alive is what consumed my parents. Then some 17 years
tionships and, most importantly, will get you to like and later—when I immigrated to the United States—scarcity,
respect yourself—the foundation for achieving inner peace. although not as extreme, reared its ugly head again. Basi-
cally I only spoke a few words of English, had $20 in my pocket So begin right now to become your own best friend, because if
and the proverbial shirt on my back. And I certainly had trouble it is not you, who is it going to be? In addition to taking really
finding all “the milk and honey” that supposedly was just wait- great care of your thoughts, also take extraordinary care of your
ing for me. However, it was all around me, and over time body. And if you want to avoid psychosomatic illnesses—which,
I learned to find it by internalizing a powerful concept that I as you probably know, account for the majority of illnesses in
learned from several different mentors: If you want more of this country—then you must eat right—which means you learn
something, you have to give it first. I know it sounds counterin- to stop when it tastes the best. Get adequate rest—seven to
tuitive. (By the way, lots of things are…otherwise men would eight hours of sleep is a great start—and do 25-30 minutes of
ride sidesaddle. If that didn’t at least make you smile, you’re aerobic exercise three times per week, alternating with strength
taking this much too seriously.) Here is how it works: If you want training for the other three days. (Go ahead and take Sunday
more love in your life, give more love. If you want to be happier, off.) It also means that you don’t put stuff into your body that
make others happy. If you want people to trust you, give does not belong there—read drugs and nicotine. (Please don’t
unconditional trust. Of course the only way you can take yawn. This is important. You only will be given one body—a the
advantage of this principle is to internalize the next one. one you’ve got is it. So treat it accordingly.)
Continued on page 88
86 The OR Connection
Medline natural OR towels
A LITTLE CHANGE
A LOT OF DIFFERENCE
The greensmart™ collection of OR products helps
reduce your impact on the environment. It includes:
• Dye-free towels with a third less manufacturing and processing.
More lint-free and absorbent than traditional towels.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. greensmart and EcoDrape are trademarks of Medline Industries, Inc.
Just about an hour later the scene repeated itself all over again. us. And then, we wonder why our life stinks. Part of what we
Except this time it was a young lady who was also interviewing carry around in our bag is resentment, hate and blame. All of
for the same job. She, too, had done her homework and these emotions will attack our souls and diminish the quality of
wanted to make a great impression. She also asked the secu- our spirit and our physiology.
rity guard, “What are the people like around here?”
In turn, he asked, “What were they like where you came from?” Instead, go ahead pay tribute to your past. Visit it. And then
The vivacious young lady answered, “Oh, I just loved the people toss it in the trash. You can make that happen by taking own-
at my former hospital. They were kind, supportive and hard- ership of all that is going on in your life. Your life is not a func-
working. Everyone worked together as a team. We cared so tion of what other people have done to you; it is today what it
much for each other that I developed some of the best friend- is because of the choices you have made in the past. And if
ships. It’s really a shame that my husband is relocating to this your feelings of resentment, hate and blame are attributed to
area. I just hate to leave all those wonderful people behind.” the actions of others, then you have to wait for those people to
“Well,” the wise elderly man answered, “I believe you will find change—which may never happen. And don’t even try to
the same kind of people here.” change them! Think about how many of us have difficulty
changing ourselves, let alone others. Instead live by the axiom:
6. Let go of the past If it is to be it is up to me. Once you’ve done that, you are ready
It’s amazing how much we mental energy to take it to the next level by substituting the emotions of love,
we spend in a place over which we have empathy and kindness for resentment, hate and blame, which
absolutely no control—the past. It was Dr. will put you on the fast track to inner peace.
Wayne Dyer who likened our past to a bag
of manure that we carry around with us. We And while you are at it, force yourself to get off your case, quit
keep putting more and more manure into living in the past, and become future-oriented by learning from
the bag. Once in a while we put the bag every action. If an action gives you the results you desired, keep
down, reach in and smear manure all over doing it. If the action did not accomplish the intended result,
88 The OR Connection
review what happened; make a commitment to do it differently 8. Never give up on your dreams
in the future, then quit doing it and let it go. No wait, I mean The purpose of life is not to make it safely to
really let it go. Get on with your life by refocusing your thoughts the grave. Pursue your dreams no matter
on the only moment you and I have any control over, the now. how late or how “weird.” Let me share an
example. Doris Haddock had a passion. She
7. Kill your ego felt that Congress needed to get off their
Ego, right along with greed and envy, is one duff and change the campaign finance
of the most powerful destroyers of inner laws! Unlike most of us; however, Doris did
peace. A look at history confirms that these not sit around and complain and whine.
emotions are responsible for more evil. Instead, Doris started to walk from
Think Napoleon, Stalin and Hitler—and more Pasadena, Calif.; walking 10 miles a day, every day. Fourteen
corporate catastrophes. Think Toyota’s and months and 3,200 miles later she arrived in Washington, DC.
even venerable Johnson & Johnson’s recent Now, here comes the startling part of the story. Doris, better
recalls—as well as relationship killers. And known as Granny D, had a severe case of arthritis, wore a brace
yet we can get rid of our ego with just five and turned 90 years “young” while on the trail. And for an added
powerful phrases expressed liberally and from the heart: measure, she was arrested twice demonstrating for her beliefs.
• You are right about that. Any time you get into a conflict, Why? Because she had a dream and a passion. So whatever
use this phrase and you will have no more conflict— you do, don’t ever give up on your dreams, it’ll make you
guaranteed! cranky. Instead, get off your butt and act on your dreams today,
• I’ve made a mistake. This phrase helps you get off your and you, too, will be on the road to achieving the most coveted
high horse gracefully. All human beings make mistakes— of all possessions—inner peace.
and since you are a…I think you get it. There is only one
omnipotent force in the universe—and it is not you. So © 2010 Wolf J. Rinke
quit defining unrealistic expectations for yourself.
• I changed my mind. You are an evolving human being,
one who is like red wine and gets better all the time. That Dr. Wolf J. Rinke, RD, CSP is a keynote
means you have to let go of your past beliefs. (Remember speaker, seminar leader, management con-
that the only person who can change his/her mind is the sultant, executive coach and editor of the free
electronic newsletter Read and Grow Rich,
one who has one.)
available at www.easyCPEcredits.com. In
• I don’t know. Admit it. You don’t know everything. It lets
addition he has authored numerous CDs,
other people know that you have high levels of self-esteem.
DVDs and books including Make It a Winning
(Only people who are OK inside of their own skin can admit Life: Success Strategies for Life, Love and
they don’t know everything.) Business, Winning Management: 6 Fail-Safe
• Let’s agree to disagree. The phrase to use if all else fails. Strategies for Building High-Performance Organizations and Don’t
By the way, do try all five of these at home; the positive Oil the Squeaky Wheel and 19 Other Contrarian Ways to Improve
results will astound you. Your Leadership Effectiveness; available at www.WolfRinke.com.
His company also produces a wide variety of quality pre-approved
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CPEUs, from which this article was extracted. Reach him at
WolfRinke@aol.com.
Now Available
On Demand 24/7!
Click on the links below to participate in a webinar any time.
PGD2
Pink Glove Dance: The Sequel
From Halifax, Novia Scotia to San Francisco, Califor- Pink Gloves for a Cause
nia, Medline traveled across North America in 2010 Our goal is to create a Pink Glove Nation – that is, get
showcasing the spirit of breast cancer survivors and as many people as possible talking about breast can-
caregivers who performed in the Pink Glove Dance: cer and to raise awareness for early detection. To that
The Sequel. To see videos of Pink Glove Dancers in end, partial proceeds from our pink gloves and other
action visit www.pinkglovedance.com. pink ribbon products are donated to the National
Breast Cancer Foundation (NBCF) to help fund mam-
Thank you, Pink Glove Dancers, for welcoming us to mograms for women who cannot afford them.
your city!
• New York, NY • La Jolla, CA Medline presents a donation check to the NBCF
• Chicago, IL • Portland, OR each year during the Breast Cancer Awareness Break-
• San Francisco, CA • New Orleans, LA fast at the Association of periOperative Nurses
• Indianapolis, IN • Denver, CO (AORN) Congress.
• Minneapolis, MN • Halifax, Novia Scotia
• Richmond, VA • Plano, TX
• Tallahassee, FL • Baltimore, MD
• Newark, NJ
92 The OR Connection
SAVE THE DATE!
Medline’s Breast Cancer
Awareness Breakfast
AORN Congress
March 19 - 24, 2011
Philadelphia, PA
Providence St. Vincent
Medical Center. Portland, OR
94 The OR Connection
HCA Johnston – Willis Hospital. Richmond, VA
Nutrition
Information
Servings: 6
Calories: 749
Fat: 19.5 g
Sodium: 1427 mg
1 lb. lean ground beef 1 green pepper, chopped 1 15-ounce can kidney beans
1 lb. lean ground turkey 4 teaspoons minced garlic 1 15-ounce can spicy chili beans
4 teaspoons chili powder 1 16-ounce can tomato sauce 1 bottle beer
1 teaspoon ground cumin 1 16-ounce can diced tomatoes 1 teaspoon black pepper (or to taste)
1 large onion, chopped 1 15-ounce can chili with beans Hot sauce to taste
2 jalapeno peppers, chopped 1 6-ounce can tomato paste
Add kidney beans, chili beans, 3 teaspoons chili powder, pepper “It’s a healthier chili recipe, made with lean meat,” she said. You’ll
and hot sauce and simmer at least 30 minutes. also notice that the onions and peppers are sautéed with cooking
spray rather than oil.
“I find the longer it simmers, the better the
taste, so after the last round of ingredients Jennifer has always enjoyed cooking, having learned by watching
are added, I let it simmer on low for 6 to 8 her mother from the age of six. Her favorite meals include
hours,” Jennifer said. seafood with lots of butter and garlic.
Senior Product Specialist Jennifer In addition to cooking, Jennifer, who lives on Illinois’ Chain
Sutschek, who has worked Medline’s O’Lakes with her husband and two children, enjoys water
corporate headquarters in Mundelein, Ill. sports, such as boating, and in the winter months, she
since 1998, won second place for this enjoys snowmobiling and skiing.
96 The OR Connection
Forms & Tools
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
SmartSponge is a registered trademark and SmartWand-DTX is a trademark of ClearCount
Medical Sloutions.
Surgical Time Out Forms & Tools
I COMMIT TO SUPPORT
TIME OUT
NAME: _______________________________________
DATE: ________________________________________
The use of Time Out is recommended by the Association of periOperative Registered Nurses (AORN),
the Joint Commission Universal Protocol, and the World Health Organization (WHO).
For more information on Time Out and how it can save patient lives, visit aorn.org.
Ambulatory
Ambulatory Surgery
Surgery V
Version
ersion 1.1
1.1
Step 1: P
Step Prior
rior to
to Incision
Incision
ALL
ALL TEAM
TEAM MEMBERS
MEMBERS STOP
STOP AACTIVITY
CTIVITY AND
AND BEGIN
BEGIN CHECKLIST
CHECKLIST
Team
Team Members
Members introduce
introduce themselves
themselves (w
(when
hen personnel
personnel h
have
ave c
changed)
hanged)
Introduce patient,
Introduce p verify
atient, v erify consent, procedure
consent, p rocedure
Confirm
Confirm site marked
site m arked and
and iiff there
there iis
sas
single orr multiple
ingle o operative
multiple o perative ffield
ield
Anesthesia
Anesthesia T
Team
eam Reviews
Reviews
Airway
Airway iissues
ssues o
orr other
other p
patient-specific
atient-specific co
concerns
ncerns ((special
special m
meds,
eds, health
health conditions
conditions affecting
affecting rrecovery,
aff ecovery,
etc.)
etc.)
Patient
Patient a llergies reviewed
allergies reviewed N/A
N/A
Antibiotics
Antibiotics given
given within
within 60
60 mins
mins before
before incision
incision N/A
N/A
Surgeon
Surgeon R
Reviews
eviews
Brief
Brief d
description
escription of
of p
procedure
rocedure and
and a
anticipated
nticipated d
difficulties
ifficulties
Describe
Describe iimplants needed,
mplants n eeded, unusual
unusual iinstruments
nstruments OR s
supplies
upplies N/A
N/A
Confirm
Confirm that
that essential
essential imaging
imaging is
is displayed
displayed and
and correctly
correctly oriented
oriented N/A
N/A
Nursing
Nursing T
Team
eam R
Reviews
eviews
Confirm
Confirm th
that
at supplies
supplies a
and
nd iimplants
mplants a
are
re av
available
ailable N/
N/AA
If
If using
using an
an iimplant,
mplant, confirm expiration
confirm expiration dates
dates N/A
N/A
Step 2: P
Process
rocess C
Control
ontrol
IF PR
PROCEDURE
OCEDURE IS
IS EXPECTED
EXPECTED TO
TO B
BEE LONGER
LONGER T
THAN
HAN ONE
ONE HO
HOUR:
UR:
Active
Active warming
warming iin
n place
place N/A
N/A
Glucose
Glucose checked
checked for
for diabetic
diabetic patients
patients N/A
N/A
VTE
VTE p
prophylaxis
rophylaxis N/A
N/A
Step 3
3:: Debriefing—At
Debriefing—At Com
Completion
pletion of Case
Case
(Surgeon
(Surgeon and
and Nursing)
Nursing) Before
Before closure:
closure: Confirm
Confirm that
that instrument,
instrument, sponge,
sponge, a
and
nd n
needle
eedle c
counts
ounts c
correct
orrect
If
If counts
counts incorrect,
incorrect, confirm
confirm x
x-ray
-ray n
negative
egative
(S
(Surgeon
urgeon a
and
nd N
Nursing)
ursing) Confirm
Confirm s
specimen,
pecimen, llabel
abel & instructions
instructions to p
pathologist
athologist N/A
N/A
((All)
All) C onfirm n
Confirm ame o
name off p rocedure
procedure
((All)
All) E
Equipment
quipment issues
issues to be addressed? No Yes,
be addressed? Yes, a
and
nd response
response p
plan
lan formulated
formulated (Who/When)
(Who/When)
((All)
All) W
What
hat could
could h
have
ave b
been
een b etter? Nothing
better? Nothing So
Something,
mething, with
with plan
plan to address
address (Who/
(Who/ W
When)
hen)
(Surgeon
(Surgeon and
and Anesthesia)
Anesthesia) Key
K ey c
concerns
oncerns fo
forr rrecovery
ecovery (e
(e.g.,
.g., p
plan
lan for
for p
pain
ain management,
management,
nausea/vomiting)
n ausea/vomiting)
Adapted
Adapted from
from tthe
he WHO
WHO ""Safe
Safe S
Surgery
urgery Saves
Saves Li
Lives"
ves" campaign
campaign an
andd the
the WWASCA/Proliance
ASCA/Proliance Surgeons
Surgeons S
Surgical Checklist
urgical Checklist
SCOAP iiss a program
SCOAP program of the
the Foundation
Foundation for
for Health Care
Health Care Quality
Quality
www.scoapchecklist.org
w ww.scoapchecklist.org rrev
ev 1/
1/19/2010
19/2010
SCOAP
SCOAP Surgical
Surgical Checklist
Checklist Version
Version 3.7
(July
3. 7
(July 2010)
2010 )
Before
Before Skin
Skin Incision:
I n c is io n :
Briefing
Briefing
All
A lll Te
Al T eam M
Team Mee m bers
Mem b er
e rs
r N u r s i ng
Nu n g/
Nursing/Techg / T e ch
c h reviews:
r e v ie w s : A n e s th
An t h es
Anesthesia e s i a reviews:
r e v ie w s :
A tt
t te
tending S
((Attending
(A u r g e on
Surgeon o n Leads)
L e a ds
ds): Equipment issues
Equipment issues (instruments
(in s tru m e n ts Air
irw
way or
Airway or other
other concerns
concerns
E ach p
Each erson introduces
person introduces self self ready,
ready, trained
trained on,
on, requested
re q u e s te d Special meds
Special m eds
by
by nname
ame and
and rolero le implants
implants available,
available, gasgas tanks
tanks full)
full) ((beta
beta blockers,
blockers, etc.)
e tc .)
Surgeon, A
Surgeon, nesthesia team
Anesthesia team and and Sharps management
Sharps management plan plan Allergies
Allergies
N u rs e c
Nurse onfirm patient
confirm patient (at (at least
le a s t 2 Other patient
Other patient concerns
c o n c e rn s Conditions affecting
Conditions affecting recovery
re c o v e ry
identifiers), site,
identifiers), site, procedure
p ro c e d u re
Personnel exchanges:
Personnel exchanges: timing, timing,
plan ffor
plan or announcing
announcing changes change s
Description of
Description of procedure
procedure and and
anticipated
anticipated difficulties
d iffic u ltie s
Expected duration
Expected duration o off procedure
p ro c e d u re
Expected blood
Expected blood loss loss & blood
blood availability
availability
Need ffor
Need or instruments/supplies/IV
in s tru m e n ts /s u p p lie s / IV
access
access b beyond
eyond tthosehose normally
n o rm a lly
used
u sed for
o the
he p procedure
ocedu e
Ques ons ssues from
Questions/issues om anyany
team
eam member
m em be a and
nd Invitation
nv a on to o speak
speak up
up
a any
at any timeme in n the
he procedure
p ocedu e
Process Control
Process Control
A cases:
All cases case expected
If case expec ed to
o be
be 1h ou add:
hour, add
S ur
u rg
r g e o n reviews
Surgeon ev ews (as
as applicable):
app cab e S u r g eo
Su
Surgeon e o n reviews:
ev ew s
Essen a imaging
Essential mag ng displayed;
d sp a y e d G ucose checked
Glucose checked foro diabetics
d abe cs
gh and
right and left
e confirmed
con m ed nsu n protocol
Insulin p o oco initiated
n a ed if needed
neede d
An b o c prophylaxis
Antibiotic p ophy ax s given
g ven in n DVT PE chemoprophylaxis
DVT/PE chemop ophy ax s and/or
and o mechanical
m echan ca
as 60
last 60 m nu es
minutes p ophy ax s plan
prophylaxis p an in
n place
p ace
Ac ve w
Active a m ng in
warming n place
p a ce pa en on
If patient on beta
be a blocker,
b ocke post-op
pos o p
Spec a instruments
Special ns umen s and/or
and o implants
m p an s p an formulated
plan o m u a ed
Re dos ng plan
Re-dosing p an for
o antibiotics
an b o cs
Spec a y spec c checklist
Specialty-specific check s
Just Before
Just Before C lo s u re o
Closure off O p e ra tiv e F
Operative ie ld
Field
No Retained
No Retained O bjects
Objects
A ttt en
At e nd
Attendingd ng
n g Su
S u r g e on
Surgeon o : Nu
u rs
ur s ng Te
T e ch
Nursing/Tech ch:
Pe o m m
Perform e hod ca visual
methodical v sua and
and physical
p h y s ca A music,
All mus c conversation,
conve sa on and
and distractions
d s ac ons halted
ha ed
sweep
s of the
w eep o he wound
w ound Pe o m preliminary
Perform p e m na y count
coun of
o
needles/sponges/instruments
need es sponges ns um en s
Show Surgeon
Show Su geon and
and Anesthesia
Anes hes a all
a sponges
sponges and
and
laps
aps in
n holders
ho de s (“Show
Show Me
Me Ten”)
Ten
A fte r S
After kin Closure
Skin C lo su re C omplete:
Complete: e:
No Retained
No Retained Objects,
Objects, Debriefing,
Debriefing, C are Transition
Care Transition
A Te
All T e a m Me
Team M e m bers
Mem b er
e rs
r s ((Attending
A t te
t e nd ng
n g Su
S u r g e on
Surgeon o n Leads)
L e a ds
d s)
s : Su
urgeon a
ur
Surgeon and A n es
e st
s t h es
nd Anesthesia es a:
Con m final
Confirm na needles/sponges/
need es sponges instruments
ns umen s count
coun correct
co ec Key concerns
Key conce ns for
o patient
pa en recovery
e co v e y
Nu s ng Tech show
Nursing/Tech show Surgeon
Su geon andand Anesthesia
Anes hes a all
a sponges
sponges and
and laps
aps in
n Wha is
What s the
he plan
p an for
o pain
pa n management?
m anage m en ?
holders
h o de s (“Show
Show MeMe Ten”)
Ten Wha is
What s the
he plan
p an for
o prevention
p even on of o PONV?
P O NV ?
C on m n
Confirm ame of
name o procedure
p ocedu e Does patient
Does pa en need
need special
spec a monitoring
mon o ng (timeme
If s pec m en c
specimen, on m label
confirm abe and
and instructions
ns uc ons (e.g.,
e g orientation
o en a on of
o in
n RR,
RR ICU,
CU tele?)
e e?
specimen,
s pec m en 1 12
2 lymph
ymph nodes
nodes foro colon
co on CA)
CA pa en has
If patient has elevated
e eva ed blood
b ood glucose,
g ucose plan
p an for
o
Equ pmen issues
Equipment ssues too be
be addressed?
a d d e sse d ? insulin
nsu n drip
d p formulated
o m u a ed
Response planned
Response p anned (who/when)
w h o w hen pa en on
If patient on beta
be a blocker,
b ocke post-op
pos op continuation
con nua on
W ha c
What ou d have
could have been
been better?
be e ? plan
p an formulated
o m u a ed
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Arglaes is a registered trademark of Giltech Limited Corporation.
Facility name:
Date:
Scheduling/Consent (a standardized form is suggested) CASE CASE CASE CASE CASE CASE CASE CASE CASE CASE
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10
Exact description of procedure was on OR schedule (including site, level, side, digit)
Exact description of procedure was on consent (including site, level, side, digit)
Consent was completed (including exact procedure, all required signatures, dates)
Preoperative Verification (a standardized checklist is suggested) CASE CASE CASE CASE CASE CASE CASE CASE CASE CASE
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10
Verification and documentation were completed independently by at least two providers
Duration for the surgeon to complete the verification process and marking process
(MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES)
Site marking occurred after reconciliation of all documents (schedule, consent, H&P)
Site marking was visible after patient was positioned, prepped, and draped
Site marking was confirmed by intraoperative imaging, if for vertebrae, ribs, or ureters
Forms & Tools
The OR Connection
A separate time-out was conducted prior to regional or local anesthesia, if applicable
The final time-out was conducted after patient was positioned, prepped, and draped
All documents (schedule, consent, H&P) were verified during time-out
Surgeon was engaged during time-out—all work stopped and verbal acknowledgement occurred
Anesthesia provider was engaged during time-out—all work except ventilation stopped and verbal
acknowledgement occurred
Nurses were engaged during time-out—all work stopped and verbal acknowledgement occurred
Wrong-Site Surgery
Surgeon encouraged the entire surgical team to speak up if there were any concerns
OR Turnover CASE CASE CASE CASE CASE CASE CASE CASE CASE CASE
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10
All patient information and specimens were removed from the OR before the next patient arrived
MS10211_PUB_810A
2010 Pennsylvania Patient Safety Authority Page 2
Patient Handout - Medicare Forms & Tools
MAY 2010
106 The OR Connection Aligning practice with policy to improve patient care 106
Patient Handout - Medicare Forms & Tools
HEALTH CARE LAW
Improvements Beyond Medicare That You and Your Family Can Count On
Improves Long-Term Care Choices
• New tools and resources in the Elder Justice Act, which was included in
the new law, will help prevent and combat elder abuse and neglect, and
improve nursing home quality.
• The new law creates a new voluntary insurance program called CLASS
to help pay for long-term care and support at home.
• Individuals on Medicaid will receive improved home- and community-
based care options, and spouses of people receiving home- and community-
based services through Medicaid will no longer be forced into poverty.
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The OR Connection
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110
The Patient Handout Forms & Tools
OR Connection
Aligning practice with policy to improve patient care
Aspirin
Avoid aspirin or over-the-counter medications containing aspirin for a week to 10 days after
Never miss an issue of The OR Connection! surgery. Aspirin interferes with blood clotting and makes it easier for bruises to form near
the incision.
Subscriptions are free and signing up is a snap!
Sun Exposure
Subscribing to The OR Connection guarantees that you’ll To subscribe, simply go to www.medline.com/orconnection. As an incision heals, the new skin that forms over the cut is very sensitive to sunlight and
continue to receive this info-packed magazine and won’t miss You will need to provide: will burn more easily than normal skin and lead to worse scarring. Keep the incision area
out on our industry updates and articles addressing on-the- Your name covered from direct sun exposure for three to nine months in order to prevent burning and
job issues and tips on caring for yourself! Facility and position severe scarring.
Mailing address
E-mail address General Hygiene
Infection is the most common complication of surgical procedures. It is important, therefore,
to minimize the risk of an infection when caring for your incision at home.
We also welcome any suggestions you might have on how we can continue to improve
The OR Connection! Love the content? Want to see something new? Just let us know!
Observe the following precautions:
• Wash your hands carefully after using the toilet and after touching or handling trash;
pets and pet
Content Key equipment; dirty laundry and anything else that is dirty or has been used outdoors
We've coded the articles and information in this magazine to indicate which patient care • Ask family members, close friends, and others to wash their hands before contact
initiatives they pertain to. Throughout the publication, when you see these icons you'll with you
know immediately that the subject matter on that page relates to one or more of the • Avoid contact with family members and others who are sick or recovering from a
following national initiatives: contagious illness
• IHI's Improvement Map • Stop smoking (smoking slows down the healing process)
• Joint Commission 2009 National Patient Safety Goals
• Surgical Care Improvement Project (SCIP)
We've tried to include content that clarifies the initiatives or gives you ideas and tools Adapted from www.surgeryencyclopedia.com/Fi-La/Incision-Care.html
for implementing their recommendations. For a summary of each of the initiatives,
see pages 10 and 11.
Volume 5, Issue 4
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Principles
Now you and your family can enjoy professional for achieving
quality Remedy skin care products at home.
inner peace
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