To ensure receipt
of our emails, please add aorn@informz.net to your address book.
2009 AORN Education Events
Learn the most up-to-date, essential information about practice, patient
care, and the future of the perioperative profession to ensure excellence in the perioperative care
you provide.
July 17 - 19
Leadership Conference Reaching the Peak of Perioperative Practice Collaboration,
Patient Safety, and Quality Improvement through Leadership Denver, Colorado Early Bird Deadline is Approaching
You are not alone. All health care
professionals are questioning the economy, health care reform and
policy change. Come join us to understand these issues and how your leadership role could be changing. For a complete list
of our world renowned speakers visit the program outline or call Customer Service at 800-755-2676,
Ext. 1.
Register by June 17 and
save $100 off Registration!
Executive Symposium New Location for 2009! Napa Valley, California Register Today
The Executive Symposium
provides an opportunity for the entire surgical team to come together in a relaxed environment to learn from leaders in the
patient safety arena, other leading experts, and from participating perioperative surgical teams to ultimately change and
maintain your culture of safety in economically challenging times.
Informatics Conference Denver,
Colorado Registration opens May 29th!
As technology becomes more and more pervasive in our facilities, perioperative
nurses, information technology staff, CNOs, and CFOs must know how to optimize
these systems. Designed for perioperative use informaticists and management working directly with health
care technology, this conference will provide you and your team with critical technology and information systems’
knowledge to help you improve performance and your bottom line, and keep you abreast of what’s on the horizon.
Learn about AORN's launch of Syntegrity Standardized Perioperative
Framework which provides software content for surgical care nurses that integrate into electronic health record (EHR) systems and nursing documentation systems.
Fall Specialty Conference Orlando, Florida Registration opens
June 15!
One Location…Two Specialties!
Educator Conference – Provides information on critical topics, including developing competencies,
generational differences in teaching, and copyright issues.
Ambulatory Conference – Addresses current on-going issues that ASC face on a day-to-day basis including
infection control, risk and quality management programs, pre-op, and sterilization
and high level disinfection practices.
Ambulatory Surgery Administrator Certificate Program – This Course is designed to provide you with
the skills and tools you need to manage every aspect of an ambulatory facility.
Moderate Sedation Workshop – Provides you with essential knowledge and skills to safely care for
a patient receiving moderate sedation.
To ensure receipt
of our emails, please add aorn@informz.net to your address book.
2009 AORN Education Events
Learn the most up-to-date, essential information about practice, patient care, and the future of the perioperative profession to ensure excellence
in the perioperative care
you provide.
June 5 - 6
Perioperative Preparation for the Magnet Recognition ProgramTM Chicago, Illinois Registration is now open!
Essential strategies and tools for perioperative nursing leaders
on their way to achieving ANCC Magnet Recognition®. Take part in this learning engagement to acquire the skills and tools
to effectively implement and demonstrate the Forces of Magnetism in your perioperative setting. This intensive conference
will help you become an effective visionary leader for your perioperative team to help ensure that your facility investment
and commitment will be successful. View the event webpages at aorn.org/PeriopNursingExcellence.
Leadership Conference Reaching the Peak of Perioperative Practice Collaboration,
Patient Safety, and
Quality Improvement through Leadership Denver, Colorado Registration is opening on Thursday March 12th!
You are not alone. Perioperative leaders continuously struggle to improve
quality and patient safety in environments that can be reluctant to change. Come join us and learn from speakers who are internationally
known for their leadership success, innovative strategies, and their impact on health care.
Register by June 17 and save $100 off Registration!
AORN/OMU Perioperative Leadership Academy Exclusive Opportunity Denver, Colorado Deadline for Application Submission: March 30th
Become an effective leader and mentor to emerging leaders.
AORN and Owens & Minor University (OMU) bring you a leadership program
that will teach you the principles of effective leadership and will provide opportunities to put these principles into practice.
25 perioperative nurses
will be selected to participate in this intensive, supportive leadership academy. The 9 month program consists of webinars,
face-to-face meetings, online assignments and discussions, as well as ongoing communication with assigned mentors. Deadline
for Application Submission: March
30, 2009
Executive Symposium New Location for 2009! Napa Valley, California Registration is now open!
The Executive Symposium
provides an opportunity for the entire surgical team to come together in a relaxed environment to learn from leaders in the
patient safety arena, other leading experts, and from participating perioperative surgical teams to ultimately change and
maintain your culture of safety in economically challenging times.
Informatics Conference Denver,
Colorado Registration will open in April!
As technology becomes more and more pervasive in our facilities, perioperative
nurses, information technology staff, CNOs, and CFOs must know how to optimize
these systems. Designed for perioperative use informaticists and management working directly with health
care technology, this conference will provide you and your team with critical technology and information systems’
knowledge to help you improve performance and your bottom line, and keep you abreast of what’s on the horizon.
Fall Specialty Conference Orlando, Florida Registration will
open in April!
One Location…Three Specialties! Informatics Conference –
Provides sessions ranging from Informatics 101 to understanding and optimizing perioperative information technology.
Educator Conference – Provides information on critical topics, including developing competencies,
generational differences in teaching, and copyright issues.
Ambulatory Conference – Addresses current on-going issues that ASC face on a day-to-day basis including
infection control, risk and quality management programs, pre-op, and sterilization
and high level disinfection practices.
Ambulatory Surgery Administrator Certificate Program – This Course is designed to provide you with
the skills and tools you need to manage every aspect of an ambulatory facility.
Moderate Sedation Workshop – Provides you with essential knowledge and skills to safely care for
a patient receiving moderate sedation.
Just a reminder, as having registered on the Nursing CE Portal website, you are eligible for our FREE CE Course
---- Go to www.nursingceportal.com, sign in, click on "My CE Portal" and then "My Courses" to access "Patient Positioning in the Operating Room".
Check out our new instant-load format!!!
Also, anyone within your staff, colleagues, chapter members, and OR contacts who registers this month, will also
be eligible for this FREE course, so please pass along the word. You will also have availability to this course for
the life of the course to use as a reference guide as you see fit.
If you have any questions about our services, please let us know. We are excited to work with you to help
with your continuing education needs!
-- Lisa Brogan, Sales Manager Nursing CE Portal (toll free)
866-328-0818 330-562-1870 lbrogan@nursingceportal.com
AORN position statements articulate the Association's official position or belief
about certain perioperative nursing-related topics. Position statements are authored by a AORN Board of Directors appointees
and are approved by the Board and the House of Delegates.
AORN has published position statements on the following topics:
Hospitals try new ways to boost morale, fight 'compassion fatigue'
By Joel Hood Chicago Tribune reporter
September 30, 2008
Nobody ever told her being a surgical nurse would be easy. But even now, in her 15th year, there are days when Judy Berglund's
emotions are so spent and her body so taxed that she can barely dress herself in the locker room after her shift.
"You
don't realize how stressed you've been until you can't lift your leg to pull your pants on," Berglund said. "Your whole body
aches." Bruises and pulled muscles, hope and heartbreak—emotional and physical fatigue have contributed to a profound
nursing shortage in hospitals across Chicago and the country.
Now, many hospitals are trying to improve nursing morale,
and in turn patient care, by creating programs that reinforce healthy habits and eliminate bad ones.
Nurses typically
work 12-hour shifts, shuttling between ailing patients, demanding doctors and anxious families in the waiting room. As stress
builds and meals are eaten on the run or missed altogether, nurses sometimes lose the energy to conjure sympathy for those
they're treating.
Health-care workers have higher rates of substance abuse and suicide, and elevated levels of depression
and anxiety relating to job stress, according to a report this year by the Department of Health and Human Services. In many
cases, the caregivers simply burn out and leave the profession, adding stress for those who remain.
"You guys take
on more than most pro athletes. You must strategize a way to keep your minds sharp, your energy level high and your emotions
in balance," trainer Ryan Angelo said at gatherings of nurses recently at Adventist Hospitals in Bolingbrook and Glendale
Heights.
The message was simple: Eat better, exercise, make time to laugh, and ease stress through controlled breathing
and str etching.
At Advocate Lutheran General Hospital in Park Ridge, a team of nurses from the women and children
division last spring began exploring causes and symptoms of "compassion fatigue" with the goal of helping co-workers cope
with day-to-day stresses. Working with a tight budget, the team created a nurse's retreat in a break room where they could
assemble a puzzle or lounge in a massage chair. The team put together a handbook for nurses to make them aware of stress management
and counseling classes being offered to patients.
"It may not seem like much, but just to be able to sit and focus
your mind on something else like a puzzle makes a difference," said veteran nurse Susan Okuno-Jones, a member of Lutheran
General's "compassion fatigue" team.
"This isn't about motivating nurses to change their habits; it's about incorporating
what they already know into their lifestyle," said Angelo, a trainer based in Orlando, who last year launched a fitness and
wellness company targeting nurses, Care 4 Caregivers.
In Bolingbrook, he instructed Berglund and others to fight tiredness
by incorporating small exercises such as calf raises and even push-ups into their shifts. He taught them deep breathing exercises,
six seconds in and six seconds out, and how to clench and release various muscles to lower their heart rate.
"Your
body says to itself, if I have time to breathe in slowly, then I'm not stressed," Angelo said.
Subject: Bananas - Interesting??
A
professor at CCNY for a physiological psych class told his class about bananas. He said the expression 'going bananas' is
from the effects of bananas on the brain. Read on: Never, put your banana in the refrigerator!!! This is interesting. After reading
this, you'll never look at a banana in the same way again. Bananas contain
three natural sugars - sucrose, fructose and glucose combined with fibre. A banana gives an instant, sustained and substantial
boost of energy. Research has proven
that just two bananas provide enough energy for a strenuous 90-minute workout. No wonder the banana is the number one fruit
with the world's leading athletes. But energy isn't the only way a banana can help us keep fit. It can also help overcome
or prevent a substantial number of illnesses and conditions, making it a must to add to our daily diet.
Depression:According to a recent survey undertaken by MIND amongst people suffering from
depression, many felt much better after eating a banana. This is because bananas contain tryptophan, a type of protein that
the body converts into serotonin, known to make you relax, improve your mood and generally make you feel happier. PMS:Forget the pills - eat
a banana. The vitamin B6 it contains regulates blood glucose levels, which can affect your mood. Anemia:High in iron, bananas
can stimulate the production of hemoglobin in the blood and so helps in cases of anemia. Blood Pressure:This unique tropical fruit is extremely
high in potassium yet low in salt, making it perfect to beat blood pressure. So much so, the US Food and Drug Administration
has just allowed the banana industry to make official claims for the fruit's ability to reduce the risk of blood pressure
and stroke. Brain Power:200 students at a Twickenham (Middlesex) school
( England ) were helped through their exams this year by eating bananas at breakfast, break, and lunch in a bid to boost their
brain power. Research has shown that the potassium-packed fruit can assist learning by making pupils more alert. Constipation:High in fibre, including
bananas in the diet can help restore normal bowel action, helping to overcome the problem without resorting to laxatives. Hangovers:One of the quickest
ways of curing a hangover is to make a banana milkshake, sweetened with honey The banana calms the stomach and, with the help
of the honey, builds up depleted blood sugar levels, while the milk soothes and re-hydrates your system.
Heartburn:Bananas have a natural antacid effect in the body, so if you suffer from heartburn, try eating a banana for soothing
relief. Morning Sickness:Snacking on bananas
between meals helps to keep blood sugar levels up and avoid morning sickness. Mosquito bites:Before reaching for the insect bite
cream, try rubbing the affected area with the inside of a banana skin. Many people find it amazingly successful at reducing
swelling and irritation. Nerves:Bananas are high in B vitamins that help calm the nervous system. Overweightand at work? Studies at the Institute of Psychology in Austria found pressure
at work leads to gorging on comfort food like chocolate and chips. Looking at 5,000 hospital patients, researchers found the
most obese were more likely to be in high-pressure jobs. The report concluded that, to avoid panic-induced food cravings,
we need to control our blood sugar levels by snacking on high carbohydrate foods every two hours to keep levels steady. Ulcers:The banana is used as
the dietary food against intestinal disorders because of its soft texture and smoothness. It is the only raw fruit that can
be eaten without distress in over-chronicler cases. It also neutralizes over-acidity and reduces irritation by coating the
lining of the stomach. Temperature control:Many other cultures see bananas as a 'cooling' fruit that can lower both the physical
and emotional temperature of expectant mothers. In Thailand , for example, pregnant women eat bananas to ensure their baby
is born with a cool temperature. Seasonal Affective
Disorder (SAD):Bananas can help SAD sufferers because they contain the natural mood enhancer tryptophan. Smoking &Tobacco Use:Bananas can also help
people trying to give up smoking. The B6, B12 they contain, as well as the potassium and magnesium found in them, help the
body recover from the effects of nicotine withdrawal. Stress:Potassium is a vital mineral, which helps normalize the heart beat, sends oxygen
to the brain and regulates your body's water balance. When we are stressed, our metabolic rate rises, thereby reducing our
potassium levels.. These can be re balanced with the help of a high-potassium banana snack. Strokes:According to research
in The New England Journal of Medicine, eating bananas as part of a regular diet can cut the risk of death by strokes by as
much as 40%! Warts:Those keen on natural alternatives swear that if you want to kill off a wart, take a piece of banana skin and place
it on the wart, with the yellow side out. Carefully hold the skin in place with a plaster or surgical tape! So, a banana really is a natural remedy for many ills. When
you compare it to an apple, it has four times the protein, twice the carbohydrate, three times the phosphorus, five times
the vitamin A and iron, and twice the other vitamins and minerals. It is also rich in potassium and is one of the best value
foods around So maybe its time to change that well-known phrase so that we say, 'A banana a day keeps the doctor away!'
PASS IT ON TO YOUR FRIENDS PS:
Bananas must be the reason monkeys are so happy all the time! I will add one here; want a quick shine on our shoes. Take the
INSIDE of the banana skin, and rub directly on the shoe....polish with dry cloth. Amazing fruit!!!
Communication Alert:
Editors Thoughts
The chapter newsletter has been our primary source of communication. It is usually
printed monthly and mailed to all chapter members, and sometimes-extra copies are given to non-members. To publish a newsletter
is labor intensive and very time consuming and we do our best to get one out on time. Unfortunately life has a way of stalling
the process, and for this we are sorry. However, the newsletter is only one form of communication.
The chapter Web Site is the another means of communication. Chapter officers', meeting
minutes, updates, and just about everything in the newsletter is also on the Web Site.You can access the site directly at http://aorn43010.tripod.com/check it out. Peggy Humphreys does an excellent job of keeping the site up to date.
Another thing, Penny has set up a meeting notification via e-mail. Any member
that wants to receive notification please sends her your e-mail address at PoohPenny@aol.com .
With Faxes, phones, "snail mail", person-to-person, our chapter tries to stay in touch
with it’s members. Remember that for communication to work, it has to be two-way. Please feel free to call or e-mail
any officer, talk to the member ambassador at your facility. Send your e-mail address to Penny Joyce and she will add you
to her list. Or call her and give her the fax number at your facility and you
will be added to the fax list. With all this technology we can improve our communication.
Nurses Work To Uncover Cause Of Salmonella Outbreak
Nurses can be described in many ways — as caregivers, healthcare providers, companions, and lifesavers. As
it turns out, nurses also can be good detectives.
The ability to sleuth may not be what first comes to mind when describing
a nurse's job qualifications, but the Salmonella outbreak that has sickened nearly 1,200 people nationwide has showcased this
critical part of public health nurses' jobs.
Unlucky numbers
The outbreak began in April and, as of early
July, had hit 42 states, the District of Columbia, and Canada and was being linked to certain kinds of tomatoes, jalapeńo
peppers, and cilantro. On July 17, tomatoes were cleared as no longer a threat by the U.S. Food and Drug Administration. The
epidemic has raised some disturbing questions about the nation's ability to trace the path of food back through the food chain.
It also has highlighted the vital role of public health nurses, whose quick identification of patterns of illness early on
led to the rapid discovery that seemingly random cases of stomach cramps, diarrhea, and fever were part of a more widespread
problem.
Kimberlae Houk, RN, MSN, a captain with the U.S. Public Health Service and a public health nurse with the
Indian Health Service at Northern Navajo Medical Center in Shiprock, N.M., was in the thick of it at the beginning of the
investigation. The quick response of her team of public health nurses and of her state's epidemiologists in May helped form
the basis of the national investigation that continues today.
Houk started getting phone calls when abnormal laboratory
results began coming in showing multiple cases of Salmonella serotype Saintpaul, one of the more dangerous varieties. "It
was the state epidemiology department that realized they had almost 20 cases in one week, and that was really high," Houk
recalls.
That's when the public health nurses stepped in.
Because the region is extremely rural and some patients
lacked telephones, the New Mexico nurses in some cases visited the homes of those who had become ill, often driving more than
an hour to do so. Because some patients were on the Navajo reservation and some were off the reservation, Indian Health Service
nurses worked closely with their counterparts in the state health department.
The nurses asked those who had become
ill a battery of questions from a 20-page survey known as a "shotgun" questionnaire that explores potential sources of disease,
from animal contact to sources of drinking water to attendance at various locations that could be contaminated. The nurses
went through what each person had eaten during the week before the illness struck to attempt to identify what caused the outbreak,
sometimes trying to jog memories by opening refrigerators or going through pantry shelves, Houk says. The goal was to find
a common element, whether it was a food item or some kind of contact or common location.
"It's like shooting in a barrel
hoping to hit something," Houk says.
But they did hit something.
Hunting down the culprit
Within
their first day of questioning patients, the public health nurses had collected hundreds of pages of data on the initial 20
cases. As it turned out, 84% of those who were sickened had eaten a tomato, Houk says. Milk and potatoes were next at 75%
and 71%, respectively. The nurses went back and asked those who had been ill more questions from a more detailed questionnaire.
Finally, the nurses compared these results with the diets of healthy individuals who lived nearby. The overall results of
the questioning pointed to tomatoes. By then, more people had become ill, and 88% of them had eaten raw tomatoes, while only
64% of the well cases had reported exposure to tomatoes, a significant gap, according to Houk.
Nurses and epidemiologists
around the country have repeated this type of process to try to pinpoint what exactly has been making people sick. In the
months since and in other regions, jalapeńo and serrano peppers, as well as cilantro, have been added to the list of possible
culprits, according to the U.S. Centers for Disease Control and Prevention.
Nurses who have been involved in the initial
detective work say they are proud of their contribution to the investigation. What makes them good at this kind of microbial
sleuthing is their knowledge of disease process and willingness to go beyond the obvious with patients, Houk says.
"I
had one client who told me he didn't eat tomatoes," she says. Someone without a medical background might have left it at that,
but Houk probed further.
"He actually had five tomato exposures," she says. "He had tacos twice and chips and salsa,
but he didn't think of them as tomatoes."
Carri Redden, RN, MSN, BC, COHN, an emergency preparedness nurse epidemiologist
with the New Mexico Department of Health in Roswell, also has been involved in the Salmonella investigation and has a similar
take on nurses' roles. The value they bring, she says, is their pursuit of details through critical thinking skills, information
processing, and communication with patients. "Nursing is not only a science, but an art that lends credibility to many areas
of expertise to help explain the complex nature of human illness and wellness," she says.
John Redd, MD, MPH, FACP,
the chief of the infectious diseases branch of the Indian Health Service's division of epidemiology and disease prevention,
says nurses' skill in getting out into the community and talking to people was essential in helping control the outbreak.
Some of the first cases of illness were among American Indians in rural areas.
"It's a subtle business, and it involves
knocking on the door of someone who doesn't expect you and asking them whether they've had diarrhea," Redd says. "It takes
a lot of people skills and local savvy. Public health nurses were critical to getting that case-control portion done."
In
many outbreak scenarios, public health nurses take on roles normally reserved for physicians, Redd says. For example, with
pertussis, another communicable disease, public health nurses go out and interview patients to see who has been coughing.
If they discover suspected cases, they will often have written permission from physicians to dispense antibiotics on the spot.
They also are educators who explain to people how they can protect themselves from infection and from infecting those around
them.
As the nation's ability to detect and respond to public health emergencies improves, the need for public health
nurses has become even greater, Redd says. Nurses are in a battlefield that is becoming more sophisticated every day.
Beth
Melius, RN, MN, MPH, describes the satisfaction she gets from being a "disease detective," as she refers to her job as manager
of the disease response and control division of the Whatcom County Health Department in Washington. Her group of public health
nurses, for example, was able to make the connections that pegged a local Campylobacter outbreak to unpasteurized milk.
"If
we find out about an infectious disease quick enough, we can prevent it from spreading," she says. "That's why we do what
we do, and that's why we work weekends if we have to."
Nurses are often able to get information from patients that
others might not be able to because patients tend to trust them, says Patricia Frank, RN, MSN, a regional infectious disease
nurse epidemiologist with the state of New Mexico who also worked on the Salmonella outbreak.
"They trust that we're
not going to share information inappropriately and that we're calling for what we say we're calling for," she explains. This
is helpful when a nurse has to call a patient many times, as she had to do in the Salmonella investigation, for follow-up
information. "[Patients] always have to know they're part of the solution," Frank says.
While nurses have been instrumental
in helping fit the pieces of the Salmonella puzzle together, there are limits to their skills, as Frank is willing to admit.
"All
kinds of people now bring me food to look at and tell them if it's safe," she says. "I tell them I really don't know; that's
not what I do."
The next time you see a healthcare worker wearing scrubs in public, think twice. Sure, they look clean and authoritative,
but you might wonder if there's a health risk to wandering around town wearing this supposedly sterile garb. And what about
tools of the trade like stethoscopes, blood pressure cuffs and thermometers that are passed from patient to patient? Can these
pose a health threat to the public as well as patients? Some healthcare professionals think so.
Retired pediatric
heart surgeon Dr. Joseph J. Amato of Rush-Presbyterian-St. Luke's Medical Center often sees healthcare workers wearing their
scrubs in public. "These articles of wear are only to be worn in operating rooms, intensive care areas, nurseries and other
delicate areas of extreme cleanliness," Amato said. "On a daily basis I see healthcare workers out and about at Walgreens
or Costco in the early morning and afternoon hours.
"Hospitals say they have strict rules not to leave the hospital
with scrubs, but that's not true," said Amato, who lives in Streeterville near Northwestern Memorial Hospital. "Nobody enforces
it. I see stethoscopes wrapped around employees' necks getting into their cars. They will be used the next morning." Even
ties, he said, can pose a health risk if they've had contact with a patient during an exam. Amato's concerned not just about
hospital patients but also about the risk of healthcare workers bringing home infections to families.
But Dr. Gary
A. Noskin of Northwestern warns against jumping to conclusions. "If you see people out in public wearing scrubs, they may
or may not even be healthcare workers," said Noskin, associate chief medical officer at the hospital and an infectious disease
expert. Anyone can buy scrubs through a supplier, he said, and healthcare workers may wear scrubs for convenience and not
work in a restricted area. For example, some residents wear scrubs while sleeping during long shifts. "While it is preferable
to put on clean scrubs in the hospital, someone who enters the hospital wearing scrubs from the outside poses no risk to patients
undergoing surgery because the worker must put on a sterile gown over scrubs," said Noskin. "There is no evidence that links
scrub suits with increased risk for patient infection following surgery."
Clothes are never sterile, he said. "The
single most important way to prevent infection is for healthcare workers to wash their hands." Anyone who enters Northwestern's
operating room must wear freshly laundered scrubs from its autovalet, an automated system for dispensing scrubs, Noskin said.
Scrubs must be changed when they become visibly soiled. People who have left the OR and are planning to re- enter must don
a disposable cover-up. Lab coats should be cleaned regularly.
The same is true at the University of Chicago Medical
Center, according to Sylvia Garcia-Houchins, the hospital's director of infection control. Those who work in the OR must wear
hospital-issued, freshly laundered scrubs of a certain color and are not allowed to leave the building wearing that scrub.
Those who work outside the restricted area cannot wear that colored scrub. The hospital now monitors doors and issues "red
tickets" to staff who wear the restricted-area color in from home. Still, Garcia- Houchins sees other healthcare workers wearing
scrubs in public all the time.
Updated Link: AORN asks you to please contact your Legislators & request their support of Nurse
Funding.
Washable Keyboards Aim to Prevent Pathogen Transmission
By Debra Wood, RN, contributor
It is a well-known fact that computer keyboards can harbor pathogens. Recognizing the risk of transmitting bacteria or
viruses with ordinary keyboards, a Florida-based company has developed a dishwasher-safe washable keyboard.
Brad Whitchurch, founder and CEO of Seal Shield, displays one of his washable keyboards.
“A study from the University of Arizona found computer keyboards were among the dirtiest items in an office,”
said Brad Whitchurch, founder and CEO of Seal Shield of Jacksonville, Florida. “One tagline from that study was that
the average keyboard harbors 400 times more bacteria than the average toilet seat.”
In an effort to introduce cleaner keyboards, Whitchurch developed a TrueType keyboard that is fully submersible. The inner
components and switches are sealed, and the screws are made of stainless steel with aluminum stabilizer, so they will not
rust. A later model incorporates an antimicrobial plastic.
Although he has tested the keyboards after placing them in a dishwasher, Whitchurch acknowledges that most of his health
care customers do not run them through a dishwasher. Most facilities clean them with an antimicrobial spray that gets between
the keys and in the crevices to kill bacteria, viruses and fungi.
The keyboards do not crack or cloud with repeated cleaning and function the same as traditional keyboards.
“It gives nurses what they want, a regular keyboard, with no cover,” Whitchurch said. “It protects them
and the patients.”
Another company, Unotron, based in Dallas, Texas, also makes washable corded and wireless keyboards, called SpillSeal.
In a 2005 research study by Direct Laboratories in the United Kingdom for Unotron, scientists contaminated certain keys
with Staphylococcus aureus and then attempted to clean the keyboards. On average, the study found that water alone
was 86 percent effective in eliminating the bacteria. But to eliminate 100 percent of the bacteria required use of a chemical
disinfectant solution. Presept at 1,000 ppm, the recommended level, gave the best results, killing 100 percent of Staphylococcus
aureus on the inoculated keyboards.
The author, Tony Moore, PhD, concluded, “These results suggest that the use and regular disinfection of SpillSeal
keyboards within hospital environments could assist in reducing the spread of MRSA (methicillin resistant Staphylococcus
aureus).”
Whitchurch has no data to confirm that Seal Shield Keyboards decrease the risk of infection; however, a 2005 study conducted
by Northwestern Memorial Hospital in Chicago and presented at the annual meeting of the Society for Healthcare Epidemiology
of America found that vancomycin-resistant Enterococcus faecium (VRE) and methicillin-resistant Staphylococcus aureus
can survive for prolonged periods on computer keyboards and keyboard covers. The study indicated from one to five touches
of the keyboard could transfer the bacteria to the user’s hands. Cleaning with a germacide for 10 minutes could disinfect
the keyboard.
Banner Gateway Medical Center in Gilbert, Arizona, has placed Seal Shield keyboards in all patient rooms. Sharon Panozzo,
RN, MS, an infection control practitioner at Banner Gateway, says data indicating resistant pathogens can live on keyboards
prompted the hospital to buy the washable peripherals.
“We decided, because they are a high-touch surface in the patient rooms, it would be a good idea to make sure they
were easily cleanable,” Panozzo said. “It’s another way to enhance the safety procedures we do for our patients.”
Panozzo reports the washable keyboards are holding up well with daily cleaning by housekeeping, and the patients like them.
The hospital plans to continue using them in patient rooms, because of risk for contamination. However, nurses will continue
working with laptops on wheels, which the nurses clean with disinfectant wipes.
AORN offers a wealth of resources and tools to enhance the professionalism of perioperative nurses, promote standards
of perioperative nursing practice, and advance the cause of patient safety in the perioperative setting.
AORN's Perioperative Standards and Recommended Practices are at the core of these efforts, offering a unified
network of interrelated principles that systematically guide perioperative nursing activity. Access a snapshot of the Recommended Practices or view AORN Position Statements which articulate AORN's official beliefs on various topics, from Pediatric Medication Safety and Environmental Responsibility,
to the Perioperative Advanced Practice Nurse.
Standardize communication and
documentation, or establish benchmarks, with the Perioperative Nursing Data Set (PNDS), developed by AORN to assist perioperative nurses document nursing care while providing a foundation for examining
and evaluating the quality and effectiveness of that care.
Learn about AORN's research and evidence-based initiatives, from recently funded projects to the ongoing effort to support research that results in quality patient care in the perioperative
setting.
AORN offers other useful resources
to AORN members, including:
Tool Kits addressing critical patient safety issues such as surgical fires, correct site surgery, and safe medication administration.
Safety resources including information addressing workplace safety and emergency management.
The AORN Library, offering access to electronic resources, books, journals and audiovisual titles.
AORN strikes deal to offer ANA affiliate memberships
Soon the benefits of AORN membership
will include an affiliate membership to the American Nurses Association (ANA), following an agreement AORN recently struck with ANA to provide every AORN member with affiliate, non-voting-status
membership to ANA, effective July 1, 2008
Tampa
General patient nearly gets wrong procedure
TAMPA - Doctors at Tampa General Hospital had just started a nonsurgical heart procedure last week on a man when they
realized there was a mistake. A cardiac catheter had been inserted into the wrong patient. The patient, who was not harmed
during the diagnostic procedure, was at the hospital for a different treatment, Tampa General Hospital spokesman John Dunn
said today.
Dunn did not elaborate on the actual treatment the male patient was scheduled for because of medical privacy
laws. The names of the patient and the medical staff involved were not released by the hospital. The man was sedated but not
under anesthesia. No incisions were made and no dye was injected, he said. "We are treating this as a serious incident," Dunn
said. "We have found the staff involved failed to follow the proper procedures for patient identification."
The error
was discovered soon after the catheter was inserted into the patient's groin, Dunn said. He did not say how doctors realized
the mistake, but said "the staff spoke to the patient to verify his identification rather than reading his wristband I.D."
The physician explained to the patient what happened and apologized. The man was then discharged. He is still receiving his
regular treatments from his doctors at the hospital.
Dunn said he is not aware of any medical malpractice suit being
filed. An internal review is being completed and the hospital will file a report with state and local agencies, he said. The
staff involved in the mistake "will be subject to the appropriate disciplinary action" after the internal review is completed
and the report is filed, he said. (Tampa Tribune) TBO.COM
"Be kinder than necessary because everyone
you meet is fighting some kind of battle".
AORN
electronic Standardized Perioperative Record initiative announced
During the Association of periOperative Registered Nurse's (AORN) 55th Annual Congress held in Anaheim, CA, the association's
board of directors approved the development of an electronic Standardized Perioperative Record (SPR). This development initiative
will result in the creation of a standardized record that will be integrated into perioperative information systems. The SPR
will incorporate AORN's standardized nursing vocabulary, the Perioperative Nursing Data Set (PNDS), and align with clinical
standards, accreditation specifications, and regulatory requirements to promote ongoing compliance and consistent patient
care.
Standardized, evidence-based data derived from SPR documentation will be gathered into a secure national data
repository. This data repository will support benchmarking activities across settings and institutions and will enable OR
health care professionals to measure outcomes and evaluate the quality and effectiveness of care.
"As the recognized
authority for safe operating room practices and the definitive source of perioperative guiding principles, AORN is uniquely
positioned to lead the creation of a truly comprehensive standardized patient record. The SPR will provide reliable data that
can be used for many operational and clinical evaluations such as identifying the effectiveness of care, utilization of resources,
and evaluating costs in relation to desired outcomes," explained Carol Petersen, RN, BSN, MAOM, CNOR, Manager Perioperative
Informatics in AORN's Center for Nursing Practice.
"With the advent of federal requirements for all patients to have
an electronic health record by 2014, AORN is leading perioperative professionals into the future of healthcare. The approval
of this initiative by our board of directors clearly demonstrates AORN's continued support and commitment to perioperative
professionals" said AORN Executive Director Linda Groah, RN, MSN, CNOR, FAAN. "This innovative initiative to create an electronic
standardized, evidence- based data collection system will, ultimately, improve the quality of patient care during the surgical
experience."
AORN has engaged Computer Sciences Corporation (CSC) to create the SPR and the data repository. "CSC
enhances the quality of care delivery and clinical outcomes by providing improved performance through interoperable, standards-based
information systems and optimized management processes," said Deward Watts, Vice President and Managing Partner, CSC's Health
Services Sector. "We've established a worldwide track record of success in helping our clients achieve superior results through
innovative solutions and thought leadership, such as this initiative with AORN." AORN and CSC are now beginning the development
of SPR and AORN will share further details of this important initiative as they are available.
Fanning the flames of surgical fire prevention
by Susan Cantrell, ELS
S
hout "Fire!" and it’s sure to grab the attention of everyone in hearing distance.
Maybe the last place you’d want to hear that is as you’re sailing into LaLa Land while a surgeon
hovers over you wielding an electrosurgical tool close to your tender parts. It’s a scary—make
that terrifying—thought, but unfortunately it does happen.
Possible but not probable
Mark Bruley, vice president, accident and forensic investigation, ECRI Institute, Plymouth Meeting, PA, told Healthcare Purchasing News that fire in the operating room (OR) is one of three "never"
events, the other two being wrong-site surgery and leaving an instrument in the patient. Obviously these are things that can
be prevented and so should n-e-v-e-r happen to a patient. These are the sorts of incidents for which Medicare will
soon discontinue reimbursing.
Fortunately, surgical fires don’t happen as often as you might think. Bruley noted that figures published
in September 2007 by the Pennsylvania Patient Safety Reporting System cite the chance of a surgical fire in Pennsylvania as
being 1 in 87,646 operations, with an average of 28 per year. Extrapolating those numbers to the entire United States, the
number of fires occurring nationally ranges from 550 to 650. That’s not good, but it’s not much
when balanced against the 50 million inpatient and outpatient surgeries performed each year nationally. Even better news is
that 80% to 90% of the fires are minor, resulting in no injury. In only 10 to 20 cases per year are victims of surgical fires
seriously burned or disfigured. That’s seldom enough to deem surgical fires as being rare, claimed Bruley.
Are surgical fires on the rise, or are we just hearing about them more? Roger Odell, co-founder, chairman, and director
of Encision Inc, Boulder, CO, believes there really is no way to know the answer. "Only 1% to 2% of complications, including death, are reported
to the FDA. The data base is flawed." Melissa K. Fischer, RN, BSN, CNOR, clinical specialist, Megadyne Medical Products, Draper, UT, added: "Statistics do not demonstrate that OR fires are on the rise, but there is more awareness of the problem
and better reporting of smaller incidents."
On the rise or not, fire in the OR is definitely getting more attention, according to Bruley. "Increased attention to surgical
fires started in 1999 with the release of the Institute of Medicine study on medical errors, ‘To Err Is Human:
Building a Safer Health System.’ I think fewer fires are happening now, but they’re getting more
attention because it’s more culturally acceptable to talk about medical error now."
Where to turn for help
Encision Inc.’s Active Electrode Monitoring
It seems reasonable to assume that staff are surgical-fire savvy, but often that’s not the case. Bruley pointed
out that educating clinical staff on the risk of surgical fire is critical, because it’s not something that’s
usually addressed in most surgery or anesthesia residency programs. O’Dell added: "Education amongst all disciplines—anesthesia
personnel, perioperative nurses, and surgeons—is needed. Policies, protocols, and procedures must be in place
for preventing surgical burns. Energy sources are not the root cause. Oxygen-enriched atmosphere or flammable liquids that
are not allowed to dry are two of the most common causes of OR fires."
Fortunately, there are some excellent resources for which to turn for help. The bank of literature on surgical fires is
growing, in large part due to ECRI Institute’s efforts. ECRI alone has published over 50 articles on the subject,
both in their own monthly journal, Health Devices, and elsewhere. ECRI’s clinical web site, Medical Device
Safety Reports (MDSR), is chock full of information on surgical fires. Go to http://www.mdsr.ecri.org, and search for "fire" to investigate articles on various aspects of surgical fires. Bruley also recommends making use of
educational aids, such as ECRI’s poster that summarizes how to prevent surgical fires, posting them in places
where staff can’t miss seeing them, such as the back door of toilet stalls (but not posting them where the patients
can see, because it could cause them undue stress). The poster on preventing surgical fires is available at http://www.mdsr.ecri.org/static/surgical_fire_poster.pdf. While you’re on the MDSR web site, check out ECRI’s Electrosurgical Checklist at http://www.mdsr.ecri.org/summary/detail.aspx?doc_id=8271&q=fire.
Bruley also noted that, "Over the past 2 years, several professional societies, such as the American Society of Anesthesiologists
(ASA) and AORN have developed recommendations for preventing surgical fires. ASA’s recently approved "Practice
Advisory for the Prevention and Management of Operating Room Fires" is slated for publication within a couple of months in
their journal, Anesthesiology.
"AORN has published recommended practices regarding fire prevention, which are very well done, as well as recommended practices
for minimally invasive surgery and prevention of laparoscopic burns," said Odell. AORN also offers a Fire Safety Tool Kit,
which members can download and earn 4.0 contact hours. Member price is $20.95; nonmember price is $131.95. (Note: Standard
and Associate memberships to AORN are $100; so, nonmembers could join AORN, buy the kit at member price, and save $11.00.)
The Fire Triad
The fire triangle relates surgical team members to components of surgical fires
The operating room (OR) is essentially a formula for fire. The components necessary for creating fire are present in abundance.
Fischer believes that "training and awareness of the Fire Triad" can minimize risk. "The three sides of the Triad represent
the following: fuel source, heat or ignition source, and oxidizer or oxygen source. These three areas, when brought together,
place the patient and room staff at a very high risk for a fire. Each area of the triangle belongs to a specific role in the
OR. The fuel source is typically the nurse’s role, as drapes, preps, and dressings are provided to the field
by the nurses. The ignition source is frequently the role of the surgeon, who is applying the electrosurgical pencil or laser.
The oxidizer, or oxygen source, belongs to the anesthesia provider. By providing training focused toward all members of the
surgical team, risk for surgical fires can be greatly reduced if not prevented."
Communication key to prevention
Communication between the players is the key to balancing these components to prevent tragedy. Bruley noted: "Preventive
measures almost solely rely on good communication in the OR. Surgeons and anesthesiologists need to understand what the other
is doing. The surgeon needs to know how much oxygen the anesthesiologist is delivering to the patient; the anesthesiologist
needs to know which instruments are being used that have the potential for fire. Most fires (75%) are caused by oxygen that
has built up under the drapes during surgery under local anesthesia," explained Bruley. "This happens because the surgical
team has not communicated well."
Bruley suggests following the lead of Christiana Care Health system in Delaware. This facility developed a "time out" for
surgical fire, similar to a time out for identifying the patient or counting sponges after surgery. About 20 seconds prior
to each surgery is reserved for communication between the surgical team. It’s a time when participants can ask
each other about the risks for surgical fire unique to the case coming up.
In case of fire
Breakdown of locations of surgical fires occurring in and around patients
Fire in the operating room presents dangers specific and unique to the circumstances. The response that’s
best in so-called average circumstances may not be the best choice in the event of surgical fire, but one thing is for sure:
response had better be quick. Fischer explained the most important thing to know in responding to a surgical fire: "The most
important thing is how to respond quickly to a situation. If a flame is not brought under control, the high oxygen content,
with the many fuel sources in the OR, will result in an out-of-control situation."
If you have a surgical fire, Bruley believes instinctive reaction by the surgical team is the best response: the anesthesia
provider should stop the flow of gas; the surgeon should remove the burning material; and the nurses should extinguish the
burning material. Once the fire has been extinguished, attention must be turned to the patient, resuming ventilation but using
only air until it’s certain the fire is totally out, then resuming use of oxygen appropriate to the patient’s
needs; controlling bleeding; evacuating the patient if in danger from smoke or fire; and examining the patient for injuries.
If the fire cannot be controlled quickly, the OR staff and the fire department must be notified. The room should be isolated
to contain smoke and fire.
Fortunately, many small surgical fires can be resolved simply by patting them out with a gloved hand or a towel, but it’s
important to be prepared for the worst. "Fire drills can help to maintain awareness," advised Bruley. Fire drills require
advance planning and should be practiced to determine their effectiveness. Plans should be developed for the different kinds
of fires that can occur in an OR and should clearly outline how each staff member should respond; what, when, and how to communicate
within the OR, within the OR suite, with the remainder of the facility, and with local authorities; where and how to remove
the patient safely; how to prevent spread of smoke; location and operation of fire extinguishers, fire-alarm pull stations,
and exits; location, operation, and coverage area of electrical-supply panels; location, operation, and coverage of medical-gas
shutoff valves; and what to expect from the local fire fighters.
Additionally, ECRI recommends that carbon dioxide extinguishers—not water-based or dry-powder extinguishers—be
mounted just inside the entrance of each OR in the hospital. ECRI discourages use of fire blankets in the OR because they
can worsen fire due to oxygen buildup under drapes, causing further injury to the patient, and because the blanket can displace
instruments, also causing injury.
Stifling Murphy’s Law
"Risk management’s new buzz words are ‘loss prevention’," noted Odell. Addressing
loss prevention, things that can go wrong, can help to thwart Murphy’s Law in the OR. "If less harm is done,
you have fewer lawsuits and lower insurance premiums. Industry can help by optimizing instruments through engineering designs
that mitigate or eliminate stray energy burns."
An electrosurgical pencil tip modified incorrectly with a red catheter can cause fire and patient injuries
because it is petroleum-based.
Encision designed and sells an instrument that automatically shuts off when it detects stray energy due to insulation failure
or capacitive coupling. The technology is known as active electrode monitoring. "AORN has recommended use of active electrode
monitoring as best practice since 1999," said Odell. "Encision’s ACTIVE ELECTRODE MONITORING system is registered
by the FDA to protect patients from unseen stray energy burns during laparoscopic procedures. Intraabdominal burns can result
in peritonitis, which carries a death rate of 20%. We have had not even one substantiated report of a burn while our instrument
was in use. Our product is warranted to be fail-safe. Non-shielded, non-monitored laparoscopic instruments have an inherent
design defect. They’re not fail-safe, and they can kill somebody brand new out of the box."
Recommending use of disposable active cords, Odell noted that insulation failure can be caused when cords that deliver
energy are placed in an autoclave several times a day at 270oF. He also noted that, when not in use, active electrodes should
be placed in a sterile, insulated holster. Most importantly, said Odell, "Always use recommended electrosurgical practices.
ECRI and AORN have covered the entire waterfront."
Fischer explained how Megadyne’s products are designed to reduce risk of surgical fire. "Electrosurgical
generators and accessories are the number one heat source for OR fires; so, Megadyne takes product safety and education seriously.
Our generator has a clear tone alerting staff members when the pencil has been activated. Some fires have occurred when the
pencil was activated without staff awareness. Megadyne provides a safety holster for our pencils for storage of the active
electrode when not in use. Megadyne provides a full line of modified insulated tips for use in narrowed cavities. Prior to
this type of product, physicians often modified their own tips using a red rubber catheter. This modification actually
led to OR fires and patient injuries due to the product being petroleum-based and not made for this function."
Odell observed that, in today’s medical environment, a hospital could be called on the carpet for failing
to use safety equipment to protect patients and staff. He also noted that at least one insurance company, State Volunteer
Mutual Insurance Company (SVMIC), Brentwood, TN, strongly encourages their physician policyholders to use active electrode
monitoring systems for patient safety. SVMIC offers an online, interactive, self-study program entitled "Avoidance and Management
of Complications in Laparoscopic Surgery." O’Dell, who serves on the faculty, explained that physicians get
a 10% discount off their annual premium for participating in the self-study program.
Megadyne offers a CEU presentation on preventing surgical fires, available at no charge for their customers. It can be
scheduled as part of a monthly inservice or other staff meeting. "The objectives of this program," explained Fischer, "are
to help raise awareness of the risks of surgical fires by identifying the sides of the Fire Triad and how those items may
interact to cause surgical fires. The program also outlines key factors that may contribute to an OR fire and interventions
that nurses and other staff members can take to mitigate the risks." To schedule a program, call 1-800-747-6110.
Suggested Reading
1. ECRI Institute. Surgical fire safety. Health Devices 2006;35:45-66.
2. ECRI Institute. A clinician’s guide to surgical fires: how they occur, how to prevent them, how to put
them out. Health Devices 2003;32:5-24.
3. Bruley ME. Surgical fires: perioperative communication is essential to prevent this rare but devastating complication.
Qual Saf Health Care 2004;13:467-471.
During this election year, we are hearing both Hillary and Obama talking about a "single
payer" medical system. That sounds like an innocent enough term, but we need to understand what that means. PLEASE
take five minutes to watch this video and understand what they are talking about when they say we should go to a "single payer"
system.
But it's FREE!!!!!!
Universal
Health Care
A short
but poignant independent film on government sponsored healthcare systems. Everyone who plans to vote for our new President
in 2008 NEEDS to see this.
Regardless
of the person for whom they would vote. Please forward this to everyone you can think of as soon as you can.
During WWII, there was an advisor to Churchill who organized a group of people who dropped what they
were doing every night at a prescribed hour for one minute to collectively pray for the
safety of England, its people and peace. This had an amazing effect as bombing stopped.
There
is now a group of people organizing the same thing here in America .
If
you would like to participate: each evening at 9:00 PM Eastern Tim e (8:00 PM Central, 7:00 PM Mountain, 6:00 PM Pacific),
stop whatever you are doing and spend one minute praying for the up-coming election, and for the revival of Christianity
in this great country.
Someone
said if people really understood the full extent of the power we have available through prayer, we might be speechless.
Our prayers are the most powerful asset we have.
A review of measures taken to address a 2004 outbreak of the highly infectious Norwalk virus at The Johns Hopkins Hospital
has provided the first solid documentation of expenses and efforts in the United States to stop the infection from spreading
among patients, staff and visitors.
Total hospital costs for the three-month outbreak — including extra cleaning supplies, staff sick leave,
diagnostic tests, replacement staff, and salaries and lost revenue from closed beds — were estimated at more
than $650,000.
The outbreak at Johns Hopkins Hospital (JHH) was one of at least 24 at Maryland hospitals during the first half of 2004.
Norwalk virus is highly contagious because even small amounts, as few as 10 to 100 viral particles, can lead to infection.
It is spread or passed from person to person through fecal matter when people fail to wash their hands properly after using
the bathroom and when people touch or share handling of the same objects, such as doorknobs.
“We hope our approach will help other hospitals prepare for or manage an outbreak,” says Cecilia Johnston,
MD, an instructor at Hopkins in infectious diseases who led the investigation. “Outbreaks need to be identified
quickly and dealt with immediately, and relying on standard infection control procedures is not adequate,” she adds.
“It may be necessary to close the infected units, isolate the infection source, get strict on hand hygiene, conduct
a thorough washing down of units, and keep repeating these steps until the outbreak is stopped. Healthcare workers especially
need to be vigilant about these steps because they are the group primarily affected by outbreaks.”
Reporting in the Sept. 1 edition of the journal Clinical Infectious Diseases, Johnston and her team of Hopkins patient-safety
experts describe how an outbreak spread among 265 healthcare workers and 90 patients between February and May 2004.
No one at Hopkins died from their infection, but 13 afflicted hospital staff either visited the emergency room for treatment
or required hospitalization after becoming severely dehydrated.
Norwalk-like viruses, formally known as noroviruses, cause serious gastrointestinal illness for which no treatment currently
exists except for keeping the patient well hydrated. Symptoms include nausea, vomiting, diarrhea and severe stomach cramps.
Those infected generally recover on their own within two to three days after symptoms appear.
“Healthcare workers really do need to be on the lookout for norovirus infections, and if there is an outbreak,
hospitals need to address it very aggressively,” says senior hospital epidemiologist Trish Perl, MD, a professor of
medicine and pathology at The Johns Hopkins University School of Medicine. “Our experience shows that people
can get very sick and that it costs a lot to fix the problem and address disruptions to staffing.”
First reported in the hospital’s coronary care unit, or CCU, the JHH outbreak quickly spread over a two-week
period but remained clustered in the CCU, a nearby echocardiography laboratory and a floor housing psychiatric services where
patients and staff frequently interact, especially during group therapy sessions.
The outbreak was detected soon after it began when two staff members who worked closely together became ill with diarrhea.
Their illnesses were immediately reported to Hopkins’ infection control team, which monitors hospital operations
daily for potential hazards to patient safety.
A norovirus outbreak was immediately suspected because there had been numerous reports of illness throughout the Baltimore
region.
As part of their investigation, nurse managers began screening all staff and patients for any signs of gastrointestinal
illness. Patient stool samples confirmed that the culprit was a norovirus, and genetic testing later verified that it was
the same viral strain, genogroup II.4, that caused a series of widely publicized outbreaks in nursing homes and on cruise
ships traveling from Europe and the United States in 2002.
As the investigation proceeded, staff implemented strict precautions to control the outbreak and prevent it from spreading.
Patients with symptoms were placed in isolation, by being moved to either private rooms or into the same room with other sick
patients. Group therapy sessions in psychiatry were temporarily halted, and no new patients were admitted to the units primarily
affected. Sick staff were sent home for as long as they had symptoms plus an additional 72 hours, sufficient time
for the illness to pass and no longer be contagious.
The investigation showed that many of the initial healthcare workers in the CCU who became ill had attended a social event
outside of the hospital, where one of the non-staff guests was already experiencing symptoms. Others likely became
ill after touching a patient chart that had been handled by another ill colleague.
Standard precautions to guard against infection were also followed, including a mandatory, hospital-wide staff review of
basic infection control procedures with an emphasis on more frequent hand washing, accompanied by a thorough washing down
of all affected hospital facilities. Even the CCU was closed for 24 hours to allow for a thorough cleaning, with all exposed
surfaces getting washed down with bleach solution.
The easiest known way to kill noroviruses is through repeat washing of surfaces using bleach solutions containing at least
10 percent sodium hypochlorite. However, researchers say that even after intense cleaning efforts, norovirus particles have
been found to cling to carpet surfaces, elevator buttons, bed rails and dining room tabletops.To address any virus remaining,
all disposable supplies in infected areas were thrown out and replaced with fresh ones, an effort that cost more than $53,000.
Because the norovirus outbreak was citywide, staff from outside of JHH were not allowed to work on site, while Hopkins
staff, in turn, were banned from working at other facilities. Even visitors to the hospital were asked screening questions
to identify stomach problems and, if present, were told not to see patients for 72 hours. Staff working on units hit by the
outbreak wore gowns and gloves to guard against unwittingly picking up or spreading the disease. All group meals or shared-food
events were banned inside the hospital.
After three months of intense efforts to prevent the spread of infection, new infections stopped by early May 2004. The
outbreak was deemed to be over, and affected units returned to normal activity.
The researchers’ review showed that the number of patients infected, or so-called attack rate of the virus,
in the CCU was low, at 5 percent (seven patients out of 133), but was notably higher for healthcare workers, at 30
percent (29 out of 97). The attack rate numbers were higher for psychiatry services, at 17 percent for patients (39
out of 233) and 38 percent for staff (76 out of 200).
Everyone infected experienced diarrhea or vomiting, while some others experienced such symptoms as chills and muscle aches.
Calculations of costs associated with the cleanup included expenses for cleaning supplies ($96,000), staff sick leave and
overtime ($89,000), plus lost revenue from closing the units and echocardiogram laboratory to new patients ($418,000). Indeed,
nearly 460 hours of sick leave were used by staff on the CCU, 138 hours in the echocardiogram lab, and more than 2,000 hours
in psychiatry services.
Expenses not taken into account were those associated with other areas of the hospital where few cases were reported and
no restrictions were placed on the unit. Costs incurred outside of main units were not included in this estimate because researchers
were not certain that the infection had indeed resulted from contact within the hospital and not from exposure in the community.
In addition, costs associated with lengthier stays in the hospital and more intensive patient care were also not factored
into the estimates because researchers would have had to guess at what the patients’ length of stay would have
been in the absence of a norovirus outbreak.
Researchers say their next step is to evaluate which specific infection control strategies and procedures are most effective
at preventing noroviruses from spreading.The Centers for Disease Control and Prevention (CDC) estimates that each year more
than 23 million people become infected with Norwalk or Norwalk-like viruses, and the disease is considered a leading cause
of foodborne illness, after people have contaminated food with dirty hands.
Funding for the study was provided by Johns Hopkins Hospital. Testing services were provided by the state of Maryland’s
Department of Health and Mental Hygiene, with additional confirmations provided by the National Institutes of Health.
Besides Perl and Johnston, other members of the Hopkins team involved in this investigation and study were Haoming Qiu;
John Ticehurst, MD; Conan Dickson, PhD; Patricia Rosenbaum; Patricia Lawson; Amy Stokes; Charles Lowenstein, MD; Michael Kaminsky,
MD; Sara Cosgrove, MD, MS; and Kim Green, PhD.
Surgical errors
rare but serious in ophthalmic procedures
Surgical confusions, for instance, operations involving the wrong site, the wrong patient or the wrong procedure, occur
infrequently in eye surgery procedures, according to a report in the November issue of Archives of Ophthalmology, one
of the JAMA/Archives journals. Although most surgical confusions cause little or no permanent injury, they may involve serious
consequences for the patient, physician and profession, yet could often be prevented. "Surgical confusions (i.e., wrong patient,
wrong site, wrong procedure) are an increasingly recognized cause of morbidity, recently representing the most common category
of reportable medical error," the authors write as background information in the article. "In July 2004, the Joint Commission
on Accreditation of Healthcare Organizations, in concert with many professional organizations, including the American Academy
of Ophthalmology, promulgated the Universal Protocol in an effort to prevent such confusions in all surgical procedures. This
protocol includes consistent preoperative verification, site marking and a time-out immediately before incision."
John
W. Simon, M.D., of the Lions Eye Institute, Albany Medical College, NY, and colleagues retrospectively analyzed 106 cases
of surgical confusions involving eye operations that occurred between 1982 and 2005. This included 42 cases from the Ophthalmic
Mutual Insurance Company and 64 from the New York State Health Department. Their analysis found that: The most common confusion
was wrong lens implants, which occurred in 67 of 106 cases (63 percent) and most often happened because lens specifications
were not checked properly before implantation. The wrong eye was injected with anesthesia in 14 cases (13 percent) and operated
on in 15 cases (14 percent). In eight cases, confusions involved the wrong patient or the wrong procedure. The wrong tissue
was transplanted in two cases.
Confusions involving the wrong implant or transplant more often caused severe injuries
than those involving the wrong eye, patient or procedure. The Universal Protocol, if implemented, would have prevented 85
percent of the confusions. The authors estimate that these data suggest a rate of 69 surgical confusions for every 1 million
eye operations. "The causes of these confusions were faulty systems, processes and conditions that led people to make mistakes,
more often than an individual's recklessness," the authors write. "The traditional response to medical error, 'blame, shame
and train,' therefore misses the point. Humiliating or otherwise disciplining caregivers tends to perpetuate a culture of
secrecy that impedes effective root-cause analysis and future improvement. A more enlightened approach is entirely non-punitive,
drawing on methods of crew resource management adapted from the airlines and the defense department."
Registered nurses have lower overall mortality risk
Fri Jan 4, 2008 2:36pm EST
NEW YORK (Reuters Health) - Nurses have a lower risk of dying from several different conditions compared with individuals
in the general population, according to the findings of a large Canadian study of registered nurses (RNs).
However, the researchers also found that the risk of melanoma, the most deadly type of skin cancer, climbed with the number
of years a nurse spent in her profession.
A subgroup of nurses who worked in hospitals or medical-surgical specialties had an increased risk of lung cancer.
The increased risk with longer-term work could be related to occupational exposures to carcinogens, such as radiation and
certain drugs, while disruption of circadian rhythms due to shift work could also be a factor, Dr. Helen Dimich-Ward of the
University of British Columbia in Vancouver and her colleagues suggest.
The researchers reviewed mortality data for the 58,125 RNs working in British Columbia from 1974 to 2000, most of whom
were women. Because the number of male RNs was too small to produce statistically valuable data, the researchers didn't include
them in their analysis.
Overall, the researchers found that the RNs were 39 percent less likely to die during the course of the study than individuals
in the general population. They also had a lower risk of death from a number of specific causes, including heart disease,
stroke and cancer in general.
The subgroup of nurses who had been on the job for at least 15 years had a significantly increased risk of malignant melanoma
and rectal cancer. Those who had been in the profession for 25 years or longer had an increased risk of breast and lung cancer
compared with those who had been working in nursing for less than 5 years.
"Further investigations are needed to determine whether increased cancer risk among female RNs can be attributed to occupational
exposures," the researchers conclude.
SOURCE: American Journal of Industrial Medicine, December 2007.
Time to Order Your 2008 Edition of the Perioperative Standards and Recommended Practices! The 2008 Edition of the Perioperative Standards and Recommended Practices is now available! Plan now to put the new book and
CD-ROM on your reference shelf and incorporate numerous additions and changes into your perioperative practice.
This year, you'll notice a whole new look – and title! Previously titled the Standards, Recommended Practices,
& Guidelines, the new Perioperative Standards and Recommended Practices features eight new or updated recommended
practices on areas such as moderate sedation, patient positioning, sterilization, skin prep, environmental cleaning, and much
more.
Get your copy of the book and CD-ROM at aornbookstore.org or at the 2008 Congress bookstore in Anaheim!
The anesthetized patient on the operating table is immobilized to prevent movement during surgery, but nobody on the
medical team knows that behind those eyes taped shut is a mind that is still awake. Every word is heard, every cut is felt.
The scenario is horrifying fiction. Hayden Christensen portrays the patient in the movie Awake, which opened nationwide last
Friday. But scarier still is the fact that about 30,000 people a year experience their own real-life versions of the operating
room nightmare.
Thousands of doctors have adopted a safety technology: a monitor that watches brain activity during
surgery and reduces by 80% the chances the patient will wake up. Patients who have awakened during surgery hope the movie
and the increased public awareness of the problem will lead to a change of heart among doctors who have been reluctant to
use the technology. The monitor was used in about 700 hospitals in 2000 and now is used in nearly 3,000 hospitals and 400
surgical centers, according to the manufacturer, Aspect Medical Systems. That's about 60% of all U.S. operating rooms. Tom
McKibban, former president of the American Association of Nurse Anesthetists, says some hospitals balk at the cost of the
monitor - $5,000 to $9,000, depending on how many are purchased. Some doctors still object because the monitor is imperfect.
"The device doesn't tell you if the patient is going to move," says Marc Bloom, an anesthesiologist at New York University
Medical Center. But he likes it because he "can use significantly less drug" to keep patients asleep by watching their brain
activity.
Doctors say it is extremely rare for a patient to wake up on the operating table. It happens in 0.1% to
0.2% of surgeries, according to studies. The vast majority of the 21 million people who are put to sleep in an operating room
each year wake up after their procedures with no memory of the surgery. And most people who do awaken hear voices and feel
pressure but not pain. An increasing number of anesthesiologists are taking a "one is too many" stance.
The drug dosages
are based on averages, but people respond differently to the medications. The question, Bloom says, is "Are you average?"
What complicates matters is that no two operations are exactly alike. Different medical conditions and medications can affect
anesthesia. Some patients are intentionally given less of the drugs. Women having emergency cesarean surgery, for instance,
get less medication because doctors don't want to overdose the baby. Trauma victims and others with low blood pressure get
less because the medications could put them into shock. Those patients are among a subset who are 10 times more likely to
experience "intraoperative awareness."
Too much anesthesia can lead to something as harmless as nausea after surgery,
but doctors also are learning more about the long-term risks of giving too much medication, known as "running too deep." A
recent study showed patients who died within a year of surgery were more likely to have had higher doses of anesthesia. "There
seems to be an association of running too deep and mortality," Bloom says. The link does not mean the anesthesia caused the
deaths, and more research is needed, he says, but the message appears to be: Less is better.
Sometimes, a patient
wakes up because of something as simple, and preventable, as an intravenous line getting crimped, a vaporizing machine running
dry of a drug or the wrong medication being used because two labels are similar. Whatever the cause, the stories are haunting.
The bottom line, McKibban says, is "a vigilant anesthesia professional" can prevent such traumas. Awake grew out of
writer and director Joby Harold's own struggle in a hospital. He was suffering the intense pain of a kidney stone, and he
tried to distract himself by thinking of other things, which Christensen's character does in the movie. Harold calls it "a
primal fear, the act of having your body penetrated, and you can't protect yourself." Some anesthesiologists hope people who
come forward after seeing the movie to tell of their experiences might drive more research. A registry sponsored by the American
Society of Anesthesiologists (href="http://rs6.net/tn.jsp?e=001YCjfs_vkEy08kdAwwZA7bNi7gFWZgBHhEGFweyByzB3ihClMBe_F6-V2pbjur6guy2YRFIJ1xFDE4t02MWVcZMZqTJaiPyFJfwdUnk7pwN0="
target=_blank>www.awaredb.org) captures stories and key details. (USA TODAY) CLICK HERE
If you
don't want to fall ill this Christmas, then share a festive kiss but don't shake hands
We've all heard people say 'I won't kiss you, I've got a cold'. But a report just published warns that we may be far
more at risk of passing on an infection by shaking someone's hand than in sharing a kiss. A group of hygiene experts from
the United States and the UK have published the first detailed report on hand hygiene in the home and community, rather than
in hospital and healthcare settings. Their findings are published in the American Journal of Infection Control. They
say that, if we want to avoid catching flu or tummy bugs, or protect ourselves and others from organisms such as MRSA, salmonella
or C. difficile, then we have to start in our own homes, by paying greater attention to good hand hygiene. They also warn
that, in the event of a flu pandemic, good hand hygiene will be the first line of defense during the early critical period
before mass vaccination becomes available.
This new report follows a study published last month in the British
Medical Journal which indicated that physical barriers, such as regular handwashing and wearing masks, gloves and gowns
may be more effective than drugs in preventing the spread of respiratory viruses such as influenza and SARS. Good hygiene
at home prevents organisms spreading from one family member to another. By reducing the number of carriers in the community,
the likelihood of infections being carried into health care facilities by new patients and visitors is reduced. Cold and flu
viruses can be spread via the hands so that family members become infected when they rub their nose or eyes.
The report
details how germs that cause stomach infections such as salmonella, campylobacter and norovirus can also circulate directly
from person to person via our hands. If we put our fingers in our mouths, which we do quite frequently without being aware
of it, or forget to wash our hands before preparing food, then stomach germs can also be passed on via this route. Some of
us also carry MRSA or C.difficile without even knowing, which can be passed around via hand and other surfaces to family members
or, if they are vulnerable to infection, go on to become ill.
The authors say that breaking the chain of infection
from one person to another all depends on how well we wash our hands. If we don't do it properly, washing with soap and rinsing
under running water, then we might as well not do it at all. They recommend also using an alcohol handrub in situations where
there is high risk, such as after handling raw meat or poultry, or when there is an outbreak of colds or stomach bugs in the
family home or workplace, or if someone in the family is more vulnerable to infection. They suggest carrying an alcohol rub
or sanitizer at all times so that good hand hygiene can still be observed away from home in situations where there is no soap
and water available.
Although the hands are the main superhighway for the spread of germs - because they are the 'last
line of defense', surfaces from which the hands become contaminated, such as food contact surfaces, door handles, tap handles,
toilet seats and cleaning cloths also need regular hygienic cleaning. Clothing and linens, baths, basin and toilet surfaces
can also play a part in spreading germs between family members in the home.
Dr. Val Curtis, Head of the London School
of Hygiene & Tropical Medicine's Hygiene Centre concludes: 'Handwashing with soap is probably the single most important
thing you can do to protect yourselves and your loved ones from infection this Christmas'.
If there is righteousness in the heart, there will be beauty in the character. If there is beauty in the character,
there will be harmony in the home. If there is harmony in the home, there will be order in the nation. If
there isorder in the nation, there will be peace in the world. So let it be.
-Scottish Blessing
Get healthy—practice wellness in the workplace
By Elizabeth Lones Associate Editor, AORN Journal
Nancy Stanley, AORN Senior Exhibit Sales Executive helps unpack the new Sterile Processing Department at
The Children's Hospital in Denver, Colo.
Team AORN. AORN staff who participated in the Susan G. Komen Race for the Cure, Oct. 7 in Denver.
Rose Seavey and members of her staff in the Sterile Processing Department at The Children's Hospital in Denver
take time to stretch everyday.
Members of AORN's Wellness and Retention Committee
Katie
Cooke Patti Hamilton Kelley Kadlecek Janet Knox Audrey Lang Debbie Robichaud Stephen Cathy Sparkman Marisa
Tapia Stacy Thivener
Do you take time to practice wellness and good health in your workplace? AORN wants to hear about it. As part of an
effort to make employee wellness a priority, AORN Connections wants to feature members who are instituting wellness initiatives
in the workplace. To share your story, send an email toAORNnews@aorn.org.
Employers increasingly are promoting health and wellness of their employees as a key
driver of positive workplaces, and AORN is no exception. Earlier this year, AORN established a Wellness and Retention Committee
responsible for promoting health, wellness outreach and satisfaction among its Denver headquarters staff. The committee's
charge included finding creative ways for AORN employees to care for others, as well as for themselves.
"It is challenging for all of us to find the time to take care of ourselves on a daily basis, and make good behavior a
habit when the majority of our time is spent at work," acknowledged Debbie Stephen, AORN governance coordinator and chair
of the new Wellness and Retention Committee. "However, we are encouraging health and wellness for AORN staff because we need
to take time to care for ourselves, whether we are eating healthy, exercising, or reaching out to our community."
Value
of helping others With encouragement from Executive Director Linda Groah, RN, MSN, CNOR, CNAA, FAAN, and other
members of AORN's executive staff, the employee wellness committee has made community outreach a priority. For example, last
month, a team of AORN staff members volunteered to help out as The Children's Hospital of Denver moved from its downtown location
to a new suburban campus in Aurora, Colo.
"Helping set-up the new Children's Hospital gave us an entirely new perspective;
it helped us to see all that goes into making a hospital work and how our members are so integral in that process," said AORN
staff member Nancy Stanley, AORN Senior Exhibit Sales Executive.
Another recent outreach opportunity for AORN
employees involved raising funds for breast cancer research. AORN's Facility Relations Manager Patti Hamilton organized Team
AORN, 12 AORN staff members who participated in the 2007 Race for the Cure.
"I have walked in the Race for the last
four years and wanted to do more," said Hamilton, a two-time survivor of breast cancer who knows first-hand what a worthwhile
cause the race supports. "I was very lucky both times to be diagnosed early and, thanks to AORN, had excellent (health) insurance.
The proceeds from the walk help women who don't have insurance get mammograms and care."
Team AORN's efforts raised
$905 for the cause, a total that included significant donations by AORN staff. The initiative actually proved a "two-fer"
for the committee, involving not just a rewarding community outreach program but also a healthful avenue toward wellness by
participating in the race's 5K walk/run.
Spotlighting personal health Outreach is an integral part
of wellness at work, but AORN's committee members also believe giving employees the time and resources to care for themselves
is essential to the staff's mental and physical health. With encouragement and support from Human Resources, a Weight Watcher's
club was launched to provide a community support group for staff members to focus on healthy eating and reaching target body
weights.
In the first six weeks, participants collectively lost more than 175 lbs., while also creating a new community
support group of staff from various AORN departments. "Workplaces are increasingly adopting a wellness attitude because instituting
health practices increases employee health and happiness, which can lead to higher productivity and retention" Stephen said.
One
healthcare facility that has successfully incorporated wellness into employees' lives on the job is The Children's Hospital.
Earlier this year, the facility's Sterile Processing Department, led by department director and AORN member Rose Seavey, RN,
MBA, CNOR, ACSP, instituted daily health and wellness routines. So far, results have been impressive, as the group collectively
shed more than 900 pounds of body weight.
"Our group begins each morning with a stretch called a 'morale booster',
then throughout the day, we avoid elevators, instead choosing the stairs, and follow with another stretch later in the day,"
Seavey noted. The group also is working on finding ways to maintain their weight losses and reward staff members who reach
personal benchmarks.
"We are like a family; we work closely together and push each other. We share our successes, and
our 'little' secrets,'" Seavey said. "We look forward to bringing in healthy food for the team, and the benefits have snowballed-we
are happier, more energized, and we aren't as tired at the end of the day."
AHRQ offers 17 tool kits to reduce medical errors Seventeen tool kits designed to help physicians, nurses, hospital
managers and patients reduce medical errors are available from the U.S. Department of Health and Human Services' Agency for
Healthcare Research and Quality. The tool kits, developed by AHRQ-funded experts in patient safety research, range from checklists
for reconciling medications when patients are discharged to processes for enhancing communications among caregivers. Read more+
R.I.
raps hospital for errors in surgery; Facility is fined after latest mix-up
The Rhode Island Department of Health reprimanded Rhode Island Hospital yesterday, and fined it $50,000, for its third
wrong-site surgery this year, the most recent involving an 82-year-old patient in the neurosurgical intensive care unit. The
incident at the Providence hospital occurred Friday, when a resident, a doctor in training, began drilling into the right
side of the patient's head during a bedside procedure. A CT scan had shown bleeding on the left side of the patient's brain.
The resident realized the mistake, closed the initial incision, and performed the procedure on the left side. The hospital
reported the error to the health department, which conducted a surprise inspection Sunday. State health officials had ordered
the hospital on Aug. 2, 2007, to improve its procedures, because of a pattern of wrong-site surgery dating back to 2001. This
latest incident is the hospital's fourth wrong-site surgery in six years, all involving brain operations.
"We are
extremely concerned about this continuing pattern," said Dr. David R. Gifford, director of the agency, in a statement yesterday.
"We have not seen an adequate response in the hospital's system and protocols since the last order was issued. While the hospital
has made improvements in the operating room, they have not extended these changes to the rest of the hospital." In July, a
surgeon also operated on the wrong side of the brain of a patient who had internal bleeding. Following that incident, the
health department ordered the hospital to hire a consultant to review policies and procedures related to neurosurgical services.
Health officials also required the hospital to have a second physician review the proper site for all surgical cases prior
to surgery. The hospital said in a statement yesterday that it had put the policy in place for procedures done in the operating
room. As a result of the latest incident, all intra-cranial neurosurgery procedures will have an attending physician present
for the entire procedure, hospital officials said. A "time out" process to verify the site for significant procedures in the
operating room or at the bedside will include a physician, a nurse or physician assistant, as well as the resident. (Boston
Globe)
AORN Piedmont Chapter of SC #4103
Announces its
Winter Seminar 2008
Save the Date!
February 1-2, 2008
Hilton Hotel
Greenville, SC
Matters of the Heart:
Caring for Our Patientsand Ourselves
CHANGES / UPDATES
Candidates Forum (election speeches) and the Candidates Forum (Meet the Candidates) will be held on SATURDAY, March 29th
from 2pm to 5pm
Awards Reception on Saturday evening will be structured differently from past years. - 6:00 - buffet of heavy hor d'oeuvres
outside ballroom - 6:30 - enter ballroom; ejoy a dessert buffet; mingle with the award candidates/recipients who will be
stationed at tables around the room. There will be an award ceremony and the event will conclude at 8pm, giving us time to
go out to dinner. Cost for the event will be $25.00.
Voting has been changed from Thursday to Wednesday from 10a to 1p
Required activities for delegates - Candidates Forum (Saturday 2-5pm - First Forum (Sunday 2-3:30pm) - First
House of Delegates (Tuesday 9-9:30am) - Second Forum (Wednesday 8-9:30am) - Voting (Wednesday from 10am to 1pm -
Second House of Delegates (Thursday 1:30-3pm)
Hospitals
adopt STERIS Advanced Room Sterilization Technology in the fight against 'Superbugs'
STERIS Corporation announced it has received the first orders for its VaproSure Room Sterilizer from several U.S. hospitals.
The VaproSure Room Sterilizer incorporates STERIS patented technologies and is the first product of its kind for the healthcare
market. Since being introduced in June of this year, systems have been ordered by Wellmont Health System (VA, TN, KY) Lake
Hospital System (OH), and the VA Boston Healthcare System (MA). These hospitals are demonstrating leadership in patient safety
and infection control and will use their VaproSure Room Sterilizers to sterilize all the exposed surfaces in critical hospital
rooms. As highlighted in recent national news media reports, the persistent spread of germs and infections in healthcare facilities
is a significant challenge for patient safety and compromises the ability for hospitals to deliver economically efficient
healthcare services.
With the VaproSure Room Sterilizer, it is now possible to sterilize all of the exposed pre-cleaned
surfaces within a sealed room. STERIS is the only company to offer a complete hygiene solution to hospitals as a way to enhance
their infection control programs and improve the efficiency of their operations. The VaproSure Room Sterilizer utilizes Vaprox
Sterilant (EPA Registration No. 58779-4) to create a dry sterilization vapor that inactivates the full spectrum of biological
contaminates on dry, pre-cleaned, exposed, porous and non-porous surfaces within a sealed hospital room. The chemistry is
recognized as sporicidal, bacteriacidal, fungicidal and virucidal. Additionally, the technology is environmentally friendly,
reducing to water vapor and oxygen at the conclusion of the cycle.
Halting assaults: Strategies to prevent workplace violence
According to the National Institute for Occupational Safety and Health (NIOSH), healthcare workers,
especially those providing emergency and psychiatric care, have a particularly high risk of work-related assault, with nurses
being in the most precarious position, as they administer direct patient care. In fact, NIOSH reports an average of 69,500
assaults against nurses annually.
What are the risk factors for violence?
Although the risk factors for violence vary from hospital to hospital depending on location, size, and type of care, common
risk factors for hospital violence include the following:
Working directly with volatile people, especially if they are under the influence of drugs or alcohol or have a history
of violence or certain psychotic diagnoses
Working when understaffed, especially during meal times and visiting hours
Transporting patients
Long waits for service
Overcrowded, uncomfortable waiting rooms
Inadequate security
Lack of staff training and policies for preventing and managing crises with potentially volatile patients
Unrestricted movement of the public
Prevention strategies and safety tips
To terminate violence in hospitals, nurse managers should develop safety and health programs encouraging staff involvement
in hazard prevention. Although risk factors for violence are specific for each hospital and its work scenarios, managers can
follow general prevention strategies, such as developing emergency alarms, monitoring systems, and security devices. Individual
nurses and other healthcare workers should always be alert and cautious when interacting with patients and visitors. Some
helpful safety tips are as follows:
Watch for signals that may be associated with impending violence, such as anger expressed verbally and threatening gestures
Maintain calm behavior that helps diffuse anger
Evaluate each situation for potential violence when you enter a room or begin to relate to a patient or visitor
Don't isolate yourself with a potentially violent person
Don't let a potentially violent person stand between you and the door
Call security for help
Editor's Note: This excerpt was adapted from the article, "Halting assaults:
Strategies to prevent workplace violence" featured in the Reading Room on HCPro's new online resource center, www.StrategiesForNurseManagers.com!
A dozen
DC hospitals are going tobacco-free; Even outside, smoking will be barred
A dozen hospitals in Montgomery and Frederick counties in Maryland, and Northern Virginia will declare themselves "tobacco-free
health zones" starting today, a pointed and sweeping move that will apply to employees, patients and visitors alike. The use
of tobacco products will be prohibited anywhere on the hospitals' grounds, outside entrances, on walkways or in parking lots
and garages. Gazebos where smoking has been permitted are being dismantled, and cans for cigarette butts will disappear. The
ban, which takes effect on the American Cancer Society's 31st annual Great American Smokeout, affects Frederick Memorial Hospital,
all five Montgomery hospitals and the entire Inova Health System. They join more than 500 healthcare institutions across the
country that have forbidden tobacco on their property. The number has increased exponentially in the past several years, though
with relatively little momentum in the Washington region.
In suburban Maryland, the collective nature of the hospitals'
action is meant to amplify the message. The six facilities planned the change together, bringing in experts from the Mayo
Clinic to train tobacco-cessation counselors this summer and agreeing to offer certain benefits, from stop-smoking classes
to nicotine patches and medications. They also printed small cards with "scripts" for staff members to follow if they see
a colleague, visitor, patient or family member puffing away. The suggested dialogue is more courteous than curt, but employees
could face disciplinary action for repeated violations. A worker with clothes smelling of tobacco might be issued disposable
coveralls or asked to go home and change. "We're healthcare professionals, and so you have to treat this as an addiction.
You're not going to treat it as a crime," said Brian A. Gragnolati, Suburban Hospital's president.
Although the days
are long gone when nurses and doctors lighted up outside patients' rooms, he and his counterparts estimate that up to 20 percent
of their employees smoke. The hospitals acknowledge that they are playing catch-up. Montgomery passed a no- smoking law for
bars and restaurants more than four years ago, and a statewide prohibition will take effect in February. Officials now peg
Maryland healthcare costs related to smoking at $2 billion. "To permit an act to occur on our campuses that is recognized
as the single most common cause of death and disease was simply a disconnect that none of us could allow to continue," Thomas
A. Kleinhanzl, president of Frederick Memorial, explained at a news conference. (Washington Post)
Newly licensed nurses: the key to better retention
In an effort to better understand nurse turnover rates in hospitals, researchers conducted a three-year study on the work
experience of newly licensed nurses. Presented in the American Journal of Nursing (AJN), the study revealed that
better orientation programs and management may be the key to improved retention.
According to AJN, a randomly selected sample of 3,266 newly licensed nurses from 60 sites across the country participated
in the study survey that focused on four major areas of their employment:
Respondent characteristics
Work-setting characteristics
Respondents' attitudes toward work
Job opportunities
Despite relatively high levels of job satisfaction, 37% of new nurses stated they would probably look for another job within
the year. Furthermore, they described work-group cohesion to be high (4.1 on a 5-point scale) but support from supervisors
to be somewhat lacking (3.6 on a 5-point scale). The results suggest that newly licensed nurses may not remain in the acute
care settings they started out working in due to inadequate orientation and management.
Positive coworker relationships to improve communication
Maintaining solid communication among coworkers is essential to any work environment. But when that
line of communication breaks down and conflict ensues, confronting the discord is an important step in upholding positive
relationships and avoiding paying grim costs.
As a means to improving communication, Catherine Witsberger, MSN, RN-BC, nurse educator at the University
of Pittsburgh Medical Center (UPMC), has been working with various nursing units and offering unit-based sessions. The mandatory
classes consist of two, four-hour-long sessions and have been effective at improving personal and group relationships within
the hospital. Each staff member, at every level, was required to take part in the sessions.
Most staff members said that physician-nurse communication was most lacking, says Schebeeka Croft, RN,
who took part in the program.
The first session contained discussion about the principles of positive coworker relationships, as developed by Wendy Leebov
in her book Working Together for Professionals in Health Care.
Additionally, during the first session, participants discussed communication styles and how coworkers tended to interact
with each other. Two main questions that participants pondered were:
1. How honest is the communication?
2. How considerate is the communication?
When the second session got under way, participants focused on the importance of building a common mission. The second
session also helped staff members learn how to resolve conflicts.
"It allowed us to understand where everyone was coming from," says Croft. "We saw how to make other people's jobs easier
and took the time for understanding. I thought it was great because it brought us together."
For tips on how to create your own program, click here.
Editor's Note: This excerpt was adapted from the article, "You've got a friend in me" featured in the Reading Room on HCPro's new online resource center, www.StrategiesForNurseManagers.com!
If this email does not display properly,
please view our online version.
NOVEMBER 7, 2007 Vol. 3 No. 11
AORN
thanks Integrated Medical Systems International, Inc. (IMS), the exclusive sponsor of AORN Management Connections.
A Message from IMS Sponsor of AORN Management
Connections
Who's most at risk? The majority of ambulatory
surgery centers are free-standing, with no formal partnership associating them with another healthcare facility for back-up
when equipment malfunctions or when equipment is sent out for routine repair/maintenance. What does this cost us? Read more+
ASC industry pros like what they hear about plans for FASA/AAASC merger
The announcement early last month that the two major business associations representing ambulatory surgery centers—FASA,
Inc., and the American Association of Ambulatory Surgery Centers—had agreed to merge drew nearly universal praise from
ASC owners and industry consultants. Read more+
Other Articles
Hospitals adopting technology allowing bidding for open shifts
A growing number of hospitals are using online bidding technology to manage traveling and per-diem nurse staffing requirements,
particularly keeping track of and filling open shifts. The goal isn't just filling an open shift position at the lowest cost.
Well-designed bidding systems enable perioperative managers to match skills to case requirements and offer flexible work arrangements
to a multigenerational workforce. Read more+
Medicare, private plans to combine data for broad national transparency initiative
A broad alliance of private-sector and government entities working to improve the quality of U.S. health care announced
plans last month to develop a consistent national approach to transparency. They aim to make public not only physician and
hospital quality-of-care data, but also measures of the cost of treating a list of common health conditions. Read more+
CMS issues final 2008 payment rules for hospital outpatient, ASC services
The federal Centers for Medicare and Medicaid Services issued final rules Nov. 1 updating hospital Outpatient Prospective
Payment System rates and ambulatory surgery center payment rates for services to be performed in calendar year 2008. Read more+
CDC study finds higher rate for invasive MRSA infections
As this edition of AORN Management Connections neared completion, a flurry of media attention in recent weeks
to the spread of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections was sure to focus attention
on a conference to be held in Atlanta Nov. 5-6 sponsored by the Association for Professionals in Infection Control and Epidemiology,
Inc. Read more+
Overview of surgical research findings presented at ACS Clinical Congress
New treatments to stem massive bleeding in trauma patients—the leading cause of death
for trauma patients in the U.S.—were among a host of surgery-related research findings presented during the American
College of Surgeons' Clinical Congress in New Orleans Oct. 7-11. Read more+
AHRQ study compares results of CABG, angioplasty trials
A study of controlled clinical trials involving almost 10,000 atherosclerois patients found no difference in long-term
survival outcomes for those treated with coronary artery bypass grafting surgery and those treated with coronary stents. But
freedom from angina and repeat revascularization procedures were significantly greater for patients who underwent CABG. Read more+
Physicians advised on reducing risks with fault-prone defibrillator leads
Medtronic, manufacturer of fault-prone Sprint Fidelis® cardiac
electrodes that link patients' implantable cardioverter or cardiac resynchronization therapy defibrillators to their hearts,
is offering guidance to physicians on reducing the risks of life-threatening failures. Read more+
News briefing for perioperative leaders
This month's news briefing for perioperative managers includes an update on hospitals' voluntary compliance with Medicare
quality-reporting guidelines, a healthcare supply chain coalition's push for standardized organization and product identifiers,
two proposed AORN recommended practices currently up for public comments, a study finding a big mortality drop for six quality-of-care-dependent
surgical procedures and much more. Read more+
ASC news review
This month's ASC News Review includes several ASC-specific Joint Commission initiatives, such as an ongoing study of the risks
of inaccurate or incomplete preoperative nursing assessments conducted by ASCs, as well as a research study comparing the
safety and prices charged for laparoscopic cholecystectomies when performed in hospital outpatient departments and freestanding
surgical centers. Read more+
Managers Soap Box
The spotlight is on nursing competency Dawn Q. McLane, RN, MSA, CASC, CNOR Chief Development Officer, Nikitis Resource Group
Since nursing organizations
first began to take a hard look at demonstrating competency in the mid-1980s, the spotlight on competency has shown brighter
year by year. Read more+
spacer here
Manager resources from AORN For additional information on some of the topics in this month's issue of AORN
Management Connections, access the following resources offered by AORN:
You are receiving AORN Management Connections
as a benefit of membership with AORN. If you no longer wish to receive the perioperative news, resources, and member benefits
information published in AORN Management Connections, unsubscribe here. Or, choose to stop receiving ALL email
communication from AORN here.
If you received AORN Management Connections
from a friend and would like to subscribe, join AORNtoday.
Updated Link: AORN asks you to please contact your Legislators &
request their support of Nurse Funding.
*Please note corrected link at the bottom. If you cannot follow that link, please copy and paste this
URL into your browser's address window: http://capwiz.com/aorn/home/
Dear Registered Nurse,
AORN is asking you to contact your Senator and Representative and urge support of the $169.7 million appropriation
for funding Title VIII Nurse Workforce Development Programs contained in the Senate version of H.R. 3067. These funds are
the primary source of federal funding for nursing education and support for advanced nursing education, nursing workforce
diversity, nurse education, loan repayment assistance, nurse faculty financial support, and nursing education to care for
the elderly. Currently, the senate has approved $169.7 million (a 13.4% increase over FY 2007) while the House bill provides
for $165.5 million (a 10.7% increase over FY 2007). It is imperative that nursing education receive full financial support.
Your senators and congressional representatives need to hear from you about the importance of this funding. Please write them
and urge their support of the full $169.7 appropriation. The growing nursing shortage is impacting every aspect of the US
health care delivery system and is contributing to diminished patient care. Providing funding to attract, educate and sustain
both nurses and nurse educators will help reverse this trend and improve safe, quality patient care.
Please feel free to include information about yourself, such as what you do, where you work, how long you have been a perioperative
nurse, etc. We encourage you to add a personal story, reflection, or anecdote: how the nursing shortage is affecting or impacting
you, your facility, and your patients. Or, perhaps, how the nurse faculty shortage may adversely affect the ability of those
you know or have encouraged to choose nursing as a profession to realize that goal. Or, how financial support (loans, loan
forgiveness) supports the nursing profession. Your personal voice is the best voice! Thank you for your contribution to this
worthy endeavor! If you have any questions, please contact Brian Bainbridge at AORN Government Affairs, grassroots@aorn.org or 800-755-2676, ext. 395.
If you no longer wish to receive e-mail from us, please click here.
Tennessee AORN Legislative Update
November 2007
AORN Government
Affairs
Cathy Sparkman and Cathy Becker remain in place
as our advisors.
Becky Becker left AORN national office to move
to Tennessee and now lives in Brentwood a suburb outside Nashville.
We knew she had good taste!
The new legislative assistant is Brian Bainbridge.
Please send him a welcome note and a place him on the electronic reminder list regarding you chapter legislative coordinator’s
birthday.
News from TNA
Convention
Both resolutions submitted on behalf of AORN were
approved by the TNA House of Delegates at the convention this year. We had introduced some revisions in language to update
these documents from their original introduction 10 years ago. We owe any thanks to TNA for their continued support of perioperative
nurses throughout the state. Are you a member of TNA? Please consider adding this membership to your professional portfolio.
This is the organization that represents you for legislation at the state level. Over the past 5 years this support has been
invaluable as we’ve dealt with local issues.
Legislative Session
Break
The Legislative session for Tennessee is in recess until January 8th,
2008. This is a great time to review the new names on House and Senate committee rosters and take time to contact
your representatives with a cheerful introduction so that you’ll be recognized when you make a call during the session.
Nurses in the Legislature are now in strong leadership
roles. Senator Rosalind Kurita (a former perioperative nurse) is the Speaker Pro Tempore of the Senate which means she is
in charge when the Lieutenant Governor is not available to chair sessions. This makes her the most powerful female in the
Tennessee state government.Senator Diane Black is the Republican Party Caucus Chair. You should also look at committee rosters for General
Welfare committee (lots of East TN representatives here) as well as Calendar committee.
These are the people we go to in trying to effectively influence the outcome of votes in the Senate.
On the House
side, Representative Joanne Favors (MSN) from Chattanooga
is now the subcommittee chair for Professional Occupations. You will remember that this is the first stop for any legislation
regarding scope of practice and allied health proposed legislation.
Our ability to interact positively with members
of this subcommittee is essential. If the buck stops here, it doesn’t go anywhere else. Check out all members of this
subcommittee and all members of Health and Human Resources. These are the people who can change your practice with
a single vote. Please get to know them.
Nursing Workforce
Study
Dr. Maureen Nalle at UT Knoxville School of Nursing
is a primary investigator for a TNA study looking at local workforce conditions. You can register for this study (TNA membership
is not necessary) on the TNA website www.TNAonline.comor contact
Dr Nalle @ 865-974-7598. This takes approximately
30 minutes to complete.
Free AORN Congress
Registration Opportunity
Infection Control Today journal is conducting
a research survey about the actual practice of how scrubs are laundered and the attitude of practitioners to how this is being
handled.
It includes questions about your personal practices
if the scrubs are laundered at home. The outcomes of this study will be published in a future issue of ICT. Anyone who has
an opinion on these practices should participate in the questionnaire found on the ICT website. This one takes about 5-10
minutes to complete.
National Legislative
Committee
Claire Karas is now a Member at Large of NLC.
The next conference call is on November 13 and will include the Legislative coordinators for Region 3. If you have not yet
received a reminder of the TN coordinator’s birthday, this would be a good time to make note of it. (Hi Penny! We love
you!)
AORN Grassroots Network – Are you a member?
Sign up online. The Region 3 state with the greatest percentage of member participation will receive complimentary Milano
cookies at their hotel rooms for 2008 Congress. The leading Chapter delegates from Tennessee
will be welcomed to Happy Hour at Penny Joyce’s hotel.
2007 Congress
Follow Up
Delegates will remember that in the closing minutes
of HOD Second Forum, there was a resolution from the Texas State Council passed recommending guidelines for reviewing legislation
about allied health personnel. President Mary Jo Stiert appointed a Task Force to review the document and offer recommendations
for implementation. Claire Karas was among the membership invited to address these issues based upon her extensive work with
allied health legislation in Tennessee. The resolution from
Texas can be found in your June issue of AORN Journal (p.
1145). If you will be a delegate for the 2008 Congress, make yourself familiar with that information now.Task Force ande Board of Director’s recommendations will be introduced in the coming Pre-Congress
Journal and will appear on the agenda for the next House of Delegates. Please give this subject thought and discussion as
it will influence all future legislative activity by the organization.
AORN Day in the
Tennessee Legislature
Please discuss this idea and lets get a game plan
together is you’d like to do a mock OR or information booth for our representatives. It could be lots of fun, but it
would have to take place on a weekday in Nashville. Nashville chapter members can offer hospitality and make sleeping arrangements
(Pajama Party at Claire’s house!)
Thoughts to Consider
Are
we motivated to bring a bill to ensure RN circulator language in the Tennessee Code? National AORN is looking for target states
to support on this venture. It will take commitment from all chapters to get this accomplished, but with the leadership in
our legislature, we could be very successful.
Do
we need a mandate for all MRSA cases to be reported to the Dept of Public Health? This is now a community acquired disease
that costs thousands of dollars to treat. Individual school districts are now left to draw up infection control policy. This
could be a great way to introduce yourselves to the local schools as a nurse resource. Classroom discussions on handwashing,
care of simple cuts, and signs of infection are well within our realm of expertise. Community Education opportunity!!!! Health
Fair idea!!!
A
frequent source on conversation regards the implementation of legislation regarding Surgical Technologist Certification. Specifically,
are all persons scrubbed in the state of Tennessee meeting
these criteria? Does your facility have other job titles and descriptions to employ persons without training? Do you perceive
this as an issue? If so, how would you like to approach it?
You
name it!!!! Penny and Claire can always find time to talk up a good idea.
Contacts
Penny JoyceKnoxville
Chapter & TN State Council Legislative Chair
During gallbladder surgery at North Shore Medical Center (Salem, MA) four years ago, a female patient became a victim
of a little-known medical hazard: A flash fire ignited on her midsection. Her surgeon rubbed an alcohol-based cleaning solution
on her abdomen after her surgery, wiped it clean, and then decided to remove a mole from her stomach with a hot cautery instrument.
Blue flames immediately shot up from her midsection, "similar to a flambé," the surgeon told state public health investigators.
The surgeon and other operating room staff quickly patted down the flames and pulled off the sterile draping that also ignited,
he said. But the patient suffered painful first- and second-degree burns, state investigators determined.
Operating
room fires have received less attention than other potential hazards such as wrong- site surgery, but fires have seriously
injured and even killed patients. And new data show that they are more common than previously believed. Pennsylvania, which
collects some of the most comprehensive statistics, has had 28 operating room fires a year for the past three years, 1 in
about every 87,000 surgeries. The state's data, released in September, suggest that nationally there may be hundreds of such
fires out of roughly 50 million inpatient and outpatient surgeries annually, not the 50 to 100 previously estimated by patient
safety organizations.
The patient filed a lawsuit against her surgeon who denied allegations of malpractice
in court papers. Last month, the patient and her lawyer filed a lawsuit against the surgeon's malpractice insurer, Medical
Liability Mutual Insurance Co. The hospital, which is not named in the lawsuit, said it disputes some of the patient's allegations
about the fire and her treatment afterward, as well as some of the findings of health officials. But hospital executives acknowledge
the fire occurred and said they reported it to the state Department of Public Health.
Several oversight groups, including
the Department of Public Health and the Joint Commission, have published warnings about surgical fires and recommended preventive
measures since the early 2000s. In the past year, several professional organizations, including the American Academy of Otolaryngology
- Head and Neck Surgery, the Association of periOperative Registered Nurses, and the American Society of Anesthesiologists,
have also launched educational efforts. Mark Bruley, vice president for accident and forensic investigation at the ECRI Institute
in Pennsylvania, said these programs are beginning to decrease the number of accidents.
Traditionally, anesthesiologists
used highly flammable gases such as ether to put patients to sleep, and doctors and nurses were vigilant about preventing
fires, Bruley said. But as doctors began using less flammable anesthetics in the 1980s, prevention efforts started to wane.
At the same time, other fire hazards grew, including the use of 100 percent oxygen, which can leak into the air, increasing
the combustibility of gauze and hair; alcohol-based skin cleansers; and advanced surgical tools such as lasers and electrocautery
devices. According to ECRI, 44 percent of operating room fires occur during head, face, neck, or chest surgery, when electrical
surgical tools are closest to the oxygen the patient is breathing. As with other types of surgical errors, poor communication
between surgeons, nurses, and anesthesiologists can be the root of the problem. Operating room safety specialists recommend
that doctors use less than 100 percent oxygen during head and neck surgery, that surgeons store hot instruments off the operating
table when they are not in use, and that doctors wait two or three minutes until alcohol- based products have evaporated from
the skin before using cautery tools.
In this patient's case, her surgeon told health investigators in 2003 that he
applied an alcohol- based "skin prep" to her abdomen and chest before removing her gallbladder to help prevent postoperative
infections. The substance is sticky, he said, so after he finished the operation, he applied an alcohol- based cleaner to
remove it. He said he then remembered that he promised to remove a mole, so he grabbed the cautery device, and a flash fire
occurred. According to the chief medical officer at North Shore, the fire led to more aggressive prevention policies, some
of which were already in the works before the incident. (Boston Globe)
March 30 - April 3, 2008 Anaheim Convention Center - Anaheim,
California
55th Annual AORN Congress
Grow What You Know at Congress!
In 2008, the Association of periOperative Registered Nurses (AORN) will offer the
premier OR nursing event of the year.
The 55th AORN Congress offers world-class educational opportunities, prominent industry leading speakers, information packed
general sessions, and countless paths to connect with your colleagues, industry partners and friends.
Laura Mahlmeister, RN, PhD, staff nurse in the birth center at San Francisco General Hospital
When Deborah L. Phillips, RN, CVNS, CRRN, JD, went into nursing more than 30 years ago, nurses never worried about medical
malpractice lawsuits. "It was almost unheard of for a nurse to be named," says Phillips, a nurse attorney in Pleasanton, Calif.
But these days a growing number find themselves involved in litigation, either as part of a legal action against a facility
or, increasingly, as an individual defendant.
Nurses on the losing end of a lawsuit face losing their jobs and their licenses, as well as personal assets, even if their
mistake was inadvertent or they thought they were simply following a physician's orders, Phillips says. In a few recent cases,
nurses have found themselves facing criminal charges and even jail terms for medication errors that have resulted in patient
deaths.
State nursing boards and the public expect perfection in nursing practice, even as patients get sicker and nurses take
on more responsibilities, according to Phillips. "There's no tolerance for human error," she says.
Why nurses get sued
Among healthcare providers, physicians remain the main targets of medical malpractice lawsuits. Nurses account for about
2% of all medical malpractice payments, according to the National Practitioner Data Bank, operated by the U.S. Department
of Health and Human Services.
But medical malpractice payments on behalf of nurses nearly doubled from 307 in 1997 to 586 in 2005. About two-thirds of
these were against non-advanced practice RNs. Most of the others were against nurse anesthetists, nurse midwives, and nurse
practitioners.
"More and more nurses are being sued individually," says Rita Kae Restrepo, RN, BS, CPAN, a legal nurse consultant and
post-anesthesia care unit nurse at San Francisco General Hospital, who teaches nurses about legal issues. "It's becoming the
new trend."
Tort reforms in some states have capped the amount of money patients can seek from physicians, nurses, or hospitals.
However, "The patient's attorney is going to examine the nurse's conduct for breaches in the standard of nursing care,"
says Laura Mahlmeister, RN, PhD, president of Mahlmeister and Associates, a risk management and continuing education company,
and a staff nurse in the birth center at San Francisco General Hospital. "If the damages awarded to the patient exceed the
limits of the doctor's malpractice policy, the additional damages may be paid by the nurse's insurer, if the nurse has been
found negligent."
Nursing responsibilities have also expanded. Busy physicians who spend less time at the bedside rely more on nurses to
be their eyes and ears, which increases pressure on the nurse to report and follow through on changes in the patient's condition,
Mahlmeister says.
The biggest reasons for lawsuits against nurses include medication errors; communication errors; failure to monitor and
assess; failure to properly advocate for the patient; working while impaired, whether by inadequate sleep or controlled substances;
and negligent or inappropriate delegation and supervision, say nurse legal experts interviewed for this story.
They add that the best way for a nurse to avoid a lawsuit is to be aware of the standards of nursing practice and follow
them to the letter.
"Ultimately, to prevent errors, you meet the standard of care," says Cheryl Randolph, RN, MSN, CRRN, CEN, FNP, a legal
nurse consultant and owner of Paragon Education, a nursing education company in the San Francisco Bay Area. "That means being
aware of your hospital's policies and procedures, your state nursing practice act, and the professional standards of your
specialty."
Minimizing the risk
Nurse attorneys and legal nurse consultants offer the following suggestions for nurses, whether they want to reduce the
risk of being named in a lawsuit or they seek protection if they're involved in a lawsuit already.
Thorough documentation. Documentation may not be nurses' favorite activity, but nurses who find themselves involved
in litigation who have documented thoroughly will thank themselves later.
"Charting is probably the most vital aspect of proving that nurses have met the standard of care," Mahlmeister says. "It's
important to get the story down on paper." Electronic medical records result in greater legibility, but may limit nurses'
capacity to write narrative notes. Nurses should determine if they are limited by digital templates in writing narrative notes
about an event and ask their managers how to document an adverse outcome.
But noting that you checked the patient's blood pressure or gave medications isn't enough, Mahlmeister says. She adds,
"Charting has to define how you meet the patient's needs." As the patient's condition changes, nurses need to change their
plan of care and reflect those changes in their charting, she says.
Mahlmeister recalls a case in which a patient did not get a drug on time and suffered a poor outcome. The nurse testified
she looked for the medication in the dispensary, where it should have been, but couldn't find it. The nurse then asked her
supervisor for help, but got no response.
Unfortunately, the nurse did not document her actions. The supervisor's response was that she dealt with dozens of emergencies
every night and didn't recall the nurse asking for help.
"I believe the nurse," Mahlmeister says. "But where's the evidence?"
Follow the chain of command. One of the worst cases Restrepo has seen involved a man in his mid-30s. He'd never
had serious medical problems, but after three days of vomiting and diarrhea, he went to a hospital emergency department, where
he received fluids, then was sent to the med/surg unit for observation.
"His blood pressure was 60/30," Restrepo says. It stayed that way for four hours as his body slowly shut down, although
he remained alert and oriented for much of that time. Neither the nurses nor the physician took any action, Restrepo says.
The patient went into acute renal failure, dehydration, and septic shock and died. The family sued, and the case eventually
settled for millions of dollars.
"The nurse said in deposition that his blood pressure never changed," Restrepo says. "But you can't sustain a pressure
of 60/30. They should know that. I don't care if they are day one out of nurses' training."
The case is a good illustration of how many nurses end up involved in legal action, either directly against them or against
the facilities where they work, Restrepo says. She adds, "The failure here is the failure to follow the chain of command."
Even when a physician decides to take no action, if the nurse knows something is wrong, he or she must request help from
the charge nurse or the nursing supervisor and keep asking for help until the patient receives proper care.
Restrepo has seen many cases involving nurses who believed they had fulfilled their responsibilities because they called
a physician and got an inappropriate order to simply continue watching the patient. "They were not using their critical-thinking
skills," she says. "That's where the lawsuit comes in."
Make the patient your partner. Sharing information with the patient can help reduce errors, Mahlmeister says. Tell
your patients or family members what you are doing for them or giving to them and listen to their response, she recommends.
If they say something like, "My doctor canceled that order," or "That dose was supposed to be increased," the nurse should
double-check with the physician and only proceed if the order appears safe.
Nurses should also pay attention to the concerns of family members, Restrepo says. They often notice when a patient's condition
has changed. Family members who are upset and angry and don't understand what happened to their loved one or who feel they
were mistreated may be more likely to take legal action, she adds.
Recognize system flaws and report them. "Increasingly, attorneys who sue look at the bigger picture," Mahlmeister
says. "Juries are more likely to support claims of negligence against the system when they are provided with proof that the
patient is in an error-prone environment." This takes the legal focus off the individual nurse into the realm of corporate
negligence.
Spurred by information about systems errors and patient safety, managers are also starting to pay more attention to correcting
system problems, she says.
Mahlmeister recommends finding out if other nurses are experiencing similar problems and addressing them as a group. Don't
be afraid to file incident or unusual occurrence reports of system errors or work for changes, she says.
As individuals, nurses should make it clear to others that they will not practice in a way they feel is unsafe or beyond
their scope, Phillips says. This includes turning down extra shifts if a nurse feels tired or stressed.
Consider carrying individual malpractice insurance. Many nurse legal experts believe it's good to have individual
malpractice insurance, and carry it themselves. Nurses may want to speak to an attorney about the advisability of carrying
it, especially if they have a fair number of assets.
"It's a lot of comfort for a small amount of money," Randolph says.
Nurses in large healthcare systems are generally covered by their employer and can be reasonably assured the facility will
provide them with legal counsel for acts "carried out in the normal course of their employment," Mahlmeister says. Nurses
who work for an agency or in an office should make sure they are covered, either by their employer's insurance or their own.
No employer is expected to defend criminal acts, such as assault and battery of patients, she adds. Nor will any professional
liability insurance, employer-purchased or individually purchased, provide coverage for criminal acts or intentional torts,
such as defamation or false imprisonment.
Most of the time, a facility will protect a nurse involved in a legal action, Phillips says, but when the facility doesn't
-- or if the nurse faces a hearing in front of a state licensing board -- individual insurance may allow the nurse to hire
an attorney without worrying about legal fees. Individual insurance can also keep nurses from losing their assets in the unlikely
but possible event of a huge judgment against them. During their orientation, nurses should ask the risk manager whether their
employer's malpractice insurance policy covers them for all aspects of their work. For example, in one case, nurses discovered
they were not covered for care rendered while transporting a patient from their facility to a higher level of care, Mahlmeister
says.
After obtaining information from the employer about the coverage provided, the nurse should explore the possibility of
purchasing his or her own policy. Such a decision is an individual one that each staff nurse should make.
Individual malpractice coverage varies, so the nurse should read the coverage and know what he or she is getting, Phillips
says. For instance, the insurance may pay $150 an hour for attorney time, and if an attorney bills for $250 an hour, the nurse
must cover the rest.
The importance of assuming control
Nothing is foolproof, nurse legal experts say. Even the most cautious nurses sometimes make mistakes. Occasionally, even
when nurses do everything right, patients still die or don't recover properly, and they or their families may sue.
Like most things in life, nursing carries a risk, Mahlmeister says. But nurses can counter that risk by assuming control
of their practice, she adds.
Nurses who feel in control of their practice will call a physician repeatedly, even when they think the physician might
get angry, or tell a supervisor they can't work a double-shift because they feel exhausted, or won't let anyone interrupt
them while they are giving medications.
"That's a big issue in preventing lawsuits," she says.
Although she is probably more aware of the risks than most nurses are, Mahlmeister says she loves the job too much to give
it up. Nurses should not be afraid to practice, she contends, adding, "The risk is absolutely manageable."
Cathryn Domrose is a senior staff writer for NurseWeek. To comment on this story, e-mail editorca@nurseweek.com.
2007 Perioperative Nurse Week
AORN President's Message
Dear Colleagues:
On November 11-17, 2007, we will celebrate a special event - Perioperative Nurse Week. Held annually, this is a time in
which perioperative nurses are recognized and lauded for their professional nursing qualities, dedication to patient care,
and excellence in perioperative practice.
Please plan to join individual AORN members, AORN chapters, hospitals and other medical facilities participate in Perioperative
Nurse Week by actively educating others about the vital roles performed by perioperative nurses in every setting. Every day,
these roles focus on quality improvement efforts and standards implementation.
The theme this year is Perioperative Nurses: A Legacy of Leadership in Safe Patient Care. My hope is that it instills
a reminder that we have made great strides in leading the way for improved patient safety and that safety will continue to be one of the key elements of our daily practice - from safe medication administration to fire safety, wrong-site surgery to surgical counts and error reduction.
To promote this culture of safety, we must take an active role in mentoring our peers, rewarding staff, and acting as the primary resource for our colleagues
in all facets of health care. Additionally, AORN asks you to use Perioperative Nurse Week to promote our professional values
and instrumental role in patient safety through community activities. Start now using AORN as a resource to plan your outreach
activities!
Sincerely, Mary Jo Steiert, RN, BSN, CNOR AORN President
A Simple Guide for Weeding Out Your Clothes Closet
Fall is here and it's the perfect time to
get your clothes closet organized and fresh for the new season. But how do you decide what to keep and what to part with?
Here is a simple guide:
1. It's too big or too small. Get it out of your closet and donate it so that someone
who DOES fit into it can wear it. Even if you're trying to lose or gain a few pounds, it's not worth keeping it.
Live in the 'now', and once you reach your goal, you can always reward yourself by shopping for a few new outfits to fit your
new figure.
2. You don't like it. This is a no-brainer. Get rid of it today.
3. It's stained. If you really
like the garment, but can't wear it because it's stained, spend some time this week getting that stain washed out. If you
can't get the stain out, bring the garment to your local dry cleaner. If they can't get the stain out, and there's no other
way for you to hide the stain, such as a patch or accessory, then bite the bullet and part with this piece of clothing.
4.
It's ripped or torn, a hem needs to be sewn or it needs to be taken in to fit. Either repair it yourself, have someone else
repair it or get rid of it if the price of the repair is not worth it. Make one of these choices today, rather than allowing
this damaged item to take up precious space in your closet.
5. It's a wear-once outfit. If you have a wedding dress,
prom dress, tuxedo or other wear-once dress in your closet, you have an emotional decision to make. If you can't bear to part
with these items because they bring back happy memories, then you may have to just keep them. However, if you have photographs
of yourself in the wear-once outfit and that's good enough for you, consider parting with it so that someone else can make
his or her own good memories in that outfit. On the other hand, if they bring back bad memories, by all means get rid of them.
Bring them to a consignment shop, sell them at your next garage sale or donate them.
6. It's a special
occasion outfit. If you have an outfit that you'll only wear if you plan to attend a special occasion, like a wedding or baptism,
keep it. But only if a) you love it, b) it fits, c) it's in good condition. If you never or rarely attend a special occasion,
why not set a special date with your spouse or a friend and go out on your own special occasion dinner?
7. It may come
back in fashion. This is a bad reason to keep an outfit. It could take years before clothes come back in fashion (if they
ever do). What if there's a theme party someday? You can likely recreate the look by visiting a local thrift shop.
8.
You don't have anything to match it. Perhaps you have a shirt that you love, but can't seem to find pants to match it--or
vice versa. Make it a point to go shopping this weekend in search of that perfect match. Remember, neutral colors such as
black, brown, beige and gray go well with most other colors. You might even want to bring the piece you have to the store
with you and have a sales clerk help you find a good match. Try the mall, so you can get assistance from several different
stores before you make your choice. You'll be thrilled that you can finally wear that shirt that's been sitting in your closet!
9.
You never wear it simply because you have too much. If your closet is packed with clothes and you have outfits you never wear
simply because of the high volume, you may want to consider putting some of those clothes into storage so that your closet
doesn't feel so stuffed and cramped. One thing you definitely should not do is go clothes shopping. Don't add anything else.
Another possibility, if it's within your budget, is to have a professional closet system installed. These systems help you
to organize and separate your clothes well so you can see everything you have at a glance.
Touching 418 Million Lives, Hepatitis Still Presents Significant Threat to Global Health
Posted on: 09/07/2007
NEW YORK -- Globally, approximately 418 million people are currently infected with hepatitis, and the unrecognized
importance, danger, and costs of hepatitis in the 21st century cannot be understated or underestimated, according to Global
Hepatitis Strategies, a new report by Kalorama Information.
Paradoxically, despite the obvious crisis, world governments are not taking the necessary steps to contain
hepatitis. Yet the incidence and prevalence of hepatitis have begun to rise in certain parts of the global community, and
even industrialized nations are lacking hepatitis control policies. Moreover, there is a greater crisis in hepatitis screening,
diagnosis, and treatment emerging, particularly in those areas where HIV/AIDS is becoming more prevalent.
Kalorama Information estimates that the theoretical global market for all hepatitis testing products and
therapeutics in 2006, assuming that aggressive screening were to be conducted, would be $3.3 trillion, with the western Pacific
and southeast Asia showing the greatest need. However, the estimated realistic market potential for the various global regions
for 2006, based on their currently reported hepatitis status and pricing structure, fell far short, reaching just $326 million.
"The strategic concept of hepatitis diagnosis and therapy is one of the most insufficiently recognized
areas that the healthcare industry has ever seen," notes Kenneth. G. Krul, PhD, the report's author. "Governments, with the
exception of a limited few, seem unable or unwilling to devise comprehensive hepatitis containment and prevention policies.
In order to cope with the challenges and opportunities of hepatitis diagnostics and therapeutics, companies must think on
a global basis, focusing on three points for the development of strategy: potential market, epidemiology and technology."
Global Hepatitis Strategies focuses on the factors that influence policy aspects of hepatitis, the options
presented, the factors associated with strategic market development of hepatitis diagnostics and therapeutics, and prospects
for the future. The report analyzes strategic market effects of epidemiology, market potential and technology, trends in epidemiology,
and social/political attitudes towards hepatitis.
Source: Kalorama Information
MRSA Happens . . .
Doctors' long-sleeved coats banished to counter MRSA
(UK) Alan Johnson, the health secretary, will today declare the long-sleeved white coats worn by generations of
hospital doctors to be an MRSA-infection hazard that must be eliminated throughout the NHS in England.
He will issue a new dress code for all NHS staff requiring them to remain bare below the elbow whenever they are
in contact with patients. Ministers believe the MRSA superbug has been spreading from one patient to another on the cuffs
of doctors' white coats. They think the bare arms rule will make it easier for staff to go through the correct hand-and wrist-washing
procedures.
Guidelines being issued t o every NHS trust will also order doctors, nurses and therapists to stop wearing watches
and jewellery. They will be advised to avoid wearing ties and to don plastic aprons when carrying out clinical activity. Mr
Johnson will announce the new rules at the start of a publicconsultation on ways to improve the NHS. He will say fear of catching
a hospital superbug has overtaken waiting times as the public's most pressing concern about the health service. Some NHS trusts
have already banned the traditional white coat on the wards and the government expects all to follow suit by January.
Mr Johnson said last night: "I'm determined that patient safety,including cleanliness, should be the first priority
of every NHS organisation. Across the NHS we continue to bring the number of MRSA cases down and make progress on measures
to reduce Clostridium difficile." The dress code and other measures being announced today were "a clear signal to patients
that doctors, nurses, and other clinical staff are taking their safety seriously".
Latest infection figures from the Health Protection Agency (HPA) showed there were 1,444 cases of MRSA bloodstream
infections in the first three months of this year, compared with 1,542 in the previous quarter. There were 15,592 cases of
C.diff infection, compared with 12,814 in the previous quarter. Other measures will include greater authority for matrons
and ward sisters to report directly to the hospital board if they have concerns that managers are not providing enough resources
for infection control and cleanliness. They will make quarterly "ward-to-board" progress reports on hygiene.
There will be new clinical guidance to increase the use of isolation for patients who are infected with MRSA or C.diff.
The National Patient Safety Agency will also extend a "clean your hands campaign" from hospitals to GP surgeries, ambulance,
mental health and care trusts, care homes and hospices. A new legal requirement will be placed on all chief executives
to report all outbreaks of MRSA and C.diff to the HPA. It will be backed up by fines for non-compliance.
Peter Carter, general secretary of the Royal College of Nursing, said:"This guidance offers a positive step forward
in introducing dress code standards across all health professions to help reduce healthcare associated infections."
If this email does not display properly,
please view our online version.
SEPTEMBER 5 2007 Vol. 3 No. 9
AORN
thanks Integrated Medical Systems International, Inc. (IMS), the exclusive sponsor of AORN Management Connections.
A Message from IMS Sponsor of AORN Management
Connections
Is your CSP department ready? "Ready" is the way
Central Sterile departments should conduct business. How does a department as diverse in responsibilities as Central Sterile
Processing (CSP) get ready and stay ready? Two crucial elements are education and communication. Read more+
OSHA offers new resources For healthcare compliance
Healthcare facility and perioperative managers will be able to access information and resources on compliance with federal
safety and health rules in a convenient new Web tool made available by the federal Occupational Safety and Health Administration
(OSHA). AORN leaders signed an alliance agreement with OSHA Administrator Edwin G. Foulke Jr. in Washington, D.C., last December. Read more+
Other Articles
CMS 'conditions-for-coverage' update Generally welcomed by ASC groups
A federal Centers for Medicare and Medicaid Services (CMS) proposal to update the basic "conditions for coverage" that
ambulatory surgical centers (ASCs) must meet to provide Medicare or Medicaid services drew general praise from ASC representatives.
Read more+
AORN accepted as member Of National Quality Forum
AORN received formal acknowledgement Aug. 23 that its application to join the National Quality Forum (NQF) coalition of healthcare
and community leaders has been approved. Read more+
Abbreviations the culprit for 5%
Of medication errors, study
says
A review of medication errors reported to the U.S. Pharmacopeia (USP) MEDMARX program between 2004 and 2006 found that almost
5% of the medication errors were attributable to the use of abbreviations that resulted in miscommunication. Read more+
Court rules Medicare claims By doctors should be public
Armed with a federal district court ruling favoring disclosure, a nonprofit consumer research and information organization
in Washington, D.C., intends to create an Internet-accessible database reporting the "number of various types of major procedures
performed by each physician" who is reimbursed by Medicare. Read more+
News briefing for perioperative leaders
This month's news briefs cover new Joint Commission Resources MDRO consulting service, a report on improved emergency preparedness,
information on a new color-coded writstband tool kit, HAI prevention guidelines in Massachusettes, revised guidelines for
acute coronary artery disease, and much more. Read more+
ASC News
Need help calculating payments you'll receive for Medicare services under the rules recently unveiled by CMS? AAASC offers
a free online tool. This month's ASC roundup also includes studies on gastric banding procedures and a report comparing total-joint
replacement outcomes at orthopedic specialty hospitals against similar procedures performed in hospitals. Read more+
Future technology advances promise Big impact on perioperative practice
An increase in high-risk obstetric and pediatric surgical procedures associated with a predicted spurt in immigration,
together with stepped-up demand for surgical care from aging baby boomers, point to a dramatic rise in surgeries requiring
general anesthesia in the years ahead. Read more+
CMS issues final rules For inpatient payments
Medicare payments to hospitals will increase by an estimated 3.5% for Fiscal Year 2008, under final Inpatient Prospective
Payment System (IPPS) rules issued by the federal Centers for Medicare and Medicaid Services (CMS) early last month.
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World Conference on Surgical Patient Care The World of Perioperative Nursing: Evidence, Practice,
Future
October
1-4, 2007 COEX Center Seoul, South Korea Don't miss this unique learning experience! The World Conference
is expected to bring together close to 1,500 surgical nurses from around the world, approximately 25 poster presentations,
and over 20 exhibits representing industry leaders in the global perioperative arena.
What can you expect?
Four Days of Education Hear presenters from around
the world present the latest in perioperative practice and safety. Obtain solutions to your workplace challenges.
Networking Past World Conferences have brought together
perioperative nurses from over 40 different countries! You'll learn from the first-hand experiences of others and take
home a new vision for your profession.
International Fellowship Night Celebration A highlight
at the World Conference! Join your colleagues for an evening gathering where delegates are invited to dress in the traditional
attire of their home countries.
Visiting Seoul South
Korea is a country rich in culture, breathtaking architecture, unique dining, and much more.
Stay a few extra days to explore the city of Seoul with your colleagues!
Register early to receive a monthly e-mail about
the conference, including travel tips and tourist information about Seoul from June through September!
You are receiving this promotional email because you
are a member of AORN. Click to review AORN's Privacy Policy. We take your privacy seriously and pledge to keep our email updates as timely and pertinent to your stated needs as possible.
No matter how busy you are, there should still be plenty
of time for you to relax and enjoy yourself. Here are seven easy solutions for finding that personal time.
1. BLOCK
OUT SOME TIME. Restrict specific days and times of the week that you only use for fun or relaxing activities. Mark these
on your schedule so you don't schedule an appointment or meeting during these time frames.
2. PUT IT ON YOUR TO DO
LIST. To Do lists aren't just for tasks and chores. They're also for fun activities or relaxing moments.
3. SWITCH
OFF. Throughout your day, do a task and then do a fun or relaxing activity. Keep repeating in this order.
4. GIVE
IT AWAY. Do you have tasks you can delegate? If you're always trying to do everything yourself when you can get help from
a spouse, child, associate or outside source, you'll never have time for you. There are almost always others that can help.
5.
STREAMLINE. For two weeks, write down all of your tasks and how long they take you to perform. Analyze your log at the
end of the two weeks and determine which tasks need to be streamlined. Perhaps you might find that the two hours it's taking
you to clean each day can be streamlined to one hour, or the time it's taking you to get ready for work can be reduced by
20 minutes.
6. SAY 'NO' SOMETIMES. You don't have to say Yes to every single request for your time. So many people
wear themselves thin by being so agreeable. So if you're already making cookies for your daughter's bake sale, don't also
agree to babysit your neighbor's son in the same week. If you respect your time, others will too.
7. MAKE FUN A PRIORITY. Many
people consider fun and/or relaxation to be a low priority--something they only do if they get everything else done. Having
personal time is key to a balanced, healthy life. Although it shouldn't take over, it should show up regularly throughout
your day--just like your other important tasks.
Great tips to help simplify your life!
8 Can-Do Ways to Simplify Your Life
Life doesn't have to be work, work, work, from the second
you wake up to the second you go to bed. Try these 8 'anyone can do' ways to simplify your life.
1. Choose 10 Meals.
If you don't like having to come up with a different meal idea for each night of the week, why not come up with 10 standard
ones you just rotate? Put the work upfront into thinking through a variety of meals such as:
Day 1: Chicken Dish. Day
2: Pasta Dish. Day 3: Fish Dish. Day 4: Vegetarian Dish and so on.
Once the initial planning is done, you'll
never have to think about your meals again. Shake it up every 11th day and go out to eat, or order in.
2. Sign
up for automatic payment. More and more companies these days are allowing you to have your bill payments automatically
debited from your checking account. No more worrying about making out a check and having to drop it in the mail.
3.
Use what you have. If you have a crafty hobby, chances are you have crafty supplies piled high in your closet. Make it a point
to put a halt on buying yet more supplies, and instead use up those you already have. This applies to hobbies such as quilting,
scrapbooking, card making, knitting, and more.
4. Focus on an area each day. Rather than worrying
about everything you'd like to organize and/or clean in your home or office, choose just one area each day and focus on it
for a minimum of 15 minutes, and a maximum of one hour. This will help ensure you don't feel overwhelmed and will also give
you a rewarding feeling that you worked on something that has been on your mind.
5. Take 3. Take a look at your To
Do list and choose three tasks to work on today. Try to choose at least one A Priority, one B Priority, and you can toss in
another A, B or C Priority as your third choice. Don't work on anything else on your list until you've completed all three
of these.
6. Avoid unnecessary overload. Fill the dishwasher as soon as you're done eating, go through
your mail on a daily basis, empty your email inbox each night, fold clothes as soon as the dryer cycle ends--in other words,
if you don't delay on most tasks, they will never get out of hand.
7. Take off your shoes. If you
want to spend less time vacuuming, don't wear your outside shoes inside your house. Of course, this applies to anyone else
in your house and visitors. Less dirt and dust will be tracked in, which means less cleaning necessary. Plus, you'll save
the life of your carpet.
8. Kick back. Everyone needs time to simply kick back and do something relaxing,
even if it's for only 30 minutes each day--and I wholeheartedly recommend an hour whenever possible. Schedule this time on
your calendar. You are the only person who can control how your time is spent.
ANA: Working to Win Instead of Just Playing The Game For over seven years, ANA has been on record
as supporting the use of an Occupational Health and Safety Standard (OSHA) for safe patient handling -- versus promoting
voluntary guidelines In fact, ANA members, who had experienced back injuries and other musculoskeletal injuries
themselves ? testified twice in 2000 at OSHA public hearings and in the US Senate on behalf of an OSHA standard In
2002, ANA supported S. 2814, a federal bill that would require the US Department of Labor to reissue a rule to address
work related musculoskeletal disorders and workplace ergonomic hazards within two years In June 2003. ANA Board
approves position statement titled ?Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders?
in June 2003 In September 2003, ANA launched the Handle with Care® program whose goal is to establish a no
manual lift policy nationally. Primary components are Partnerships - Government agencies, state nurse associations, specialty
associations and student nursing groups. ANA also serves as a co-sponsor to the annual Safe Patient Handling Conferences
in coordination with the Tampa VA Patient Safety Center of Inquiry Outreach Web resources such as www.nursingworld.org/handlewithcare, speaking events, media interviews and publications Legislation/Regulation (see below) Education/Training
- Safe patient handling curriculum module for nursing schools funded through the National Institute for Occupational
Safety and Health (NOSH) and workshops In 2004, ergonomics was the ANA?s nationwide state legislative agenda In
2006, ANA and the House of Representatives Nursing Caucus sponsored a luncheon for over 30 representatives from House and
Senate offices to learn about how a Safe Patient Handling and Movement (SPHM) program can provide a secure way to move
patients and decrease injuries both for nurses and their patients Clearly, ANA's long track record on safe patient
handling is solid and strong We believe that our nation?s nurses need relief today in the form of a different legislative
approach that will be signed into law by the President We believe the nation is now facing a serious nursing
shortage & can no longer afford the estimated 12 percent of RNs who leave the profession because of back injuries ANA
is aggressively pursuing a proven approach successfully taken by six states that have enacted safe patient handling legislation
(WA, NY, OHIO, RI, TX and HI) ANA supports: o demonstration programs, o interest-fee loans and grants to
facilities to encourage them to purchase use and train lifting equipment, and; o studies to explore the impact of the
use of this equipment on nurse retention, patient outcomes, and workers compensation claims. ANA is working to
win by bringing together all the stakeholders at the table ANA is committed to building critical consensus toward
the introduction of viable federal legislation on safe patient handling
Learn How and When to Remove Jewelry From Pierced Patients
Robin Huiras
March 12, 2007 Tucked into the pastoral hills of northeastern
Ohio, the rural community of Bryan, population 8,389, isn't the sort of place most people envision when they think about body
piercing. The largely blue-collar residents of the William County seat take pride in its small-town atmosphere, characteristic
of farming communities throughout the nation's heartland. Despite Bryan's modest size and relative isolation from urban
areas ---- 50 miles separates it from Toledo, Ohio, and 55 miles separates it from Fort Wayne, Ind. ---- the community is
the sort of place its residents should imagine when they picture navel rings, tongue barbells, and Prince Alberts, a type
of male genital piercing. "Every community is [a place with pierced people]," says Barbara Rash, BSN, assistant director
of nursing for the emergency department at the Community Hospital and Wellness Center of William County in Bryan. "We are
a small community but we still have a piercing parlor. I think every community has people for whom piercing seems to be a
real identifying thing." In 2005 alone, upwards of 800,000 piercings were done nationally, according to figures gathered
during the 2005 Annual Association of Professional Piercers Conference and Exposition. It's a figure that comes as no surprise
to Rash. Within the past few years, more nurses and doctors at the 76-bed hospital have found themselves treating pierced
patients and asking questions about the necessity of and technique behind removing the jewelry. "We are here to serve everyone
and part of that is keeping up with those lifestyles so we can take care of them adequately," Rash says. "And that means being
able to remove their piercings if they have an infection, if they need surgery, or if they need a CT scan." Up until last
year, when emergency room nurses at Newton Medical Center, an 83-bed facility in Newton, Kan., needed to remove a patient's
body piercing they consulted a small box of tools containing screwdrivers, pliers, and various other devices, says Mitch Jewett,
RN, CEN, director of the emergency room. "We literally got the tools and if that didn't work, we would call maintenance
and ask if they had a thingamajig that might stretch this or pull that," Jewett says. "And, on the one hand, we laugh because
there are farm boys from Kansas working in the emergency room willing to do anything with a screwdriver, a ball peen hammer,
and duct tape ---- but that's not professional. "If it's my family member who comes in with something pierced and it needs
to come out, I hope the nurse has the right knowledge base and the right tools. And if a person has the ability to use the
proper tools, it just makes common sense to do so," Jewett says. Needled into action Until two years ago, however,
proper equipment was nonexistent, leaving nurses with only innovation and household tools to get jewelry out of patients needing
intubation, catheterization, emergency cesarean sections, and other procedures. "The big issue is that nowadays piercing
is becoming more and more commonplace," says Scott DeBoer, RN, MSN, CEN, CCRN, CFRN, flight nurse for University of Chicago
Hospitals. "Twenty years ago, people would stop in their tracks when they saw something as shocking as a guy with his ear
pierced. In 2002 there was a study that really opened my eyes done at a New York City college campus that showed 51% of the
undergraduate student population had piercings other than on ears. "But if you looked at medical journals, there is no
conformity on what healthcare providers should and shouldn't do with piercings. It's clear that most of the authors never
talked to body piercers," says DeBoer. To DeBoer, who was designing a lecture outlining the medical myths and research
realities of body piercings, it was glaringly obvious that his industry was not meeting the needs of a growing majority. So
the Dyer, Ind., resident set out to talk to body piercers. Not only was he interested in learning about how best to remove
the different kinds of piercings ---- there are upwards of 50 varieties ---- but also in gaining piercers' perspectives on
the appropriateness of removing the jewelry in medical settings. His search led him to Seattle resident Troy Amundson,
a professional body piercer for seven years and a certified emergency medical technician. "We came up with this idea that
we needed to create something for the hospital setting to show people how to safely remove this stuff and also to give them
some medical aspects of when these things really do need to come out," DeBoer explains. That idea turned into a business
venture called MedPierce, Inc., which supplies removal kits to medical facilities and educational agencies across the nation.
The kits contain appropriate removal tools, samples of common jewelry, an illustrated handbook with step-by-step removal instructions,
and instructional DVDs. "It's our intent to provide more than a product. Our goal is to establish a credible resource for
healthcare and public health officials about body piercing," says Amundson, who lobbies for body piercing legislation and
advises Seattle's public health department on revisions to its municipal code regulating piercing establishments. A
sticky education Contrary to what the majority of providers believe about removing jewelry ---- that jewelry should
almost always be taken out when tests or procedures involve the pierced area ---- medical research indicates that in the majority
of cases piercings don't have to be removed, DeBoer says. "Certainly if you're undergoing surgery and it's in the way,
that's a no-brainer," he explains. "A navel piercing would need to come out if you're doing an emergency, stem-to-stern cesarean
section. And if you have to insert a urinary catheter and the patient has a Prince Albert through the urethra, it'll have
to be removed." Tongue rings in patients needing intubation can remain or can be removed, depending on the urgency of the
situation. "The concern is that it's going to come undone and roll down the throat, but that's a hypothetical concern ----
it has never been documented in journals," DeBoer says. Mouth exams, ear exams, and genital exams, among others, can all
be done with piercings in place. And jewelry made of non-magnetic, implant-grade stainless steel and titanium, the same
materials used in joint replacement, would not have to be removed for an MRI, Amundson says. "I really hope (the kit) encourages
anyone in medicine to consider what the real problems are with piercing," says Amundson, who took over MedPierce, Inc. six
months ago. "When they provide a procedure, if the jewelry has to be removed, fine, but I would hope the professionals would
ask themselves why: 'Am I removing it to get it out of the way for a medical reason, or am I removing it because I am uncomfortable
with it?' " Piercing misconceptions With 25 years of nursing and 20 years of piercing experience, David Vidra,
a certified licensed practical nurse, has encountered his share of falsehoods about piercing, or body modification, in medical
facilities. Not only does he have multiple piercings and tattoos, but as president and founder of Cleveland, Ohio-based
Health Educators, he specializes in teaching healthcare providers, health department personnel, and piercers about bloodborne
pathogens, infection control, sterilization, wound care, and other body modification-specific topics. The 50-something
expects and is eager to correct untruths about the body modification community in his professional outreach, but he says he
cannot stand the misinformed beliefs he inevitably encounters when he's treated by healthcare providers. Lack of understanding,
much like lack of proper tools, hinders healthcare professionals from providing patients the best care possible, says Vidra,
adding that the information in the kit, which he purchased for use in his educational workshops, is just as valuable as the
tools. Healing influence In places like Bryan, Ohio, and Newton, Kan., the kit has increased the quality of care
for pierced patients. Just last month, says Jewett, a patient with an infected lip piercing visited Newton's emergency room. "I
grabbed the kit, took it into the room, looked at the kind of lip labret she had, opened it up to the picture, had the sample
jewelry for the doctor, and told him, 'This is what we're dealing with. This is how is comes apart.' [Then] basically we took
it right out," he explains. But the resource does so much more than equip nurses with the proper piercing removal training
and tools. "Our mission is to excel in health care by understanding and responding to the individual needs of those we
serve, and it doesn't matter if the patient happens to have a piercing or not," Jewett says. For more information on MedPierce,
Inc. visit http://medpierce.com. Robin Huiras is a freelance writer.
A 4-year-old boy lay on an operating table here a few weeks ago with a tumor that had eaten into his brain and the base
of his skull. Standard surgery would involve cutting open his face, leaving an ugly scar and hindering his facial growth as
he matured.
But doctors at the University of Pittsburgh Medical Center knew a way to avoid those devastating consequences. They removed
much of the tumor through the boy's nose.
Since then, doctors in New York and in France have announced they removed gall bladders through the vaginas of two women.
And doctors in India say they have performed appendectomies through the mouth.
It's a startling concept and a little unpleasant to contemplate. But researchers are exploring new ways to do surgery using
slender instruments through the body's natural openings, avoiding cutting through the skin and muscle.
Many questions remain about that approach. But doctors say it holds the promise of providing a faster recovery with less
pain and no visible scars. And in the brain, it can avoid a need for manipulating tissue that could disturb brain and eye
function.
For abdominal surgeries, going through the mouth, vagina or rectum would avoid the need to cut through sensitive tissues.
And deep inside the body, where tissue doesn't feel lasting pain, the procedures themselves might be less traumatic.
Some abdominal surgeries like bowel operations can require patients to spend a week or more recovering at home. With the
natural-opening surgery, the theoretical hope is that "they really can go back to work the next day," said Dr. David Rattner
of Massachusetts General Hospital.
"It would be like going to the dentist and getting a root canal," Rattner said. "It's not trivial, but it also isn't disabling."
Sometimes doctors even pass up one natural body opening for another. On the same day they treated the 4-year-old, doctors
in Pittsburgh operated on neck vertebrae of an elderly man through his nose. Usually, this operation would have been done
through the mouth.
But going through the nose meant the patient could start eating right away rather than waiting a few days. And he avoided
the risks of a feeding tube and a surgical hole in his throat to help him breathe, said neurosurgeon Dr. Amin Kassam.
Doctors at the medical center first reached the spine through the nose just two years ago, he said.
They have even removed brain tumors the size of baseballs through the nose, nibbling at them and withdrawing pieces the
size of popcorn kernels.
However, entry through the nose isn't feasible for brain tumors in some locations. That's why doctors had to remove the
rest of the 4-year-old's tumor another way, by going through the side of his skull. They used an incision designed to hide
behind his hairline.
The key to operating through body openings is specialized slender instruments that can be inserted into the natural channels,
along with devices that provide light and a video camera lens at the site of the surgery. Doctors watch their progress on
video screens as they manipulate the surgical instruments.
Sound familiar? It's much like laparoscopic surgery, which revolutionized the operating room more than 15 years ago. For
many operations, long incisions have been replaced with three or four holes, each maybe a quarter-inch to a half-inch wide.
That has vastly reduced pain and recovery time.
The natural-opening approach holds the promise of going a step beyond that by eliminating the need for those punctures.
"Getting rid of them completely is going to be not an evolutionary step, but a revolutionary step," said Dr. Marc Bessler
of New York-Presbyterian Hospital/Columbia University Medical Center.
He led the surgery in New York that detached and removed a woman's gall bladder through her vagina. The team also inserted
laparoscopic instruments into two small incisions in her abdomen, using one instrument to hold tissue out of the way.
A week after that surgery was announced, a French doctor said his team had removed a woman's gall bladder through her vagina
without any abdominal incisions. Instead, the team pierced her abdomen with a needle about a tenth of an inch wide. The needle
was equipped with a video camera system and also allowed doctors to inflate the abdomen to create a working space.
The surgery, performed April 2 on a 30-year-old woman at University Hospital of Strasbourg, was led by Dr. Jacques Marescaux
of the Institute for Research into Cancer of the Digestive System in Strasbourg. In a written statement, Marescaux said the
procedure left no abdominal scar.
Meanwhile, surgeons have shown increasing interest in removing brain tumors through the nose over the last five years or
so, noted Dr. Gail Rosseau, chief of surgery at the Neurologic-Orthopedic Institute of Chicago.
"This is the dawn of this phase of neurosurgery," said Rosseau, a spokeswoman for the American Association of Neurological
Surgeons. "This is exciting, it's new and it may well be better for our patients. In fact, we hope it will be. But it does
raise questions."
Cancers can come back if they're not completely removed, she noted. It's too soon to tell whether attacking tumors through
the nose leads to a higher rate of cancer recurrence than going through the skull, she said. Concerns like the risk of meningitis
from spinal fluid leakage also have to be addressed.
Today, most surgeons would go through the skull to remove baseball-sized tumors, she said, "but a decade from now? I don't
know."
As for abdominal surgery, a few procedures have been done in people, but nearly all the research so far has been in animals.
There are still plenty of questions and barriers to overcome.
For example, Rattner said, new tools must be developed to perform this kind of surgery. And while it makes sense that people
would recover faster from natural-opening surgery than laparoscopic procedures, that hasn't been proven yet, Rattner said.
Then there's the basic question of just what abdominal procedures make sense for a natural-opening approach. For women,
Bessler believes the gall bladder and appendix will be among those that will be removed through the vagina.
Rattner questions whether a natural-opening approach for removing those organs offers enough of an improvement over laparoscopy
— which can get a patient back to work in four to seven days — to make it worthwhile.
He sees more potential for procedures that replace surgeries that can keep a person out of work for weeks, like removing
a kidney, adrenal gland or a portion of the intestine. Or doing obesity surgery.
"It's not going to replace laparoscopic surgery, but it's going to have a niche somewhere," Rattner said. "We're trying
to figure out where that niche is going to be."
CheckSite System Promotes Safety in the Perioperative
Setting
By Christina Orlovsky, senior writer
Miscommunication at the handoff of patients going between the preoperative setting and the operating room
is one known culprit of costly medical error. In an effort to bridge the communication gap between perioperative clinicians,
CheckSite Medical has created a simple, yet high-tech, device to enforce surgical-site marking and reduce wrong-site surgeries:
an ID bracelet.
The CheckSite ID Bracelet is embedded with a miniscule radio frequency identification (RFID) chip that is
linked to a sensor in the hallway between the preoperative area and the operating suite. The chip will trigger an alarm if
patient-safety protocol is not completed.
The system also consists of a marker pen and a sticker that deactivates the sensor. Once a clinician marks
a patient?s surgical site, for example, he or she removes the sticker from the pen and places it on the bracelet, letting
other clinicians know that step has been completed and deactivating the sensor in the hallway.
CheckSite can be used to enforce other perioperative processes including confirmation of a current or updated
history and physical, confirmation that the informed consent process has been completed, confirmation of a preoperative nurse
to OR nurse patient handoff or confirmation of all of the above.
?Our aim is to facilitate better, or more consistent, communication between the preoperative nurse and the
OR nurse,? explained Stephen Chole, president of St. Louis, Missouri-based CheckSite Medical.
?Both clinicians are responsible for making sure the proper pre-op steps are completed, but what we have found
is that because of the busyness of the OR, it can be difficult to be consistent in getting the pre-op steps completed,? Chole
continued. ?The ones we focus on are safety-related?the big hitters as far as the pre-op process is concerned. Our system
ensures nurses agree on the items being completed before the patient is rolled into the OR. Once the patient is in the OR,
the train is running and it?s hard to slow it down. Problems are best corrected in the preoperative setting.?
Launched in late 2005 and first used at Barnes-Jewish Hospital, in St. Louis, the CheckSite System is currently
in place in more than a dozen hospitals nationwide and has been used with roughly 150,000 patients. The system costs about
$3 per patient. Chole said feedback has been positive and more hospitals continue to express interest.
?Of the hospitals that have used the system, there have been no wrong-site surgeries or near misses,? he said.
?The feedback has been outstanding. People in the OR have the best intentions, but human nature alone is not 100 percent.
This provides a fail-safe for clinicians if they happen to overlook something and it reminds them to get those things done.?
In 1986, American Association of Colleges of Nursing (AACN) developed the core standards for the Baccalaureate
Nursing Education. Then, in 1998, the Essentials of Baccalaureate Education for Professional Nursing Practice was revised
to meet the rapid changes in the health care industry and to manage the patient?s needs. Seven years later, AACN revisited
these core standards in order to redesign a more appropriate preparation for nurses to meet the new demands of the health
care industry. The new advances in the health care system, the fast growing scientific and technological advances, and the
shifting demographics necessitate the reevaluation of the current Baccalaureate Essentials to prepare a new breed of nurses,
to meet the new expectations of the consumer, and to uphold the standards of the nursing profession to the highest level.
On
February 14, 2007, the president of AACN, Jeanette Lancaster gave report on the on-going revision of the Baccalaureate Essentials.
This new revision project started last October 2006 and foresee its completion by 2008. The Joint Commission of Nursing Advisory
Council created a task force with various representatives from nursing education and representatives from the different practice
settings will be involved in this project.
Through collaborative partnership, the task force will develop the documents
recommending the revision for the Baccalaureate program. The task force will explore the various workplace needs, complexities,
and various competencies in the practice settings. This will address the creation of more suited nursing competencies, an
array of role expectations, and professionalism based on changing patient care issues and new scientific advances. These data
and patient outcome-driven inquiry and analysis will address the new nursing knowledge, skills, and attitudes to better prepare
the new generation of nurses. The task force will look into more realistic learning experiences for pre-licensure program
and learning experiences after graduation to facilitate the newly graduated nurse to transition for a new entry-level nursing
position.
The goal of this Task Force is to complete the revision of the Baccalaureate Essentials by July 2008. This
will give the members of AACN to review the new program and ready to be presented on the upcoming annual meeting in October
2008.
To learn more about this topic, visit the related links.
Nurses in Beacon
and Magnet designated Units and organizations report healthier work environments and higher job satisfaction
Study findings being released yesterday by the American Association of Critical-Care Nurses (AACN), the Gannett Healthcare
Group, and the Bernard Hodes Group found that nurses who work in organizations or units that have met or are pursuing the
national excellence standard of a Beacon or Magnet designation report healthier work environments and higher satisfaction
with their jobs. Several past studies have found that healthy work environments-characterized by strong communication and
collaboration between healthcare team members, among other factors-have a direct impact on increased patient safety and improved
patient outcomes.
The Beacon Award for Critical Care Excellence was established in 2003 by AACN and recognizes individual
critical care units as well as progressive care units that meet high quality standards, demonstrating exceptional care of
patients and their families while fostering and sustaining healthy work environments. The Magnet Recognition Program was developed
and is administered by the American Nurses Credentialing Center (ANCC), an independent subsidiary of the American Nurses Association
(ANA), recognizing healthcare organizations that demonstrate excellence in nursing care and professional nursing practice.
The survey of more than 4,000 acute and critical care nurses in all 50 states and the District of Columbia found the
most significant differences related to collaboration and communication, support for professional growth and development,
leadership and satisfaction, and patient outcomes. The study found that nurses who worked in Magnet organizations, Beacon
units, or those pursuing such designations were more satisfied with nursing as a career and with their current nursing positions.
Respondents also found frontline managers, who represent vital leadership in an organization as they understand the vision
and social structure, as having higher perceived skill levels in Beacon and Magnet organizations. These survey results continue
to add evidence to the fact that healthy work environments, particularly as they pertain to communication, collaboration,
and staffing, are related to increased patient safety and improved patient outcomes. At both the unit and organization level,
nurses in the study rated the current quality of care as significantly lower in organizations and units that had not achieved
and were not pursuing excellence designation.
MSNBC.com
Environment: Easy to Be Green
By Joan Raymond
Newsweek
Jan. 8, 2007 issue - You don't have to ditch leather or sell your car to help the environment. We've
gathered 10 simple tips for living greener in 2007. Hey, it's a lot easier than losing those 15 pounds.
1. Feed the Bees Pesticides, pollution and habitat destruction are taking a toll on
the birds and insects that pollinate about 80 percent of the world's food supply (or about one out of every three bites of
food we eat), says Rose Getch of the National Gardening Association. To lend a helping hand, plant a pollinator garden. Yellow,
blue and purple flowers will attract bees, while red and orange will attract hummingbirds. For more information, go to kidsgardening.com.
2. Clean Up, Naturally Household chemicals contribute to both in-door and outdoor
pollution. This year, use more natural cleaners like the Greening the Cleaning line at imusranchfoods.com.
Or make your own using vinegar, baking soda and lemon juice. For some great tips on green cleaning, go to eartheasy.com.
3. Ditch Your Junk Not only is junk mail annoying, it kills trees. Do yourself?and
the forests?a favor by getting off the mailing lists of companies you don't support. You can contact the firms yourself, or
check out subscription services like greendimes.com or 41pounds.org that promise to lighten
your junk-mail load. For more information: thegreenguide.com.
4. Air Your Laundry Make like Grandma and line-dry your clothes once in a while. It
not only saves money, but also decreases your yearly carbon- dioxide emissions. Likewise, run your washer on cold whenever
possible?and use it only when it's full.
5. Recycle Your Gadgets Don't clog landfills with old electronics. If you're dumping
a computer, manufacturers like Dell (dell.com), HP (hp.com) and Apple (apple.com)
offer recycling options. Or consider donating. The National Cristina Foundation (cristina.org) will hook
up your old PC or Mac with a nonprofit organization. Drop off your old cell phone at your local Staples store as part of a
Sierra Club recycling effort (sierraclub.org/cellphones/). To find a drop-off center for rechargeable batteries
and cell phones, check out the nonprofit Call2Recycle program at rbrc.org. Take advantage of community resources
like hazardous-waste pickup or e-waste recycling events.
6. Cut the Lights Trade your old incandescent light bulbs for compact fluorescent
ones, says Jenny Powers of the Natural Resources Defense Council. They use about 70 percent less energy than regular bulbs
and last 10 times longer. For help in picking the best bulb for your needs, go to energystar.gov. Also, plug
all your major electronics into a power strip, suggests eco-lifestyle expert Danny Seo, author of "Simply Green Giving" ($19.95;
HarperCollins). Appliances and e-gadgets use electricity even
by Susan Cantrell, ELS
A review of measures taken to address a 2004 outbreak of the highly infectious Norwalk virus at The Johns Hopkins Hospital
has provided the first solid documentation of expenses and efforts in the United States to stop the infection from spreading
among patients, staff and visitors.
The 2008 Edition of the Perioperative Standards and Recommended Practices is now available! Plan now to put the new book and
CD-ROM on your reference shelf and incorporate numerous additions and changes into your perioperative practice. 
A growing number of hospitals are using online bidding technology to manage traveling and per-diem nurse staffing requirements,
particularly keeping track of and filling open shifts. The goal isn't just filling an open shift position at the lowest cost.
Well-designed bidding systems enable perioperative managers to match skills to case requirements and offer flexible work arrangements
to a multigenerational workforce. 
This month's news briefing for perioperative managers includes an update on hospitals' voluntary compliance with Medicare
quality-reporting guidelines, a healthcare supply chain coalition's push for standardized organization and product identifiers,
two proposed AORN recommended practices currently up for public comments, a study finding a big mortality drop for six quality-of-care-dependent
surgical procedures and much more. 
This month's ASC News Review includes several ASC-specific Joint Commission initiatives, such as an ongoing study of the risks
of inaccurate or incomplete preoperative nursing assessments conducted by ASCs, as well as a research study comparing the
safety and prices charged for laparoscopic cholecystectomies when performed in hospital outpatient departments and freestanding
surgical centers. 
The spotlight is on nursing competency
Healthcare facility and perioperative managers will be able to access information and resources on compliance with federal
safety and health rules in a convenient new Web tool made available by the federal Occupational Safety and Health Administration
(OSHA). AORN leaders signed an alliance agreement with OSHA Administrator Edwin G. Foulke Jr. in Washington, D.C., last December.
AORN received formal acknowledgement Aug. 23 that its application to join the National Quality Forum (NQF) coalition of healthcare
and community leaders has been approved. 
A review of medication errors reported to the U.S. Pharmacopeia (USP) MEDMARX program between 2004 and 2006 found that almost
5% of the medication errors were attributable to the use of abbreviations that resulted in miscommunication. 
CheckSite System Promotes Safety in the Perioperative
Setting
MSNBC.com