OR Connection Magazine - Volume 5 Issue 4

VOLUME 5, ISSUE 4
The
Aligning practice with policy to improve patient care
Volume 5, Issue 4
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The Patient Handout Forms & Tools
OR Connection
Caring for Your Surgical Incision at Home

The following are general guidelines. Consult your surgical team for more specific instructions.
Bathing and Showering

Most incisions should be kept dry for several days after surgery, except for incisions closed
with surgical glue. It is usually safe to allow glued incisions to get wet while showering or
bathing. It is important, however, to dry the area around the incision carefully after washing.
Physical Activity and Exercise

Avoid any activity that pulls on the edges of the incision or puts pressure on it. Walking and
other light activities are encouraged to restore normal energy levels and digestive functions.
Do not, however, participate in sports, engage in sexual activity or lift heavy objects until after
your postoperative checkup.
Aspirin
Avoid aspirin or over-the-counter medications containing aspirin for a week to 10 days after
Never miss an issue of The OR Connection! surgery. Aspirin interferes with blood clotting and makes it easier for bruises to form near
the incision.
Subscriptions are free and signing up is a snap!
Sun Exposure
Subscribing to The OR Connection guarantees that you’ll To subscribe, simply go to www.medline.com/orconnection. As an incision heals, the new skin that forms over the cut is very sensitive to sunlight and
continue to receive this info-packed magazine and won’t miss You will need to provide: will burn more easily than normal skin and lead to worse scarring. Keep the incision area
out on our industry updates and articles addressing on-the- Your name covered from direct sun exposure for three to nine months in order to prevent burning and
job issues and tips on caring for yourself! Facility and position severe scarring.
Mailing address
E-mail address General Hygiene
Infection is the most common complication of surgical procedures. It is important, therefore,
to minimize the risk of an infection when caring for your incision at home.
We also welcome any suggestions you might have on how we can continue to improve
The OR Connection! Love the content? Want to see something new? Just let us know!
Observe the following precautions:
• Wash your hands carefully after using the toilet and after touching or handling trash;
pets and pet
Content Key equipment; dirty laundry and anything else that is dirty or has been used outdoors
We've coded the articles and information in this magazine to indicate which patient care • Ask family members, close friends, and others to wash their hands before contact
initiatives they pertain to. Throughout the publication, when you see these icons you'll with you
know immediately that the subject matter on that page relates to one or more of the • Avoid contact with family members and others who are sick or recovering from a
following national initiatives: contagious illness
• IHI's Improvement Map • Stop smoking (smoking slows down the healing process)
• Joint Commission 2009 National Patient Safety Goals
• Surgical Care Improvement Project (SCIP)
We've tried to include content that clarifies the initiatives or gives you ideas and tools Adapted from www.surgeryencyclopedia.com/Fi-La/Incision-Care.html
for implementing their recommendations. For a summary of each of the initiatives,
see pages 10 and 11.
Aligning practice with policy to improve patient care 111

Editor
Sue MacInnes, RD, LD
PATIENT SAFETY
Clinical Editor
10 Three Important Initiatives for Improving Patient Care
Alecia Cooper, BS, MBA, RN, CNOR
Senior Writer
12 Patient Safety News
Carla Esser Lake 20 Conversation with Dr. Peter J. Pronovost
Creative Director 24 Checking it Twice: Yes! Checklists Do Save Lives
Mike Gotti 39 Why the Universal Protocol Hasn’t Eradicated Patient Harm
Clinical Team 42 A New Guidebook for Patient Safety in the OR Page 24
Jayne Barkman, BSN, RN, CNOR
46 They’re Lurking in the Operating Room and Beyond
Margaret Falconio-West, BSN, RN, APN/CNS,
CWOCN, DAPWCA 74 5-Step Approach for Avoiding VAP
Rhonda J. Frick, RN, CNOR
Anita Gill, RN OR ISSUES
Kimberly Haines, RN, Certified OR Nurse
36 Preventing Sharps Injury in the OR
Carla Nitz, BSN, RN
Claudia Sanders, RN, CFA
55 Medline Joins Greening the Operating Room Initiative
Megan Shramm, RN, CNOR, RNFA 60 Stuck Like Surgical Glue
Angel Trichak, RN, BSN, CNOR Page 60
Perioperative Advisory Board SPECIAL FEATURES

Larry Creech, RN, MBA, CDT 7 Pink Glove Survey Comments
Carilion Clinic, Virginia
14 Third Annual Prevention Above All Conference Highlights
Sharon Danielewicz, MSN, RN, RNFA
St. Luke’s The Woodlands, Texas
30 Patient, Heal Thyself
Tracy Diffenderfer, MSN, RN 56 3 Checklists on the Cleaning and Disinfection of
Vanderbilt University Medical Center, Tennessee Endoscopic Equipment
Barb Fahey RN, CNOR 69 Product Spotlight: Medline Bioguard Barrier Dressings
Cleveland Clinic, Ohio Page 74
92 Pink Glove Dance: The Sequel
Susan Garrett, RN
Hughston Hospital Inc., Georgia
Zaida I. Jacoby, MA, MEd, RN
CARING FOR YOURSELF
NYU Medical Center, New York 78 Get Set for Winter Illness Season
Jackie Kraft, RN, CNOR 84 8 Principles for Achieving Inner Peace
Huntsville Hospital, Alabama
96 Healthy Eating: Crock Pot Chili
Tom McLaren
Florida Hospital, Florida
FORMS & TOOLS
Susan Phillips, RN, MSH, CNOR Page 84
University of North Carolina Hospitals 99 AORN Surgical Time Out
Donna A. Pritchard, BSN, MA, RN, CNOR, NE-BC 100 SCOAP Surgical Safety Checklist – Ambulatory Surgery
Kingsbrook Jewish Medical Center, New York
101 SCOAP Surgical Safety Checklist
Debbie Reeves, MS, RN, CNOR
Hutcheson Medical Center, Georgia
103 Wrong-Site Surgery Prevention Tool
Diane M. Strout, BSN, RN, CNOR 105 Medicare & the New Healthcare Law
St. Joseph Medical Center, Washington 109 Tips for Safer Surgery
111 Caring for Your Surgical Incision at Home
Page 92
About Medline
Medline, headquartered in Mundelein, IL, manufactures and distributes more than Meeting the highest level of national and international quality standards, Medline is FDA
100,000 products to hospitals, extended care facilities, surgery centers, home care QSR compliant and ISO 13485 registered. Medline serves on major industry quality
dealers and agencies and other markets. Medline has more than 800 dedicated committees to develop guidelines and standards for medical product use including
sales representatives nationwide to support its broad product line and cost manage- the FDA Midwest Steering Committee, AAMI Sterilization and Packaging Committee
ment services. and various ASTM committees. For more information on Medline, visit our Web site,
www.medline.com.
©2010 Medline Industries, Inc. The OR Connection is published by Medline Industries, Inc. One Medline Place, Mundelein, IL 60060. 1-800-MEDLINE.

The OR Connection
Letter from the Editor
Another New Year is here! It’s a great time to reminisce, to make our New Year’s resolu-
tions and set our goals for 2011. Do you ever just stop and think about what was happening
this time last year or even five years ago? Do you think about what you were doing then?
Have you changed responsibilities, or maybe even careers? Did you get married, have a child,
become a grandparent, move, have to deal with a tragic situation … And when you think back,
do you ever say, “I can’t believe I’ve come this far.” Because if you haven’t, you should!
You should recognize and celebrate your achievements. I know, I know, at some point you have to get back to work
Those milestones are what will continue to inspire you and and deal with reality and everyday pressures. But it is
push you to be your very best. And, when you are at your easier to do when you make time for yourself and your
best and do your best, everyone wins…especially the family. I realize it’s hard to do everything, know every-
patients you are caring for. So, for 2011, I hope you will thing, remember everything…that is why in this issue of
take care of yourself. You are so important to your patients. The OR Connection, you are going to learn more than you
Sometimes it takes being a patient or the family member probably ever wanted to know about checklists. On the
of a patient to really appreciate all that you do. I’ve been cover isn’t just another handsome face. It is Dr. Peter
there, and so have many, many of the people I work with. Pronovost, a well-known advocate of patient safety,
We all thank you. quality and the infamous checklist. On page 20, he tells
his own personal story about his father and how it has
To set the tone for 2011, you might want to start reading on inspired him to champion a culture of safety. Whether your
page 84, “8 Principles for Achieving Inner Peace.” There is checklist is healthcare-related or a checklist for travel or a
nothing better than an inspirational article like this one to social event, it is easy to forget the simplest things when
get those New Year’s resolutions and goals flowing. High- our minds are buzzing. We should embrace and adopt
light the article, take notes, think about the message…and checklists and encourage others to do likewise. If one
then figure out what YOU are going to do to make 2011 the life is saved or one error is avoided, it’s worth it, don’t
best ever!! Once you’ve put your plan together, look again you think?
at the pictures of the pink glove dancers. Take note of the
This edition is packed full of stories and ideas you can use
hospitals involved, look at the people’s faces, feel their joy.
in your profession as well as in your personal life. You are
Breathe in all those positive vibes. Then set the magazine
the face of health care. Thank you for making a difference
aside and do something for yourself, something that makes
in so many people’s lives. And don’t forget. Step one is
you feel good. Surprise a co-worker with a smile, ask them
making sure you take care of YOU.
about their holiday, get them a cup of coffee. Or, listen to
your child or your spouse talk about their day. Be there, in
the moment, and forget everything else that is distract-
Sue MacInnes, RD, LD
ing you and taking time away from living.
Editor
4 The OR Connection
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Only Medline’s Pink Pearl™ gloves combine Medline Industries, Inc.
©2010 Medline Industries, Inc. Medline is a registered trademark and Pink Pearl ©2010 Medline Industries, Inc. Medline is a registered trademark and Pink
is a trademark of Medline Industries, Inc. Pearl is a trademark of Medline Industries, Inc.
The results are in!

We’ve tallied your votes and compiled your thoughts about Medline’s pink gloves
and the Pink Glove Dance. Thank you for your heartfelt comments and participation
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Turn the page to find the winner!

54% Voted for Pearls!
Yes, They’re Genuine.
Only Medline’s Pink Pearl™ gloves combine

Medline is a registered trademark
and Pink Pearl is a trademark of
Medline Industries, Inc.
6 The OR Connection
A
pink glove survey
What our readers said:
Q
It means unity, joy, excitement, a cause
“on the go” for all involved.
Shannon Sessoms, RN, BSN, CNOR
Southeast Missouri Hospital
Cape Girardeau, MO
Awareness! Hope! While in the OR I told

co-workers and the patient about this.
It raised our spirits. Big company
that CARES.
Deb Cimino, RN, BSN, CPSN, CNOR
Yardley Plastic & Reconstructive Surgery
Yardley, PA
Celebrating the lives of two of our nurses

who died—and the two who are still
with us.
MJ Balun
What does the Naples Day Surgery
Naples, FL
Pink Glove Dance It is a fun but touching video that shows

mean to you? the true concern healthcare workers have
for people with breast cancer.
Holly Creel, RN
The Kirklin Clinic
Warrior, AL

What does the Pink Glove Dance mean to you?
Left to right:
Tina Hollis, Patrick
Montgomery and
Cindy Gibson.
Co-workers in the Those with cancer are not alone.
surgery department
at Northeast We are out there standing beside
Alabama Regional them and showing our support.
Medical Center in
Herflin, AL. Kathleen Ingraham
FirstHealth Moore Regional Hospital
Pinehurst, NC
My mother had breast cancer, so it Shows how much healthcare workers

means everything. want to make a difference toward
Tina Hollis recognition, education and care of
Northeast Alabama Regional Medical Center breast cancer.
Herflin, AL
Susan Karns, CST, CFA
Kettering Medical Center - Sycamore
Hope for patients with breast cancer. Franklin, OH
Beautiful women, strength, good fun.
Patricia Nieszel, RN People from all different walks of life
Algonquin Surgery Center coming together for a common cause
Crystal Lake, IL – fighting breast cancer.
Sue Montgomery, RN
It shows how caring healthcare workers Foothill Presbyterian Hospital
of ALL types are towards supporting Glendora, CA
the cause!
Wonderful healthcare providers, not
Helen Aylward, RN, BSN, L.Ac.
Maine Medical Center professional dancers, working hard to
Portland, ME spread the word about breast cancer
awareness.
It made me cry to see the teamwork that Mary Valley, RN, CNOR
went into making it. I’m a breast cancer Frisbie Memorial Hospital
Rochester, NH
survivor.
Carolyn Meyer, RN, BSN, CNOR
Joy for cancer survivors and hope
St. John Medical Center
Bartlesville, OK for more.
Carol Athey, RN, MSN, CNOR
Woodland Heights Medical Center
As a breast cancer survivor it means so Lufkin, TX
much to know that many people care and
want to show it - keep it up! It makes me smile.
Ellen Whitehead, RN, CNOR Debra Ann Caise, RN, BSN
Georgia Surgical Provena St. Mary’s Hospital
Acworth, GA St. Anne, IL
8 The OR Connection
As a breast cancer survivor,
every time I see the videos I cry
The dance demonstrates the joy of with gratitude that so many people
living while increasing awareness care and did something so fun
about breast cancer. and positive as a response. Thank
Paula Bishop, RN, MSN, CNOR you to everyone who participated.
Aultman Hospital And thank you to so-hip Portland
Canal Fulton, OH
for getting the ball rolling. And as a
lifetime rock and roller, dancer and
The closer we get to a cure! I lost a silly person, every time I see these
sister and have a sister who is a survivor folks dance and carry on, I laugh and I am infused with love of
going on 10 years now! Very close to life and humanity. Boy do they get their groove on!
my heart.
Lynetta Baldwin I was diagnosed with breast cancer in mid-2004. I had two
Advanced Surgical Care lumpectomies and two months of radiation, and have been
Creve Coeur, MO
free and clear ever since (as of October 2010). I had very
good care in Marin County, CA.
A hospital works as a unified unit to
complete its mission. I made some wonderful friends in my support group and
Colleen Witt, RN BSN became closer to many of the friends I already had. Besides
Roswell Park Cancer Institute
my support group, I have about ten women friends who
Buffalo, NY
have had breast cancer. I would never wish it on anyone as
A way to show support for breast a life experience (I don’t believe that things like this happen
to teach us a lesson, but rather that we use what happens
cancer survivors.
to us in a way that teaches us something), but I used it to
John Ratliff, BS, CST, FAST
York Technical College recommit myself to the best health and the best appreciation
Rock Hill, SC of life and friendships that I can muster, which is pretty dang
good. Every single day counts, as does every single person.
People getting involved to bring
awareness to breast cancer. In the pink,
Francine Falk-Allen
Darlene McCraney, RN San Rafael, CA
South Central Regional Medical Center
Laurel, MS
It energizes you and makes you want to

move, especially when you see everyone
working toward the same goals.
Jerlene McClain, RN, BSN, MHR, CNOR
Reynolds Army Community Hospital - Fort Sill
Lawton, OK

Three Important National Initiatives
for Improving Patient Care
Achieving better outcomes starts with an understanding of current
patient-care initiatives. Here’s what you need to know about national
projects and policies that are driving changes in care.
1 IHI Improvement Map

Origin: Launched by the Institute for Healthcare Improvement (IHI) in January 2009
Purpose: To help hospitals improve patient care by focusing on an essential set of processes needed to
achieve the highest levels of performance in areas that matter most to patients.
Hospitals sign up through IHI and can choose to implement some or all of the recommended interventions.
IHI provides how-to guides and tools for all participating hospitals.
The IHI Improvement Map covers the entire landscape of outstanding hospital care to help hospitals make sense of countless requirements
and focus on high-leverage changes to transform care. There are 70 processes grouped into three domains: leadership and management,
patient care and processes to support care.
2 Joint Commission 2011 National Patient Safety Goals

Origin: Developed by Joint Commission staff and the Patient Safety Advisory Group
(formerly the Sentinel Event Advisory Group)
Purpose: To promote specific improvements in patient safety, particularly in problematic areas
Joint Commission-accredited organizations are evaluated for compliance with these goals. The Joint Commission offers
guidance to help organizations meet goal requirements.
Over the next year, the current National Patient Safety Goals (NPSGs) will undergo an extensive review process. As a result,
no new NPSGs will be developed for 2011; however, revisions to the NPSGs will be effective in 2011.
3 Surgical Care Improvement Project (SCIP)

Origin: Initiated in 2003 as a national partnership. Steering committee includes the following
organizations: CDC, CMS, ACS, AHRQ, AHA, ASA, AORN, VA, IHI and the
Joint Commission
Purpose: To improve patient safety by reducing postoperative complications
Goal: To reduce nationally by 25 percent the incidence of surgical complications by 2010
SCIP aims to reduce surgical complications in three target areas. Participating hospitals collect data on specific process and
outcome measures. The SCIP committee believes it could prevent 13,000 perioperative deaths and up to 300,000 surgical
complications annually (just in Medicare patients) by getting performance up to benchmark levels.
10 The OR Connection
Patient Safety
IHI Improvement Map: 73 Processes to Transform Hospital Care

The IHI Improvement Map is an online tool that distills the best knowledge available on the key process
improvements that lead to exceptional patient care.
1. Anticoagulation Management 1. Central Line Bundle

3 New Key Processes as of June 2010 Top 5 Key Processes Shared by Improvement Map Users
2. Essential Care for Frail Older Patients 2. CA-UTI

3. Glycemic Control in Non-Critically Ill Patients 3. Anti-Biotic Stewardship
4. Falls Prevention
5. Heart Failure Core Processes
To learn more about the IHI Improvement Map and the 73 processes to transform hospital care, go to www.ihi.org/imap/tool
Joint Commission 2011 National Patient Safety Goals

Effective January 1, 2011:
• Improve the accuracy of patient identification. • The organization identifies safety risks inherent in
• Improve the effectiveness of communication its patient population.
among caregivers. • Universal Protocol for Preventing Wrong Site,
• Improve the safety of using medications. Wrong Procedure, and Wrong Person Surgery.™
• Reduce the risk of healthcare-associated
infections.
• Accurately and completely reconcile medications
across the continuum of care.
To learn more about National Patient Safety Goals, go to www.jointcommission.org.
Surgical Care Improvement Project (SCIP): Target Areas

1. Surgical infections
By the numbers:
• Antibiotics, blood sugar control, hair removal, perioperative • 3,740 hospitals are submitting
temperature management data on SCIP measure #9, representing
• Remove urinary catheter on Post Operative Day (POD) 1 or 2 75 percent of all U.S. hospitals
2. Perioperative cardiac events • Currently, SCIP has more than 36
• Use of perioperative beta-blockers association and business partners
3. Venous thromboembolism
• Use of appropriate prophylaxis
Visit www.qualitynet.org

PATIENT SAFETY NEWS
APIC, CDC, Other Infection Control Organizations Death Rate Six Times Higher for Hospital Patients
Pledge to Eliminate HAIs1 with HAIs3
Action steps published in AJIC Adults who developed health care-associated infections
A number of professional healthcare organizations, (HAIs) due to medical or surgical care while in the hospital in
i n cluding the Association for Professionals in Infection 2007 had a death rate six times higher than patients without
Control and Epidemiology (APIC), the Society for Healthcare an HAI, according to the latest News and Numbers published
Epidemiology of America (SHEA), the Infectious Diseases by the Agency for Healthcare Research and Quality (AHRQ).
Society of America (IDSA), the Centers for Disease Control
and Prevention (CDC) and others have joined together to Patients with HAIs also had to stay in the hospital an
move toward the elimination of healthcare-associated infec- average of 19 days longer. On average, the cost of a hospital
tions (HAIs). They announced their plan in a white paper, stay of an adult patient who developed an HAI was about
“Moving Toward Elimination of Healthcare-Associated Infec- $43,000 more expensive than the stay of a patient without
tions: A Call to Action,” published in the November 2010 issue an HAI. AHRQ also discovered that:
of the American Journal of Infection Control (AJIC). • In 2007, about 45 percent of patients with HAIs
were 65 or older, 33 percent were 45 to 64 and 22
The group proposes to eliminate healthcare-associated percent were 18 to 44.
infections through a series of action steps, as outlined in the • Patients in the 45 to 64 age group had the highest
paper: rate of HAIs.
• Adherence to evidence-based practices • The top three diagnoses in hospitalized adult patients
• Aligning financial incentives who developed HAIs were septicemia (12 percent),
• Innovation and research adult respiratory failure (6 percent) and complications
• Gathering data for action from surgical procedures or medical treatment
(4 percent).
New Hampshire Hospital Initiative Aims to Eliminate
Harm to Patients by 20152 References
In a new effort to promote better and safer patient care, the 1. Cardo D, Dennehy PH, Halverson P, Fishman N, Kohn M, Murphy CL, et al.
Moving toward elimination of healthcare-associated infections: a call to action.
New Hampshire Hospital Association and Foundation for American Journal of Infection Control. 2010;31(11):1101-1105. Available at:
Healthy Communities recently began a new initiative to elim- http://www.journals.uchicago.edu/doi/pdf/10.1086/656912. Accessed October
25, 2010.
inate harm to patients by 2015.
2. New Hampshire’s hospitals commit to eliminate harm [news release].
Concord, NH: New Hampshire Hospital Association; September 27, 2010.
The definition of “harm,” according the New Hampshire www.nhha.org/WhatsNewFiles/EliminateHarm092710.pdf. Accessed October
25, 2010.
initiative, refers to an injury associated with medical care that 3. Health care-associated infections greatly increase the length and cost of
requires or prolongs hospitalization and/or results in perma- hospital stays. Agency for Healthcare Research and Quality website. October
2010 feature story. Available at: www.ahrq.gov/research/oct10/1010RA1.htm.
nent disability or death.
Accessed October 25, 2010.
A statewide steering committee will spearhead the New

Hampshire Eliminate Harm Initiative and identify which
aspects of harm hospitals will target for elimination.
Medline Partners with The Joint
Commission to Help Solve
Healthcare Quality and Safety Issues
Medline Industries, Inc. has signed an agreement with the Joint “Medline is proud to support and share in the mission of solving
Commission Center for Transforming Healthcare to contribute healthcare’s most critical safety and quality problems,” said
financially to the Center’s Endowment Fund. The Center for Andy Mills, president of Medline. “Medline’s approach is to
Transforming Healthcare was developed to help solve health- ‘Make it hard for the healthcare worker to do the wrong thing.’
care’s most critical safety and quality problems. The Center is studying some of the most pressing issues
facing providers, bringing together teams of experts to design
In this effort, Medline is joining other leading healthcare and test practical solutions to healthcare’s everyday challenges.”
organizations in their commitment to eliminate preventable
complications and transform healthcare. Issues the Center is working on include Hand Hygiene,
Surgical Site Infections, Wrong Site Surgery and Hand-off
Communication.
Ways to improve hand-off communication Hospitals and Healthcare Systems Participating

Healthcare organizations have long struggled with errors and in the Hand-Off Communication Project
issues associated with passing along critical patient information
• Exempla Lutheran Medical Center,
from one caregiver to the next, also known as hand-off
communication. Wheat Ridge, Colorado
• Fairview Health Services, Minneapolis, Minnesota
The Center and participating hospitals set out to solve these • Intermountain Healthcare LDS Hospital,
problems and recently released some new solutions using the
Salt Lake City, Utah
acronym SHARE.
• The Johns Hopkins Hospital, Baltimore, Maryland
Standardize critical content by providing details of the patient’s • Kaiser Permanente Sunnyside Medical Center,
history to the healthcare worker who will be taking over the Clackamas, Oregon
patient’s care, emphasizing key information about the patient.
• Mayo Clinic Saint Marys Hospital,
Hardwire within your system, which includes developing stan- Rochester, Minnesota
dardized forms, tools and methods, such as checklists to assist • New York-Presbyterian Hospital, New York
in making the hand-off successful.
• North Shore-LIJ Health System Steven and Alexandra
Allow opportunity to ask questions and use critical thinking Cohen Children’s Medical Center, New Hyde Park,
skills when discussing a patient’s case as well as sharing and New York
receiving information as an interdisciplinary team.
• Partners HealthCare, Massachusetts General
Reinforce quality and measurement, which includes holding Hospital, Boston
staff accountable, monitoring compliance with use of stan- • Stanford Hospital & Clinics, Palo Alto, California
dardized forms, and using data to determine a systematic
approach for improvement.
Educate and coach, which includes organizations teaching

staff what constitutes a successful hand-off and making suc-
cessful hand-offs an organizational priority.

Third Annual Prevention Above All Conference
Strategies for Thriving in the

New Era of Healthcare Reform
The heat is on in health care like never before. Error prevention, there is only one vehicle for cost containment: limiting payment
efficiency and cost containment have been top priorities for a to providers.
very long time, but now, with the introduction of healthcare re-
form, they are absolutely critical for survival, according to Joint Dr. Chassin cautioned, “You will never be paid better than you
Commission President Mark Chassin, MD, MPP, MPH. are being paid now. This was true six months ago, it’s true now,
and it will be true tomorrow and next week.”
What to expect from healthcare reform

So how do healthcare providers control costs and avoid major
Dr. Chassin delivered the keynote address at Medline’s 3rd
payment cuts and benefit reductions while also maintaining
Annual Prevention Above All Conference devoted to sharing
quality? Dr. Chassin outlined several keys to survival in today’s
new strategies for delivering cost-effective, high-quality, evi-
era of healthcare reform.
dence-based health care. An audience of more than 100 hos-
pital CEOs, chief nursing officers and other executives attended
Employ a quality-driven strategy to eliminate overuse of health
the meeting August 16 and 17, 2010, in New York City.
services. Examples include discontinuing wasteful practices
such as prescribing antibiotics for colds and inducing labor
“Today’s message is clear,” Dr. Chassin said. “Solve safety and
earlier than 39 weeks.
quality problems. Don’t say you’re trying; just solve them. Take
care of 30-plus million more people in your organizations.
“This is one part of health policy that has not received any
Become or participate in an accountable care organization. Fig-
attention,” Dr. Chassin explained. “It’s been overlooked for
ure out bundled payments. Adopt electronic medical records
decades in the research community. We must come together
quickly. And one more thing. You can’t have any more money.”
to do this.” Two more keys to survival are eliminating the waste
inherent in needlessly complex care delivery processes and
Overall, Dr. Chassin explained, healthcare reform increases
putting an end to preventable complications.
coverage while experimenting with some new payment and
care delivery ideas. Reform will increase federal costs, and
Special Feature
Deborah Adler, Trent Haywood,

Mark Chassin and Mikel Gray
answer questions from the
audience at the Third Annual
Prevention Above All Conference
held at the Hudson Theatre in
New York City.

A look into the future
Speaking from his experience as CEO of New York City’s Mount
Sinai Hospital, one of the nation’s largest and busiest hospitals,
Wayne Keathley provided a firsthand look at what he predicts
will be the norm for the average U.S. hospital amidst the new
era of healthcare reform—having to do a lot more with a lot less Left: Keynote speaker
at average capacity levels of 95 percent. Joint Commission President
Mark Chassin, MD, MPP, MPH.
“A fair number of you probably don’t recognize the kind of con-

gestion, overcrowding and difficulties with flow that I’m about
to describe,” Keathley said. “I would ask you to indulge in a lit-
tle suspension of disbelief and assume for a minute that as
health reform evolves, possibly because of a whole new group
of patients who will come to you for care … and more likely
because the economics will require you to rethink capacity and
the way you manage it — that the situation I’m going to
describe for us, in fact has some meaning for you.”
Mount Sinai is operating at 95 percent capacity, and they are

currently working with GE Healthcare to implement new
systems to accommodate this level of activity.
Keathley advocates improvement through fixing systems, Above (left to right): Medline
not by adding more resources. For example, whereas hospi- President Andy Mills, Deborah
tals often rely on intuition and personal judgment when man- Adler, Medline Chief Marketing
Officer, Sue MacInnes, RD, LD,
aging patient flow and locating empty beds, Keathley suggests Atul Gawande, MD, MPH,
that studying capacity patterns and related data leads to Medline COO Jim Abrams.
more efficient use of resources. He also encourages collabo-
ration among departments, viewing the hospital as a whole
rather than operating as individual silos.
“If money were no object, we would add more beds, add more
operating rooms, hire more nurses, and we could drive
occupancy back down to the ideal 85 percent,” Keathley Right: The Third Annual
said. “But I am telling you, that fantasy doesn’t exist.” Prevention Above All Conference
took place at the historic Hudson
Theatre in New York City.
Prevention Above All
Another solution to meeting the challenges of healthcare reform
lies in preventing costly medical errors and infections that are
indeed preventable. Sue MacInnes, Medline’s Chief Marketing Urinary Tract Infection (CAUTI) Foley Catheter Management
Officer and host of the Prevention Above All Conference, System to help prevent CAUTIs.
reviewed Medline’s growing offering of preventive strategies
for healthcare providers: These six strategies are targeted, focused and achievable evi-
dence-based solutions that are also practical. They fit with
The Gold Standard Surgical Safety Program to help prevent everyday processes and systems currently in place at most
operating room errors, the Hand Hygiene Compliance Pro- healthcare facilities.
gram, the Pressure Ulcer Prevention Program, Educational
Packaging, the ClearCount Surgical System to help prevent MacInnes emphasized, “Sometimes the simplest solutions
sponges from being left behind and the Catheter-Associated make the biggest difference.”
What the Experts Are Saying ...
Caroline Fife, MD and Kevin W. Yankowsky, JD
Lawsuits, Technology and Wound Care: How Electronic
Health Records Change Your Legal Risks
“Any time a lawsuit is filed, you and your facility and your
practitioners lose. The only question is the question
of degree ... I would suggest and recommend that you
take a moment to focus on how, in addition to improving
your clinical care, you can take steps to absolutely mini-
mize your risk of ever being involved in the legal system; of
ever being sued in the first place.” - Kevin W. Yankowsky
Fife Yankowsky
Trent T. Haywood, MD, JD

Social Practice: Observation
for Understanding and Improving
“One of the key things people have taught us in anything
that has to do with practice improvement is not really what
you don’t know; it’s what you think you know that ain’t so.”
Dale Bratzler, DO, MPH

Healthcare-Associated Infections
and Public Accountability
Haywood Bratzler “Clearly, if there is a single practice that we can do better
that will dramatically reduce healthcare-associated infec-
tions, it would be hand hygiene.”
Mikel Gray, PhD, FNP, CUNP, CCCN, FAANP, FAAN

Evolution of Evidence: New Models
for Demonstrating Effectiveness
“Insufficient evidence remains the primary challenge
of evidence-based practice; demystification of the
research process is urgently needed.”
Gray Gawande Atul Gawande, MD, MPH

Author, The Checklist Manifesto
“What we have today, though, is a volume and complex-
For video clips of the speakers’ presentations from ity of medical discovery that has now exceeded our ability
the 3rd Annual Prevention Above All Conference, as individual specialized artisans to be able to deliver that
visit www.medline.com/media-room. Or contact care to the right person, the right way, at the right time
your Medline representative for a free set of DVDs. without waste of resources.”
Continued on page 19

Before you standardize
on a patient prep,
remember this:
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AORN: Spreading knowledge,
Practicing Advanced Medicine preventing complications
Within Outdated Systems
AORN Executive Director Linda
Atul Gawande, MD, a Harvard professor and author of several K. Groah, RN, MSN, CNOR,
books, including his most recent, The Checklist Manifesto, NEA-BC, FAAN, began her pres-
addressed the challenges of delivering highly advanced medical entation with these statistics: the
care within outdated systems. average department of surgery is
responsible for 40 to 60 percent
He pointed out that we’ve entered a complex medical world in of expenses, 70 percent of rev-
which we have 13,600 different diagnoses, 6,000 prescription enue and 50 percent of errors.
medications and more than 4,000 medical and surgical
procedures. To help reduce surgical errors, the Association of peri-
Operative Nurses (AORN) promotes safe surgical prac-
Compounding matters, we’ve inherited a structure from 50 tices and optimal patient outcomes by educating
years ago that didn’t have nearly so many diagnoses, drugs perioperative nurses and partnering with other profes-
and procedures. At that time, the doctor was considered an sional and governmental healthcare organizations.
artisan, and all you really needed was the physician’s brain,
along with an operating room, a few simple tools and some AORN collaborates on patient safety initiatives with a
skills behind that. number of major healthcare organizations, including
the Centers for Medicare & Medicaid Services (CMS),
“What we have today, though, is a volume and complexity of the Surgical Care Improvement Project (SCIP), the
medical discovery that has now exceeded our ability as World Health Organization (WHO), the Joint Commis-
individual specialized artisans to be able to deliver that care to sion, IPPS, Blue Cross and others. In fact, AORN
the right person, the right way, at the right time without waste worked closely with the WHO and Dr. Atul Gawande
of resources,” Dr. Gawande said. to ensure the perioperative nurse’s role was incorpo-
rated into the Surgical Safety Checklist.
The Checklist Manifesto: How to Get Things Right
Atul Gawande, MD, MPH As a leader in the perioperative arena, AORN has also
developed a number of its own initiatives for practical
We live in a world of great and application in the OR. Some of these include Periop-
increasing complexity, where even erative Standards and Recommended Practices, a
the most expert professionals strug- complete perioperative curriculum and various toolkits.
gle to master the tasks they face.
Longer training, ever more advanced “The Perioperative Standards really are the core of
technologies — neither seems to pre- AORN,” Groah said. “They represent the intellectual
vent grievous errors. But in a hopeful property of AORN.” Groah also emphasized that hun-
turn, acclaimed surgeon and writer dreds of hospitals and surgery centers across the
Atul Gawande finds a remedy in the country look to the Perioperative Standards as the
humblest and simplest of techniques: go-to guide for evidence-based surgical practices.
the checklist. New and revised standards go through up to three
rounds of revisions based on input from surgical pro-
fessionals and the general public.
To learn more about AORN, including group and indi-

vidual membership, visit www.aorn.org.

Patient Safety
Conversation with Dr. Peter J. Pronovost
Doctor Leads Quest for Safer

Ways to Care for Patients
by Claudia Dreifus
What got you started on your crusade

for hospital safety?
My father died at age 50 of cancer. He had lymphoma. But
he was diagnosed with leukemia. When I was a first-year
medical student here at Johns Hopkins, I took him to one
of our experts for a second opinion. The specialist said, “If
you would have come earlier, you would have been eli-
gible for a bone marrow transplant, but the cancer is too
advanced now.” The word “error” was never spoken. But it
was crystal clear. I was devastated. I was angry at the
clinicians and myself. I kept thinking, “Medicine has to do
better than this.”
A few years later, when I was a physician and after I’d done
Dr. Peter J. Pronovost, 45, is medical director of the Quality an additional Ph.D. on hospital safety, I met Sorrel King,
and Safety Research Group at Johns Hopkins Hospital in whose 18-month-old daughter, Josie, had died at Hopkins
Baltimore, which means he leads that institution’s quest for from infection and dehydration after a catheter insertion.
safer ways to care for its patients. He also travels the country,
advising hospitals on innovative safety measures. The Hudson The mother and the nurses had recognized that the little
Street Press has just released his book, “Safe Patients, Smart girl was in trouble. But some of the doctors charged with
Hospitals: How One Doctor’s Checklist Can Help Us Change her care wouldn’t listen. So you had a child die of dehy-
Health Care from the Inside Out,” written with Eric Vohr. An dration, a third world disease, at one of the best hospitals
edited version of a two-hour conversation follows.
in the world. Many people here were quite anguished about
it. And the soul-searching that followed made it possible
for me to do new safety research and push for changes.
What exactly was wrong here? At Hopkins, we tested the checklist idea in the surgical
As at many hospitals, we had dysfunctional teamwork intensive care unit. It helped, though you still needed to do
because of an exceedingly hierarchal culture. When con- more to lower the infection rate. You needed to make sure
frontations occurred, the problem was rarely framed in that supplies — disinfectant, drapery, catheters — were
terms of what was best for the patient. It was: “I’m right. I’m near and handy. We observed that these items were stored
more senior than you. Don’t tell me what to do.” With the in eight different places within the hospital, and that was
thing that Josie King died from — an infection after a why, in emergencies, people often skipped steps. So we
catheter insertion, our rates were sky high: about 11 per gathered all the necessary materials and placed them
1,000, which, at the time, put us in the worst 10 percent in together on an accessible cart. We assigned someone to
the country. be in charge of the cart and to always make sure it was
stocked. We also instituted independent safeguards to
Catheters are inserted into the veins near the heart before make certain that the checklist was followed.
major surgery, in the I.C.U., for chemotherapy and for dial-
ysis. The C.D.C. estimates that 31,000 people a year die We said: “Doctors, we know you’re busy and sometimes
from bloodstream infections contracted at hospitals this forget to wash your hands. So nurses, you are to make
way. So I thought, “This can be stopped. Hospital infec- sure the doctors do it. And if they don’t, you are empow-
tions aren’t like a disease there’s no cure for.” I thought, ered to stop takeoff on a procedure.”
“Let’s try a checklist that standardizes what clinicians do
before catheterization.” It seemed to me that if you looked How did that fly?
for the most important safety measures and found some You would have thought I started World War III! The nurses
way to make them routine, it could change the picture. The said it wasn’t their job to monitor doctors; the doctors
checklist we developed was simple: wash your hands, said no nurse was going to stop takeoff. I said: “Doctors,
clean your skin with chlorhexidine, try to avoid placing we know we’re not perfect, and we can forget important
catheters in the groin, if you can, cover the patient and safety measures. And nurses, how could you permit a doc-
yourself while inserting the catheter, keep a sterile field, and tor to start if they haven’t washed their hands?” I told the
ask yourself every day if the benefits of catheterization nurses they could page me day or night, and I’d support
exceed the risks. them. Well, in four years’ time, we’ve gotten infection rates
down to almost zero in the I.C.U.
Wash your hands? Don’t doctors
automatically do that? We then took this to 100 intensive care units at 70 hospitals
National estimates are that we wash our hands 30 to 40 in Michigan. We measured their infection rates, imple-
percent of the time. Hospitals working on improving their mented the checklist, worked to get a more cooperative
safety records are up to 70 percent. Still, that means that culture so that nurses could speak up. And again, we got
30 percent of the time, people are not doing it. it down to a near zero. We’ve been encouraging hospitals
around the country to set up similar checklist systems.

In your book, you maintain that hospitals can So I asked the scrub nurse to phone the dean of the med-
reduce their error rates by empowering their ical school, who I knew would back me up. As she was
nurses. Why? about to call, the surgeon cursed me and finally pulled off
Because in every hospital in America, patients die the latex gloves.
because of hierarchy. The way doctors are trained, the
experiential domain is seen as threatening and unimportant. What can consumers do to protect
Yet, a nurse or a family member may be with a patient for themselves against hospital errors?
12 hours in a day, while a doctor might only pop in for five I’d say that a patient should ask, “What is the hospital’s in-
minutes. fection rate?” And if that number is high or the hospital says
they don’t know it, you should run. In any case, you should
When I began working on this, I looked at the liability claims also ask if they use a checklist system.
of events that could have killed a patient or that did, at several
hospitals — including Hopkins. I asked, “In how many of Once you’re an in-patient, ask: “Do I really need this
these sentinel events did someone know something was catheter? Am I getting enough benefit to exceed the risk?”
wrong and didn’t speak up, or spoke up and wasn’t heard?” With anyone who touches you, ask, “Did you wash your
hands?” It sounds silly. But you have to be your own
Even I, a doctor, I’ve experienced this. Once, during a sur- advocate.
gery, I was administering anesthesia and I could see the
patient was developing the classic signs of a life threatening
From The New York Times, © March 8, 2010 The New York Times.
allergic reaction. I said to the surgeon, “I think this is a latex
All rights reserved. Used by permission and protected by the Copyright
allergy, please go change your gloves.” “It’s not!” he Laws of the United States. The printing, copying, redistribution, or
insisted, refusing. So I said, “Help me understand how retransmission of the Material without express written permission
you’re seeing this. If I’m wrong, all I am is wrong. But if is prohibited.
you’re wrong, you’ll kill the patient.” All communication
broke down. I couldn’t let the patient die because the
surgeon and I weren’t connecting.
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Patient Safety
Checking it Twice
Yes! Checklists do save lives
It’s been more than a decade since the Institute of Medicine (IOM) issued its
groundbreaking report, To Err is Human, outlining the poor state of patient safety in the United
States. And yet, progress toward reducing healthcare errors over the past ten years has been
“frustratingly slow,” say the authors of the report.1 Patients continue to die at a rate of 99,000
per year due to hospital-acquired infections alone, according to the latest estimate from the
Centers for Disease Control and Prevention.1
Needless to say, healthcare professionals have a long Dr. Pronovost introduced the checklist at Johns Hop-
way to go toward improving patient safety. There are, kins Hospital, asking staff to run through it each time
however, glimmers of hope, one of which comes in the they inserted a line. The central line infection rate soon
form of a checklist. decreased from 11 percent to zero.4
A checklist for the ICU Next, Dr. Pronovost implemented the ICU checklist and
Buried on page 171 of the thick To Err is Human report other related safety interventions at 103 hospitals across
is one sentence recommending that healthcare organi- Michigan, resulting in a 66 percent reduction in CR-
zations use checklists as a way to prevent errors by BSIs.6 In the first 15 months of the study, known as the
avoiding reliance on memory.2 But it was not until 2006, Keystone Initiative, the checklist is estimated to have
with the published results of a study headed by now saved 1,500 lives and $175 million in costs.4
renowned patient safety advocate Peter Pronovost, MD,
PhD, that the healthcare checklist came to the forefront The ICU checklist is simple; as experts recommend
as a proven way to prevent errors and save lives.3 healthcare checklists should be. It requires clinicians to
employ the following evidence-based practices when
Dr. Pronovost, a practicing anesthesiologist and critical placing central venous catheters: hand washing, using
care physician at Johns Hopkins in Baltimore, crafted full-barrier precautions during the insertion of the
his first checklist by listing on paper the steps necessary catheter, cleaning the patient’s skin with chlorhexidine,
to avoid catheter-related bloodstream infections (CR- avoiding the femoral site, if possible, and removing
BSIs).4 The steps were nothing new; just things that unnecessary catheters.6 To download a sample copy of
clinicians may not remember to do every time they place Dr. Pronovost’s ICU checklist, go to www.ihi.org/IHI/Pro-
a new central line. He and fellow researchers then grams/IHIOpenSchool/OnCallPeterPronovostCheck-
refined the list, making sure the steps corresponded with lists.htm.
items from the CDC guidelines for preventing CR-BSIs.5
Finally!
A way to know
when the catheter
was placed
MEDLINE’S FOLEY INSERTAG™

This easy documentation tool lets you know
exactly when your patient’s catheter was placed
Foley
InserTag
Despite SCIP Measure #9 recommending removal of
urinary catheters in surgical patients by postoperative day
one or two,1 and CDC guidelines advising prompt removal
of catheters,2 74 percent of hospitals do not keep track of
how long patients have catheters in place.3
Medline’s Foley InserTag is a sticker to be placed on each

catheter bag as part of the insertion procedure. It has
space to write when the catheter was placed in order
to minimize duration and encourage timely removal. The
InserTag is included with each Medline ERASE CAUTI tray.
To learn more about Medline’s Foley InserTag and
Medline’s Foley InserTag. The one little sticker that can the ERASE CAUTI program, attend an informational
make all the difference. webinar at www. medline.com/erase/webinar.asp.
Reference
1 Saint S, Kaufman SR, Thompson M, Rogers MA, Chenoweth CE. A reminder reduces urinary catheterization in
hospitalized patients. Jt Comm J Quality Patient Saf. 2005; 31(8): 455-462
2 Patient Safety Quality Measures for the Surgical Care Improvement Project (SCIP). Health Services Advisory Group.
Available at: http://qualitymeasures.ahrq.gov/content.aspx?f=rss&id=16275. Accessed December 7, 2010.
3 Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009. Centers for Disease Control and Prevention.
Available at: http://www.cdc.gov/hicpac/cauti/001_cauti.html. Accessed December 7, 2010.
©2010 Medline Industries, Inc. Medline is a registered trademark and InserTag is a trademark of Medline Industries, Inc.
Checklists for safer surgery
Not long after the Keystone Initiative study came out,
the World Health Organization (WHO) Surgical Safety
Checklist gained recognition in 2009 with a study pub-
Four Es
for implementing a healthcare checklist5
lished in the New England Journal of Medicine describ-
Patient safety advocate Peter Pronovost, MD PhD,
ing how use of the checklist helped reduce patient
offers the following four steps to remember when
morbidity and complications.7
implementing a safety checklist at your own facility:
The WHO Surgical Safety Checklist was used at hospitals
around the world, resulting in a reduction in complication 1. Engage staff and physicians with stories and
rates from 11 percent to 7 percent. Death rates dropped baseline performance.
from 1.5 percent to 0.8 percent.7 2. Educate staff and physicians explicitly on what
needs to be done to carry out the checklist; walk
For a copy of the WHO Surgical Safety Checklist and
tips on how to use it, visit www.safesurg.org. through the checklist a few times to identify
any glitches
Another study, just published in October 2010 in the 3. Execute the checklist, making sure everyone is
Journal of the American Medical Association (JAMA),
committed to following it.
showed an 18 percent reduction in surgery deaths over
three years at 74 Veterans Affairs hospitals that used a 4. Evaluate how it’s working by analyzing
surgery checklist.8,9 collected data.
The Surgical Care and Outcomes Assessment Program He also recommends determining in advance the prod-
(SCOAP), has developed a surgical safety checklist as ucts and equipment needed to carry out the items on
well, which is being used by most hospitals and some the checklist, making sure all
freestanding surgery centers in the state of Washington. supplies are close at hand when
SCOAP links hospitals and surgeons with clinicians from clinicians go to implement the
across Washington to increase the use of best practices checklist.
in surgical care. The organization’s goal is to provide the
kind of surveillance of procedures and response to neg- For more tips, read Safe Patients,
ative outcomes that exists in the world of aviation.10 Smart Hospitals: How One Doc-
tor’s Checklist Can Help Us
To access a copy of the SCOAP Surgical Checklist, Change Health Care from the
including a version specifically for ambulatory surgery Inside Out by Peter Pronovost
centers, go to www.scoap.org/checklist. Copies of the and Eric Vohr.
SCOAP Surgical Checklists are also included in the
Forms & Tools section of this issue.
Checklist success requires teamwork

Both Dr. Pronovost and Atul Gawande, MD, who Dr. Pronovost wrote, “Until a junior nurse can correct a
co-authored the paper on the WHO Surgical Safety senior physician who forgot to use the checklist, until
Checklist, agree that in order to work, checklists must that conversation goes well, we will continue to harm
be studied carefully in advance, and then implemented patients. In most U.S. hospitals, that conversation does
wisely.11 And, although checklists are helpful, they are not go well.”12 In fact, in the OR, the lowest perceptions
only one part of the equation for improving patient of teamwork are reported by nurses with surgeons.13
safety. Before a checklist can be useful, healthcare
teams must improve communication and change the Have a serious discussion with physicians and nurses,
way they work together.12 Dr. Pronovost recommends. Instruct nurses to speak up

Seven Steps + 1
if a doctor misses a step on the checklist. Explain to the to Patient Safety
doctor that it is not about hierarchy or second guess-
for Hospital
ing. It’s about the obligation to make sure every patient
all the time receives evidence-based interventions.5 Executives
Dr. Pronovost also remarked that if any link in the chain

of accountability is not intact, the checklist will not be
effective. He said it is the hospital’s senior leadership
that is ultimately responsible for getting and keeping
staff on board.14
1. Assess your organization’s safety culture. A widely
According to Dr. Pronovost, “To reach our ultimate goal used survey developed by the Agency for Health
– making patients safer – we must engage teams to care Research and Quality (AHRQ) is available at
embrace the concepts behind checklists and become www.ahrq.gov/qual/patientsafetyculture.
full partners in developing and improving this lifesaving 2. Understand the science of improvement and
tool. And, we must measure our results to make sure reliability. Strive to be a high reliability organization.
that every patient always gets the care they deserve.”12 3. Foster transparency.
4. Create a formal, written leadership promise that
outlines the steps you personally will take to attain
and maintain patient safety at your facility.
References
1. O’Reilly KB. Patient safety improving slightly, 10 years after IOM report on errors.
5. Engage physicians in your organization’s
American Medical Association. amednews.com. December 28, 2009. Available at safety efforts.
www.ama-assn.org/amednews/2009/12/28/prsb1228.htm. Accessed November 1, 2010.
2. Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Eds. To Err Is Human: 6. Develop hiring and credentialing processes
Building a Safer Health System. Washington, DC: National Academy Press; 2000.
Available at: www.nap.edu/openbook.php?isbn=0309068371. Accessed October grounded in selecting candidates with a desire to
29, 2010.
3. Wachter RM. Patient safety at ten: unmistakable progress, troubling gaps. Health Affairs.
serve, good communication skills, an eagerness
2010;29(1). Available at: http://hospitalmedicine.ucsf.edu/downloads/patient_safety- to work in teams, a commitment to excellence and
_at_ten.pdf. Accessed November 1, 2010.
4. Laurance J. Peter Pronovost: champion of checklists in critical care. The Lancet. an appreciation for feedback.
2009;374(9688).
5. Pronovost P. On Call: How a Simple Checklist Can Dramatically Reduce Medical Errors 7. Involve board members in the safety journey.
[audio]. Institute for Healthcare Improvement (IHI) website. Recorded November 3,
2008. Available at: www.ihi.org/IHI/Programs/IHIOpenSchool/OnCallPeter-
PronovostChecklists.htm. Accessed November 2, 2010. + 1 Another helpful tool for fostering a safety culture at
6. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An
intervention to decrease catheter-related bloodstream infections in the ICU. The New
your organization is the Comprehensive Unit-Based
England Journal of Medicine. 2006;355(26):2725-2732. Available at: Safety Program (CUSP) developed at Johns Hopkins
www.nejm.org/doi/pdf/10.1056/NEJMoa061115. Accessed November 1, 2010.
7. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AS, Delliner EP, et al. A surgical Hospital by Dr. Pronovost and his team. For details, visit
safety checklist to reduce morbidity and mortality in a global population. The New
England Journal of Medicine. 2009;360(5):491-499.
www.patientsafetygroup.org/program/index.cfm.
8. Tanner L. Big U.S. study shows surgery checklist saves lives. ABC-2 News Baltimore
website. Posted October 21, 2010. Available at: www.abc2news.com/dpp/news/health- Adapted from Rupp W, Bonacum D, Frush K, Balik B, Haraden C. The role of
/USMEDSurgery-Checklist_9727648034-wews1287662508003. Accessed November
leadership. In: Frankel A, Leonard M, Simmonds T, Haraden C, Vega KB, eds.
3, 2010.
9. Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH, et al. Association between The Essential Guide for Patient Safety Officers. Oakbrook Terrace, IL: Joint
implementation of a medical team training program and surgical mortality. Journal of the Commission Resources; 2009:1-10.
American Medical Association. 2010;304(15).
10. SCOAP Surgical Checklist Initiative. Surgical Care and Outcomes Assessment
Program website. Available at http://www.scoap.org/checklist. Accessed October
22, 2010. 13. Carney BT, West P, Neily J, Mills PD, Bagian JP. Differences in nurse and surgeon
11. Szalavitz M. Study: a simple surgery checklist saves lives. Time. January 14, 2009. perceptions of teamwork: implications for use of a briefing checklist in the OR.
Available at: http://www.time.com/time/health/article/0,8599,1871759,00.html. AORN Journal. 2010;91(6):722-729.
Accessed October 22, 2010. 14. Aizenman NC. Hospital infection deaths caused by ignorance and neglect, survey
12. Pronovost P. Checklists alone won’t change health care: the full story. Huffington Post. finds. The Washington Post. July 13, 2010. Available at: www.washingtonpost.com-
February 23, 2010. Available at: http://www.huffingtonpost.com/peter-pronovost- /wp-dyn/content/article/2010/07/12/AR2010071204893.html. Accessed October
md-phd/checklists-alone-wont-cha_b_473396.html. Accessed November 1, 2010. 21, 2010.
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Special Feature
Patient,
Heal
Thyself
After shorter hospital stays,
doctors raise demands
and time for recovery
By Laura Landro
For Michael Noonan, knee surgery in April was practically a breeze —
an outpatient procedure that had the 41-year-old investment banker hobbling
home on crutches in a matter of hours after surgeon David Altchek replaced
his anterior cruciate ligament using small incisions.
But recovery was another matter. He needed the crutches The mean charge for outpatient surgery was $6,100 ver-
for three weeks, had 12 weeks of physical therapy three sus $39,000 for inpatient surgery in 2007, according to
times a week, then six weeks of exercises at home. He the most recent report on surgical costs from the federal
rented a strap-on ice compression device to reduce government. Insurance companies are also less likely to
swelling, and wore a brace for about five weeks. Though pay for stays at rehabilitation centers, places where surgi-
fully healed now, being responsible for so much of his own cal patients were often sent after hospital discharge to
rehabilitation, he says, “was like taking a new baby home recuperate.
for the first time—you don’t really feel like you’re licensed
to do it.” With patients going home so quickly, more are having to
grapple with complications on their own. Of all the com-
Surgery is easier and faster than ever before: Nearly 65% plications that occur in the 30 days after surgery, such as
of all surgeries don’t require an overnight hospital stay, infection and blood clots, almost half will surface after a
compared to 16% in 1980. Hospitals that once kept patient leaves the hospital, according to data from one mil-
patients for three weeks after some major operations now lion patients in a surgical quality improvement program
discharge them within a matter of days. But the body still sponsored by the American College of Surgeons.
heals at its own pace, and reduced time in hospital care
means patients are assuming more responsibility for their “The onus is really on patients to recognize if something is
own recovery—and more risks. Patients not only have to a problem,” says Clifford Ko, a colorectal surgeon at the
perform rehabilitation regimens at home, but they are more University of California, Los Angeles, and director of
often caring for their own incision wounds and dressings research and optimal patient care for the American College
and having to watch for signs of infections and blood clots. of Surgeons. “The recovery period is often as important as
They also may be managing drains, implanted IV ports and the procedure itself, and patients who don’t follow their
pumps, all of which can be difficult and stressful. discharge instructions could have longer recovery times,
greater risk of a complication, and potentially more pain.”
The move to speedier surgeries is largely the result of new
minimally invasive techniques, improvements in anesthesia
and cost-cutting by insurance companies and hospitals.
Surgical procedures now often use smaller incisions, cut
less muscle, and result in less blood loss. Newer anes-
thetics allow patients to regain consciousness quickly or
not go to sleep at all. Pain medications are more effective.
At the same time, concern about rising health care costs The Long Road to Recovery
has led to changes in Medicare and insurance plans that While most surgeries now require much shorter hospital
have encouraged the development of outpatient surgical stays than in years past, patients often face weeks or
centers and created financial incentives for hospitals to months of recovery on their own. The picture for some
shift less complex surgery to their own outpatient facilities. common procedures: Knee surgery patients, for example,
So, many types of surgeries previously performed in hos- are counseled to maintain their weight after surgery. But a
pitals with overnight stays are now being done on an out- recent study shows that most patients gain weight, which
patient basis: The number of freestanding surgery centers can jeopardize the health of the other knee. Depression,
grew from about 240 in 1983 to more than 5,000 now.

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Other reasons to try MediClip

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84,000 patients who developed a surgical
site infection found that more than half
occurred after discharge
another common after-surgery occurrence, also can elevate the leg and perform specific movement exercises.
inhibit healing, if patients don’t seek treatment. Blood clots and subsequent pulmonary embolisms remain
the most common cause for emergency readmission and
Efforts are underway to improve follow-up for patients, par- death following joint replacement, according to the Ameri-
ticularly those who have surgery in doctor’s offices, which can Academy of Orthopaedic Surgeons.
don’t have the same regulation as outpatient surgery cen-
ters. The Institute for Safety in Office-Based Surgery has The American Academy of Orthopaedic Surgeons spon-
developed a checklist that includes assuring that discharge sors workshops to teach its members better communica-
instructions are provided and a plan for follow-up care is tions skills to help patients understand procedures and to
clear. “Patients need to be asked things like if there is red- stress the importance of follow-up care, such as providing
ness at the incision site, do you know what to do?” says clear written instructions and monitoring patients after sur-
Fred Shapiro, a Harvard anesthesiologist and president of gery. “We can have a perfect total knee replacement but
the group. (Redness at an incision site can be a sign of then have a poor outcome if we don’t convince surgeons
infection.) that explaining the post-operative care is in everyone’s best
interest,” says John Tongue, a Portland, Ore.-area ortho-
Infections that can occur after any surgery can lead to a pedic surgeon and clinical associate professor at Oregon
severe bloodstream infection that can be fatal. A study Health & Science University who teaches the workshops.
published in July in the Journal of Hospital Infection of Insurers have become stricter about paying for inpatient
84,000 patients who developed a surgical site infection rehabilitation programs where surgical patients were once
found that more than half occurred after discharge, transferred to recover. The move has been spurred partly
increasing the risks of an emergency room visit, readmis- by studies that show that cheaper at-home visits from ther-
sion to the hospital, and another surgery. apists are effective.
For months after a procedure, surgical patients are also at But Nina Reznick, a 63-year old patient who had both hips
high risk of developing blood clots which can travel to the replaced last July, says the home therapist her insurance
lung and cause death from a pulmonary embolism. After paid for did not have the equipment or time to really help,
joint replacement, for example, though the risk is greatest so she did extra exercises on her own. She believes that
within two to five days, a second peak development period effort enabled her to walk a week after surgery. “You are
occurs about 10 days after surgery when most patients really on your own, and you have to be very motivated,”
have been discharged from the hospital. In knee surgery she says.
patients, a clot can form in the calf if the patient fails to

Blood clots and subsequent pulmonary embolisms
remain the most common cause for emergency
readmission and death following joint replacement.
Some doctors say that the changing demographics of their Andrew Minko, a 41-year-old patient of Dr. Altchek’s who
patients also can contribute to bumpy recoveries. Dr. plays tennis and surfs, has had two surgeries to repair
Altchek, who performs knee and rotator cuff surgery at the joints on his left shoulder and now needs surgery on his
Hospital for Special Surgery in New York, says that more right shoulder. Though he healed well, he admits he was
younger patients are opting to replace troublesome knees somewhat lax about doing his exercises at home and may
and hips so they can resume athletic activities such as ten- have rushed into some activities too quickly after the
nis and skiing; close to 42% of all knee replacements in previous procedures. For the upcoming surgery, he says,
2008 were for patients aged 45 to 65, compared to less “I will be more diligent about the recovery.”
than 35% in 2002, and studies show that waiting too long
once a joint starts to deteriorate before having surgery can Write to Laura Landro at laura.landro@wsj.com
make recovery more difficult.
But younger patients may also be impatient and assume

they are healed, and then quit rehabilitation too early, Dr.
Altchek says.
Reprinted by permission of The Wall Street Journal, Copyright © 2010 Dow Jones & Company, Inc.
All Rights Reserved Worldwide. License number 2537291131129
To download a new guide to help patients take care of themselves at home,

visit www.ahrq.gov/qual/goinghomeguide.htm. “Taking Care of Myself: A Guide
for When I Leave the Hospital” is published by the Agency for Healthcare Research
and Quality (AHRQ).
DASH® in use gently
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THE NEW SHAPE OF SURGERY
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The DASH retractor is 12 times more absorbent than a
standard lap sponge. Its smooth stainless steel core gives
the DASH device strength and malleability. Shape it into
almost any form to gently retract tissues from the surgical
field—without the pinch-point trauma traditional retractors
can cause.
Once you see the DASH in action you’ll never want to go

back to old, bulky metal retractors.
To find out how to get your free DASH Retractor

sample, go to www.medline.com/offers/dash.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. www.medline.com
Preventing
by Mary Ann Alexander-Magalee, MSN, RN, CNOR-BC injury protection devices, and use a one-handed recap-
ping technique, if no other alternatives exist.
Nearly 30% of the estimated 385,000 needle sticks and
other sharps-related injuries that occur each year happen The Occupational Safety and Health Administration
in the OR.1 The CDC’s recommended work practices that requires healthcare organizations to protect their workers
can help ensure safety can be simplified into three points: and have a written exposure control plan.3 Facilities must
Be prepared, be aware, and dispose with care.1 This arti- also observe local, state, and federal regulations on injury
cle describes what you can do to protect yourself from prevention.
sharps injury.
Common strategies for sharps injury prevention during a
Studies indicate that 6% to 16% of all percutaneous procedure include:
injuries for scrubbed personnel are self-inflicted during • Double gloving and monitoring gloves for punctures.2
hand-to-hand passing of suture needles, with the non- • Encouraging neutral or hands-free technique for
dominant hand being the most injured body part.2 This passing sharp items.2
often occurs during the loading or repositioning of suture • Giving verbal notification when passing a sharp item.
needles, loading or removing scalpel blades, suturing, tying • Loading suture needles using the suture packet to
sutures with the needle attached, and immediately before help mount the needle in the needle holder.
or after the sharp has been used and remains unattended • Using the appropriate instrument to help adjust or
on the operative field.2 unload the needle.
• Removing the needle before tying the suture, or using
For nonscrubbed personnel, the greatest risk of injury is control-release sutures.
during hand-off of used sharps or disposal of sharps. • Activating the safety feature of a safety-engineered
device immediately after use.2
Healthcare organizations and their employees are respon- • Using another available instrument or a magnet to pick
sible for actively participating in strategies to reduce per- up a sharp item that’s fallen on the floor. Discard the
cutaneous injuries. Wear personal protective equipment sharp immediately.
when indicated. Use needless systems or sharps with
OR Issues
sharps injury in the OR
3 Points of Sharps Safety Be prepared. Be aware. Dispose with care.
After the procedure, follow these strategies: Aligning practice

About the authorwith policy to improve patient care 37
• Transport sharps in a closed, secure container Mary Ann Alexander-Magalee, MSN, RN, CNOR-BC, is a
and place them in an approved, puncture-resistant professor of nursing at Valencia Community College in Orlando,
Fla., and a board-certified nurse informatist.
container large enough to accommodate the entire
device.
References
• Don’t put your hands or fingers into the container 1. CDC Workbook for Designing, Implementing, and Evaluating a Sharps Injury
to dispose of a device.1 Prevention Program. 2008. http://www.cdc.gov/sharpsafety/resources.html.
2. AORN. Guidance statement: Sharps injury prevention in the perioperative
• Keep your hands behind the sharp tip when setting. Perioperative Standards and Recommended Practices. Denver, CO:
disposing of the device. AORN; 2010:697-702.
3. OSHA. Regulations (Standards-29 CFR) Bloodborne pathogens 1910.1030.
http://wwwloshalgov/pls/oshaweb/owadisp.show_document?p_table=STAN-
In addition to common strategies, using safety scalpels is DARDS&p_id=10051.
recommended, as scalpels are the second most frequent 4. Taylor DL. Bloodborne pathogen exposure in the OR—what research has
taught us and where we need to go. AORN J. 2006;83(4):834-848.
mechanism of percutaneous injuries (suture needles
are first).2 Printed with permission. Mary Alexander-Magalee, Preventing sharps injury in the OR,
OR Nurse 2010, September 2010, p. 56.
If you experience a needle-stick injury, follow your facility’s

policy for postexposure management and report the injury
immediately. Maintaining a sharps-injury log is another
intervention that identifies the number of employees injured
as well as the products and circumstances of the injury.4

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Introducing CE Courses
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• Legal Implications of Pressure Ulcers
• Safe Medication Practices in the Perioperative Practice Setting
• Tell Me Again Why This Patient Needs a Catheter?
• Why is Pressure Ulcer Assessment So Important?
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* Courses are approved for continuing education credit by the

Association of Surgical Technologists.
Patient Safety
By Steve Harden
According to a recent report in the Archives of Surgery, patients

undergoing surgery still risk being victims of stunning medical mis-
takes including procedures done on the wrong surgical site and
undergoing surgery intended for another patient.
WHY THE UNIVERSAL
PROTOCOL HASN’T To try to curb the rate of surgical errors, the Joint Commission in
2004 introduced a Universal Protocol for all hospitals, ambulatory
ERADICATED PATIENT care facilities, and office-based surgical facilities to follow. How-
ever, even though these steps have largely been adopted, errors
HARM continue to happen.
The study’s author, Dr. Philip F. Stahel, a visiting associate profes-

...AND THE THREE sor at the University of Colorado School of Medicine in Denver, had
this to say about the research: “What is shocking about the data
THINGS YOU MUST is that each and every one of those wrong-site, wrong-patient
DO ABOUT IT errors is really an event that should never happen. These happen
much more frequently than we think.”
“This is just the tip of the iceberg,” he said, “introducing the Uni-
versal Protocol has not reduced the frequency of these events.”
During the research done in Colorado, doctors reported 27,370

adverse events that happened between January 2002 and June
2008. Among these, the researchers identified 25 wrong-patient
and 107 wrong-site operations. The report cites the reasons for
these mistakes.

Not surprisingly, 100 percent had poor communication as a
root cause.
And 72 percent were due to not performing a “Time Out” as

required by the Universal Protocol.
At LifeWings, we’ve helped almost 100 organizations create and

implement a successful Time Out process that really does elim-
inate patient harm. From that experience, here are three things
you can do to fix these problems with your Universal Protocol.
1. Make sure your physicians lead the Time Out. In aviation,

the captain of the aircraft always “calls” for the checklist
at the appropriate time. The captain has the responsibility
to start the checklist and to make sure that it is accomplished
correctly and in its entirety. Once the checklist is started, As Dr. Stahel, the author of the report notes, “... Now we hide
he can delegate portions of the checklist to others, but behind a safety system that should cover the problem. The Time
the captain has the ultimate and final responsibility to lead Out is performed, but people are not mentally involved—the
the checklist process. system alone cannot protect you from wrong-site surgery.”
2. To cure communication failures during the Universal Protocol, Dr. Stahel is absolutely spot on. The Universal Protocol is not
give as many folks as possible a “speaking part” in your Time going to protect your patients if your teams are not going to
Out process. Knowing that they have a speaking part and use the safety system correctly.
will have to verbally respond to a checklist item creates
mindfulness, focus on the process and participation. No About the author
one wants to be the person not prepared and gumming Steve Harden is Chairman of the Board and
up the works. CEO of LifeWings Partners LLC and co-founder
of Crew Training International, Inc. (CTI). He has
helped over 80 healthcare organizations in 28
3. Make sure your Time Out is a true “challenge and response” states implement the best safety practices from
checklist, requiring a real cross check with two or more sets aviation and other high reliability industries. He
of eyeballs confirming critical items—and not just a “tick is the author of Never Go to the Hospital Alone,
sheet” where one staff member independently puts a check published by BPS Books, and co-author of
in the box when they think an item has been completed. CRM: The Flight Plan for Lasting Change in Patient Safety, the
A “tick sheet” mentality is the number one reason we see definitive how-to text on implementing aviation-based safety tools in
for failing to complete the Time Out as required. health care, published by HCPro. LifeWings Partners is the industry
leader in using aviation safety, leadership, team building and human
factors tools to reduce patient-harming medical errors and improve
safety and quality.
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A New
Guidebook
for Patient
Safety in
the OR
by Connie Yuska, RN, MS, CORLN
Patient Safety
More than 50 million

surgical procedures
are performed in the
United States each
year.1 And while the Over the last decade, many organizations with direction on how to improve safety in
organizations have focused on the surgical suite. The book focuses not only on improving
number of procedures
principles of surgical safety, safety in procedural and operative areas, but also
is rising, so are the
such as ensuring accurate addresses the patient’s surgical experience across the
risks. The risk of sponge counts, adhering to continuum of care.
death from a surgical hand hygiene standards and
procedure is 10-100 labeling medications on the The book begins with a foreword by patient safety expert
times greater than surgical field. These practices, Peter Pronovost, MD, PhD, in which he emphasizes the
the risk of having however, have been applied need to remove barriers to complying with patient safety
inconsistently across the country.1 practices and measure performance. He also recognizes
a baby.1 Surgical
that overcoming the hurdles to patient safety requires cul-
errors are second ture change. And so, Chapter 1 discusses effective com-
Building a culture of safety con-
only to medication tinues to be a priority for hospi- munication techniques, emphasizing the importance of
errors as the most tal administrators since the senior leadership support in establishing those techniques.
frequent cause of publication of the Institute of
error-related death.1 Medicine’s groundbreaking Chapter 2 focuses on hand hygiene, a practice that often
report, To Err is Human in 1999. remains difficult for organizations to consistently practice
Awareness of patient safety and enforce. The chapter offers suggestions for improving
has been heightened, but the progress has been slow. hand hygiene compliance in the surgical suite and
Improvements in safety have grown by only one percent throughout the organization.
annually between 2000 and 2009.1 Over the past decade,
standards that specifically address safety have been Chapter 3 outlines all of the preparation that occurs before
added to the work done by regulatory and accrediting the patient enters the surgical suite. These activities
bodies. For example, The Joint Commission added include managing the operating room schedule, cleaning
National Patient Safety Goals with the purpose of pro- the room, preparation of the sterile field, ensuring the
moting specific improvements in patient safety. proper instruments are available, ensuring proper air quality
and ventilation and controlling traffic in the room and
There are many rules and regulations that address safety surrounding areas.
and guide healthcare practitioners, but unless a culture of
safety is strong and supported by senior leaders in the Chapter 4 contains information for a review of everything
organization, significant progress will continue to be slow, that must be ready for the procedure when the patient
and patients will continue to be harmed. arrives in the surgical suite. Information focuses on
assessing the patient for risk, documentation of medica-
The Safe Surgery Guide, released in November 2010 by tions the patient is currently taking and preparation of the
The Joint Commission, is specifically designed to provide surgical site.

Key points to ensure the readiness of the surgical team are
outlined in Chapter 5. The discussion not only includes Now available from
obvious preparation, such as appropriate surgical attire, Joint Commission Resources!
but also addresses the attitudes and behaviors of the per-
sonnel involved, a key component to ensuring safety in a
high stress environment such as an OR suite.
Chapter 6 discusses the Joint Commission’s ongoing

efforts to reduce the incidence of surgical errors through its
Universal Protocol for Preventing Wrong Site, Wrong Pro-
cedure, and Wrong Person Surgery. The chapter also
describes the World Health Organization’s Surgical Safety
Checklist.
Monitoring the patient through all aspects of the surgical

procedure is critical to ensuring safety. Chapter 7
Safe Surgery Guide To order
describes the activities of monitoring anesthesia and
Price: $75 (PDF version); Call 877-223-6866 (M-F, 8
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Chapter 8 discusses some of the problems that can occur
during the surgical procedure and offers suggestions for
handling those issues. Some of the problems discussed to the same goal of providing safe surgical care. The team
include objects that are inadvertently left in the patient’s must be fiercely dedicated to supporting each other in their
body, fire breaking out and distractions during the proce- individual roles and keenly aware of all steps needed to
dure that may divert the staff’s attention away from the ensure the procedure goes safely from beginning to end.
patient. There are many resources available to assist with estab-
lishing a culture of safety in your hospital. Reading the Safe
Chapter 9 reviews all of the activities that occur after the Surgery Guide is an excellent place to start.
procedure, including disposal of medical waste, trans-
Reference
portation of contaminated materials such as sheets and 1. Schuldt LM, ed. Safe Surgery Guide, Oakbrook Terrace, IL: Joint Commission
instruments, and clean-up of the operating suite. Resources; 2010. Available at: http:// www.jcrinc.com/e-books/EBSSW10/2177.
Accessed November 12, 2010.
Chapter 10 outlines the care the patient receives following

the procedure, including assessment of the patient’s phys- About the author
iological and mental status, medications ordered post- Connie Yuska, RN, MS, CORLN, began her nursing career in
operatively and care of the surgical site, including the specialty of otolaryngology. Her clinical experience includes
both inpatient and outpatient care of head and neck oncology
measures to prevent postoperative infection.
patients, and she is certified in otolaryngology and head and neck
nursing. She has held clinical manager and director of nursing
Finally, Chapter 11 is a review of the activities that promote positions in a large academic medical center and also has expe-
the patient’s discharge and appropriate care after the rience in the home care setting as vice president of operations for
patient leaves the organization. a large home care agency in the Chicago area. Connie later
joined the executive suite as the chief nursing officer of a large
Attaining a successful, safe surgical outcome is the result community hospital in Chicago, and she is currently a vice pres-
of a TEAM of healthcare professionals who are committed ident of clinical services for Medline.
SAFETY
DESERVES
ATTENTION
MEDLINE GOLD STANDARD SAFETY COMPONENTS

Medline’s Gold Standard safety products stand out against the
sea of blue in the OR to alert the surgical team to focus on safety.
Promote Correct-Site Surgery
Our Surgical Time Out Procedure (S.T.O.P.™)
safety products alert the surgical team to
perform a time-out verification and help reduce
the risk of wrong-site surgery.
Support Sharps Safety Practices

Transfer trays, scalpel holders and needle
counters with blade guards promote sharps
safety and help make you OSHA compliant.1
Improve Fluid Disposal Safety

The Safety-Splash™ fluid management system
converts biohazardous fluids into a solid, For a FREE sample bundle, email
minimizing the risk of exposure. goldstandard@medline.com.
References:
1. Occupational Safety and Health Standards, Toxic and Hazardous Substances,
Bloodborne pathogens. Regulations (Standards - 29 CFR). Available at: http://
www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_
id=10051#1910.1030(d)(2)(i). Accessed October 13, 2010.
Safety-Splash and S.T.O.P are trademarks of Medline Industries, Inc.
h e y ’re
T ng
l u r k i
in ...
Patient Safety
by Cynthia A. Fleck, RN, BSN, MBA,

ET/WOCN, CWS, DWC, CFCN
Remember the old riddle, “Where do most

pressure ulcers occur?” The answer is —
in the ambulance!
Well, the truth is pressure ulcers do occur in the ambulance — and lots of other places you
might not even think about, including the operating room (OR). In fact, the pressure ulcer
incidence rate as a result of surgery may be as high as 66 percent1 and 42 percent of all
hospital-acquired pressure ulcers are occurring in surgical patients.2
Here are some more daunting facts:

• 37 percent of patients undergoing head or neck surgery develop sacral ulcers3
• Cardiac, general vascular and open heart surgeries have a high incidence of occiput
and heel ulcers
• 72 percent of perioperative pressure ulcers occur on heels4
The following types of surgical patients are at greater risk

for pressure ulcers:
• Neonates
• Elderly
• Malnourished
• Morbidly obese
• Patients with chronic diseases
• Patients with existing pressure ulcers

Perioperative risk factors for
pressure ulcer development Perioperative tips for avoiding pressure ulcers
Certain conditions specific to the surgical experience can • Assure that the OR table or surface is of
also contribute to the risk of pressure ulcers. Some of sufficient size to support the patient –
these conditions include blood volume loss, temperature, especially important for obese patients whose
time and moisture. bodies may be larger than the average size
OR surface
Blood volume loss. Blood volume loss and shunting can • Lift – do not drag – the patient from surface
increase the hazard of pressure ulcers and lack of blood to surface.
flow to the lower extremities.5,6 • Monitor pressure points when possible during
“time outs”
Temperature. Another consideration is the cold OR envi-
ronment. The body will likely shunt blood away from the
skin into the trunk of the body to protect the vital organs, Post-operative considerations for avoiding
which can be dangerous to the skin. The use of warming pressure ulcers
blankets tends to occur in lengthy procedures. These can • Be aware of a possible delay in visualization
be helpful to prevent cooling of the body, which can con- due to bandages and other monitoring
tribute to pressure ulcers, however, the blanket should be equipment
covered with a sheet. In addition, the thermostat on the • Prolonged immobility or confinement to a bed
unit should be set at a maximum temperature of 42 de- or chair increases pressure ulcer risk10
grees Celsius.
Time. Increased time in the OR is associated with

increased pressure ulcer development as well.7 Surgeries
lasting between three and four hours had pressure ulcer
incidence rates of 5.8 percent; seven or more hours had Evaluating surgical surfaces
incident rates of 13.3 percent,8 and there is a significant Always remember that no matter where a patient’s body
increase in pressure ulcer incidence for operations lasting resides, pressure ulcers can develop rapidly. OR surfaces
longer than eight hours.9 should be evaluated before each case, and the Association
of Perioperative Registered Nurses (AORN) guidelines
Moisture. We all know moisture can wreak havoc on the recommend using pressure redistribution surfaces for
skin and predispose individuals to pressure ulcers, so it is surgeries lasting longer than two-and-a-half hours.
recommended that pooling of any fluid or blood be moni-
tored intraoperatively. It is suggested that the OR surface In fact, I recently had foot surgery, and my surgeon origi-
have minimal linens or layering. There are also novel OR nally thought it would last only a couple of hours. Lo and
products available (modern-day “chux” that are super behold, it lasted three hours and 45 minutes, and although
absorbent) that can actually absorb large volumes of fluid I am a fairly young, well-nourished and healthy individual,
and remain dry to the touch, thus protecting the patient’s skin. I succumbed to a Stage II perioperative pressure ulcer. The
lesson to be learned: because there is no guarantee how
50%
LESS
FRICTION
than the leading
competitor3
Relieve Pressure on Vulnerable Heels
HEELMEDIX™ Heel Protector

Pressure relief and skin protection all in one
The heels are the most common site for facility-acquired pressure
ulcers in long-term care, and the second most common site over-
all.1 According to clinical experts, the most effective aspect of
pressure ulcer prevention for heels is pressure relief, also known
as offloading.1,2 Offloading is achieved with the use of pillows or
2 Strapping Methods
heel protection devices that relieve pressure by elevating the heel.
The HEELMEDIX Heel Protector is designed to help eliminate

pressure, friction and shear on the skin by elevating the heel.
Made of soft, suede-like material on the inside and easy-to-clean
nylon on the outside. Adjustable straps are soft against vulnerable
skin. Includes a mesh laundry bag with patient ID label to simplify
washing and sorting.
Mention this ad to receive a 10 percent discount
on your first order. Contact your Medline sales
representative or call 1-800-MEDLINE.
1
Fowler E, Scott-Williams S, McGuire JB. Practice recommendations for preventing heel pressure
ulcers. Ostomy Wound Management. 2008;54(10):42:48.
2
Langemo D, Thompson P, Hunter S, Hanson D, Anderson J. Heel pressure ulcers: stand guard.
Advances in Skin & Wound Care. 2008;21(6):282-292.
AORN guidelines recommend using
pressure redistribution surfaces for
surgeries lasting longer than 2 1/2 hours.
Figure 1
long a surgery will take, a pressure redistribution surface Pressure ulcer risk in ancillary services
should be available in every operating room. There is also high risk for pressure ulcers in ancillary
services:
There are high-quality surfaces that self-adjust (Figure 1), • Radiology
provide a stable environment for the surgeon and OR staff • Renal dialysis
to work and conform to the patient’s body. Some of these • Cardiac and vascular procedure laboratories
surfaces contain the same type of visco or viscoelastic such as cath labs
memory foam many of us sleep on in our own bedrooms.
When evaluating various surfaces, ask the vendor about The problem is that until awareness is increased, we will
the warranty, weight limits, cleaning instructions and com- continue doing what we always did, and patients will con-
parative data such as pressure mapping. This will help you tinue to develop pressure ulcers.
make an educated decision regarding your purchase.
Patients undergoing lengthy radiology procedures have a
Important steps to take after surgery 53.8 percent incidence of pressure ulcers. Emergency de-
At the hand-off to the post-anesthesia care unit (PACU) it partments are another area of risk, with 40 percent of pa-
is advisable to: tients admitted through the emergency department at risk
• Clean and dry the patient’s skin for pressure ulcer development.11
• Conduct a post-op skin assessment, noting:
- Skin irritation The average emergency department patient waits six to
- Discoloration eight hours lying on a stretcher that usually consists of two
- Bruising to three inches of open-celled foam and an uncomfortable
- Swelling non-conformable cover that can contribute to the devel-
• Provide a thorough report including: opment of pressure ulcers.
- Results of pre-surgery risk factors and potential
new risks that developed during surgery This is especially important now that acute care facilities
- Results of threats and skin assessment performed are financially responsible for acquired pressure ulcers –
before, during and after surgery which can be quite costly. Many hospitals have instituted
- How long the surgery lasted (e.g., my own surgery a comprehensive program to prevent pressure ulcers
was scheduled for two hours and lasted almost across the continuum, including the OR, ED and ancillary
double that time) areas. Introducing a tool kit on average can reduce a facility’s
Benefits Of A Great
Work Environment
By Greg Smith
Businesses can improve retention and make their organization

the good place to work by following the five-step PRIDE model:
P – Provide a positive working environment

R – Recognize, reinforce, and reward individual efforts
I – Involve and engage everyone
D – Develop the potential of your workforce
E – Evaluate and hold managers accountable
1 Contact Hour
LEGAL IMPLICATIONS
Source: workz.com
OF PRESSURE ULCERS
Medline Named One of Becker’s Join us for this webcast presentation as two
industry experts bring you critical infor-
100 Best Places to mation on how the utilization of the nursing
process and proper documentation are vital
Work in Healthcare components in maintaining the standard of
care and avoiding litigation.
Becker’s recognizes company for Presented by attorney Kevin W. Yankowsky,

“Excellence in Promoting Teamwork, JD, a partner in the health law litigation
Professional Development” group of Fulbright & Jaworski, LLP, Hous-
ton, Texas, and physician Caroline Fife, MD,
the Chief Medical Officer of Intellicure, Inc.
Medline Industries, Inc. has been named one of the “100 Best
and an associate professor at the University
Places to Work in Healthcare” for 2010 by Becker's ASC Review
Texas Medical School at Houston.
and Becker's Hospital Review, well respected industry publications.
According to Becker’s, the list was developed “through nomina-

tions, recommendations and research, and the organizations were To view this webcast, visit
selected for their demonstrated excellence in creating a work envi- www.medlineuniversity.com
ronment promoting teamwork, professional development and qual-
ity patient care.”
Courses approved for continuing education by the Florida Board

of Nursing and the California Board of Reigistered Nursing.
pressure ulcers by 70 percent while substantially increas- References
1. Recommended practices for positioning the patient in the perioperative
ing the knowledge of licensed staff and nurse assistants.12 practice setting. In: Perioperative Standards and Recommended Practices.
Denver, CO: AORN, Inc; 2010.
Take your knowledge and pass it on 2. Beckrich K, Aronovitch SA. Hospital-acquired pressure ulcers: a comparison
of costs in medical vs. surgical patients. Nursing Economics. 1999;
Consider sharing this article with the emergency depart-
17(5):263-271
ment, ancillary areas such as the cath lab, dialysis and 3. Recommended practices for positioning the patient in the perioperative
other high-risk area personnel, and of course with the practice setting. In: Perioperative Standards and Recommended Practices.
ambulance companies where your patients could be at Denver, CO: AORN, Inc; 2010.
4. Recommended practices for positioning the patient in the perioperative
risk. If you are on a skin care committee, get the other practice setting. In: Perioperative Standards and Recommended Practices.
members involved, as these care areas present jeopardy that Denver, CO: AORN, Inc; 2010.
can be easily mitigated. 5. Keller C. The obese patient as a surgical risk. Seminars in Perioperative
Nursing. 1999; 8(3):109-117.
6. McEwen DR. Intraoperative positioning of surgical patients. AORN Journal.
When we ask ourselves the age-old question of where 1996; 63(6):1058-1063, 1066-1075, 1077-1082.
all the pressure ulcers are occurring, now we have more 7. Papantonio C, Wallop J, Koldner K. Sacral ulcers following cardiac surgery:
incidence and risks. Adv in Wound Care. 1994;7(2):24-36.
ammunition to fight the battle. And yes, the ambulance,
8. Aronovitch S. Intraoperatively acquired pressure ulcer prevalence: a national
with its tiny vinyl-covered two-inch, foam mattress may study. J Wound Ostomy Continence Nursing. 1999;26(3):130-136.
be part of the problem. The good news is that we have 9. Ratliff C, Rodeheaver G. Prospective study of the incidence of OR-induced
answers and products that can make positive change pressure ulcers in elderly patients undergoing lengthy surgical procedures.
Adv Skin Wound Care. 1998;11(suppl 3):10.
happen. 10. Allman RM, Goode PS, Burst N, Bartolluci AA, Thomas DR. Pressure ulcer
hospital complications and disease severity: impact on hospital costs and
length of stay. Advances in Skin & Wound Care, 1999;12(1):22-30.
11. Tarpey A, Gould D, Fox C, Davies P, Cocking M. Evaluating support surfaces
for patients in transit through the accident and emergency department.
J Clin Nurs. 2000;9(2):189-198.
About the author 12. Armstrong DG, Ayello EA, Capitulo KL, Fowler E, Krasner DL, Levine JM, et
Cynthia Ann Fleck, RN, BSN, MBA, al. New opportunities to improve pressure ulcer prevention and treatment:
implications of the CMS inpatient hospital care present on admission (POA)
CWS, DNC, CFCN is a certified wound spe-
indicators/hospital-acquired conditions policy. J Wound Ostomy Continence
cialist, dermatology advanced practice Nurs. 2008. 35(5):485-492.
nurse, certified foot and nail care nurse,
writer, speaker, a past president and chair-
man of the board for the American Acad-
emy of Wound Management (AAWM), past
director for the Association for the Ad-
vancement of Wound Care (AAWC), and Vice President, Clinical
Marketing for Medline Industries, Inc. Cynthia can be reached at
cfleck@medline.com.
KEEP YOUR SURGICAL
PATIENTS DESERT DRY.
Medline’s Sahara® Super Absorbent OR table sheets
are designed with your patients’ skin integrity in mind. QuickSuite®
OR Clean Up Kit
The Braden Scale tells us that moisture is one of the
major risk factors for developing a pressure ulcer.1 We also
know that as many as 66 percent of all hospital-acquired
pressure ulcers come out of the operating room.2
That’s why we developed the Sahara Super Absorbent

OR table sheet. The Sahara’s super-absorbent polymer
technology rapidly wicks moisture from the skin and
locks it away to help keep your patients dry.
Sahara OR table sheets are available on their own or

as a component in our QuickSuite® OR Clean Up Kits,
which were designed to help you dramatically improve
your OR turnover time and help reduce cross contamina-
tion risk through a combination of disposable products. To sign up for a FREE webinar on perioperative
pressure ulcer prevention, go to
www.medline.com/pupp-webinar.
References
1
Braden Scale for Predicting Pressure Sore Risk. Available at:
www.bradenscale.com/braden.PDF. Accessed November 6, 2008.
2
Recommended practices for positioning the patient in the perioperative practice setting. In:
Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008.
©2010 Medline Industries, Inc. Medline, QuickSuite and Sahara are registered trademarks of Medline Industries, Inc.
The OR Goes Green
– the only TRULY eco-friendly surgical drape
Medline’s new patent-pending EcoDrape is the only Composition Comparison
eco-friendly surgical drape available today. Made of EcoDrape SMS
more than 96% wood pulp, EcoDrape will biodegrade Fibers More than 96% No wood
wood pulp pulp
in only two to five months in a landfill – polypropylene
Petrochemical 0% 100% PP
drapes take hundreds of years to break down. EcoDrape ingredients (plastics)
has all the same great features as other Medline Additives Bio-based Fluorine
drapes, including hook-and-loop line holders, large
reinforcement zones, and premium tape and incise
film flush to the fenestration. For a quick online video demonstration,
visit www.medline.com/ecodrape
Try the new EcoDrape and take your OR to the next
level of green!
EcoDrape and greensmart are trademarks of Medline Industries, Inc.
OR Issues
Medline Joins
Greening the Operating Room Initiative
Medline has joined a group of corporate sponsors to sup- • OR Kit Formulation
port Practice Greenhealth’s Greening the Operating Room • Waste Anesthetic Gas Scavenging Systems
(GOR) initiative. This initiative to green the nation’s oper- • Fluid Waste Management Systems
ating rooms was launched earlier in 2010 to reduce the • Energy Use/Lighting & Thermal Comfort
environmental footprint of operating rooms in U.S. hospi- • Regulated Medical Waste (RMW)
tals. Hospital operating rooms contribute between 20 and Minimization/Segregation
30 percent of the hospital’s total waste.1 • Substitution of Reusable Hard Cases for Blue
Sterile Wrap
Medline will join the collaborative effort of hospitals, man- • Recycling of Medical Plastics
ufacturers and related stakeholders to develop guidance • Laser Safety/Smoke Evacuation
documents for helping reduce the environmental impact of • Green Cleaning/Proper Disinfection in a
the nation’s operating rooms and potentially reduce cost, Surgical Setting
increase quality and improve worker or patient safety. The • Medical Equipment and Supplies Donation
following are the GOR areas for “green” interventions in the
operating room: To learn more about Practice Greenhealth’s Greening the
• Single-Use Device (SUD) Reprocessing OR initiative visit www.greeningtheor.org.
• Reusables v. Disposables: Gowns, Surgical Drapes,
Basins and Other Reusables
Reference
1. Esaki RK & Macario A. Wastage of supplies and drugs in the operating room. Medscape Anesthesiology. Posted October 21, 2009.
Available at. http://www.medscape.com/viewarticle/710513. Accessed October 22, 2010.
3 Checklists
on the Cleaning & Disinfection of
Endoscopic Equipment
by Lorri A. Downs RN, BSN, MS, CIC
According to the Association for Professionals in Infec- staff quickly and efficiently adhere to infection control
tion Control (APIC), many factors contribute to guidelines for reprocessing endoscopic equipment in
endoscopy-associated infection, including numerous the central sterile processing department, same-day
reports of outbreaks associated with equipment cleaning surgery arena and freestanding endoscopy clinics.
and disinfection. Infection prevention related to the use
of endoscopy equipment begins with educating and The following checklists for the cleaning and disinfec-
training practitioners and strict adherence to reprocess- tion of endoscopes were adapted from the Society of
ing protocols.1 Gastroenterology Nurses and Associates (SGNA) Stan-
dards of Infection Control in Reprocessing of Flexible
We know that in busy healthcare environments, check- Gastrointestinal Endoscopes.2 To see the guidelines in
lists can help reduce errors and improve adherence to their entirety, go to www.sgna.org.
critical steps. Below you will find three checklists to help
Special Feature
1
Checklist 1:
Cleaning the Endoscope Immediately After
the Endoscopy Procedure
Reprocessing of soiled endoscopy equipment begins at the patient’s bedside immediately

upon removal of the endoscope from the patient and prior to disconnecting the endoscope
from the power source.
Have the following equipment available immediately after the procedure:

• Personal protective equipment: gloves, eye protection, impervious gown, face shield
or surgical mask that will not trap vapors.
• Container with detergent solution
• A sponge and a soft, lint-free cloth
• Air and water channel cleaning adapters per manufacturer’s instructions
• Protective video caps if using video endoscopes
Use the following checklist after you have gathered the supplies listed above and put on your
personal protective equipment.
❏ Immediately wipe the insertion tube with a wet cloth or sponge soaked in freshly
prepared detergent solution. (Note: Do not reuse cloths or sponges between cases.)
❏ Place distal end of the endoscope in the detergent solution and suction the solution
through the channel. Alternate suctioning, detergent solution and air several times
until the solution is visibly clean. Finish with suctioning air.
❏ Flush or blow out air and water channels in accordance with the endoscope
manufacturer’s instructions.
❏ Flush the auxiliary water channel.
❏ Detach the endoscope from the light source and suction pump.
❏ Attach the protective video cap if using a video endoscope.
❏ Transport the endoscope to the reprocessing area in an enclosed container.

2 Checklist 2:
Cleaning the Endoscope in the Reprocessing Area
Have the following equipment available in the reprocessing area:

• Personal protective equipment: gloves, eye protection, impervious gown, face shield
or surgical mask that will not trap vapors
• Leak-testing equipment
• Channel cleaning adapters (per manufacturer’s instructions)
• Large basin of endoscope detergent prepared per manufacturer’s instructions
• Channel cleaning brushes
• Sponge and lint-free cloth
Use the following checklist after you have gathered the supplies listed above and put on your
personal protective equipment.
❏ Leak test the endoscope either manually or via computer testing following the
manufacturer’s instructions. If a leak is detected, follow the manufacturer’s
instructions.
❏ Fill the sink or a basin with a freshly prepared solution (for each endoscope) of water
and a medical grade, low-foaming, neutral pH detergent formulated for endoscopes
that may or may not contain enzymes.
❏ Immerse the endoscope.
❏ Wash all debris from the exterior of the endoscope by brushing and wiping the instrument
while submerged in the detergent solution.
❏ Keep the scope submerged to prevent splashing of contaminated fluid and aerosolization
of bioburden.
❏ Use a small soft brush to clean all removable parts, including inside and under the suction
valve, air/water valve, and biopsy port cover and openings. Brush all accessible channels,
the scope body, insertion tube and the umbilicus of the endoscope.
❏ After each passage of the brush, rinse the brush in the detergent solution, removing any
visible debris before retracting and reinserting it. Continue brushing until there is
no visible debris on the brush.
❏ Clean and high-level disinfect reusable brushes between cases.
❏ Attach manufacturer’s cleaning adapters for special endoscopic channels. Flush all
channels with detergent solution to remove debris. (Note: Automated pumps are available
for flushing endoscopes. Refer to the manufacturer’s instructions.)
❏ Soak the endoscope and its internal channels for the period of time specified on the label
of the detergent.
❏ Thoroughly rinse the endoscope and all removable parts with clean water to remove
residual debris and detergent.
❏ Purge water from all channels using forced air and dry the exterior of the scope with a
soft, lint-free cloth.
3 Checklist 3:
High Level Disinfection/Sterilization for Endoscopes
in the Reprocessing Area
• Once the endoscope has been cleaned, it is ready for disinfectants and sterilants.
• Be sure to follow the manufacturer’s instructions for proper use of these chemicals.
• Test the chemical for the minimum effective concentration (MEC) according to the
label on the test strip container.
• Never use the MEC value to extend the “reuse” life claim on the product and never
use beyond the date specified on activation.
• Use product-specific test strips to check for the MEC and keep a log of the test results.
❏ Completely immerse the endoscope and all removable parts in a basin of high level
disinfectant/sterilant.
❏ Inject disinfectant into all channels of the endoscope until it can be seen exiting the
opposite end of each channel. Make sure no air pockets remain within the channels
❏ Do not coil the scope tightly and cover the basin to contain chemical vapors.
❏ Soak the endoscope in the high-level disinfectant/sterilant for the appropriate time and
temperature.
❏ Required to achieve high-level disinfection. Use a timer to verify soaking time.
❏ Purge all channels completely with air before removing the endoscope from the high-
level disinfectant/sterilant.
❏ Thoroughly rinse all surfaces and removable parts and flush all channels of the endoscope
and its removable parts with clean water and disinfectant per the manufacturer’s
recommendations.
❏ Purge all channels with air until dry and follow with 70% isopropyl alcohol (even if sterile
water is used to flush) to assist in drying the interior channel surfaces.
❏ Thoroughly rinse and dry all removable parts and do not store removable parts attached
to the endoscope when not in use.
❏ Dry the exterior of the endoscope with a soft, lint-free cloth.
❏ Thoroughly rinse the endoscope and all removable parts with clean water to remove
residual debris and detergent.
❏ Hang the endoscope vertically with the distal tip hanging freely in a clean, well-vented,
dust-free area.
References
1. Stricof RL. Endoscopy. In: Carrico R, ed. APIC Text of Infection Control and Epidemiology. 3rd ed. Washington, DC: Association for Professionals
in Infection Control and Epidemiology, Inc.; 2009.
2. Society of Gastroenterology Nurses and Associates, Inc. The Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes.
10-19. Available at: http://infectioncontrol.sgna.org/SGNAResources/tabid/55/Default.aspx#standards. Accessed November 10, 2010.
About the author

Lorri Downs, RN, BSN, MS, CIC is a board-certified infection preventionist and vice president of infec-
tion prevention for Medline Industries, Inc. She has a diverse portfolio of more than 25 years in the nursing
professions. Her expertise focuses on infection prevention surveillance at large acute care organizations,
plus ambulatory and public health settings. Lorri has developed hospital infection control programs and
local emergency preparedness plans, and she ahs lectured on various infection prevention topics.

Continuing Education Article OR Issues
Surgical
Stuck Like ^ Glue
NEW USES AND IMPROVED OUTCOMES
By Alecia Cooper, RN, BS, MBA, CNOR

and Debashish Chakravarthy, PhD
Are your surgeons increasingly requesting surgical glue? If they advancements and the expanding caseloads for which these
aren’t asking for it yet, all indications are that surgical glue will technologies apply. While traditional wound closure products,
be a mainstay in operating rooms in the near future. Let’s including sutures and staples, still command a sizable portion
explore why use of surgical glue is becoming so prominent of the overall market, their rate of use compared to alternative
among surgeons. products is relatively flat, and in some cases declining, in
certain geographic regions. In contrast, the use of surgical
Current Market Snapshot sealants and glues is growing at an estimated 10 to 15 percent
Current research on the success of surgical sealants and glues per year.1
in clinical practice was published in October 2010 by Med-
Market Diligence, a provider of data and insight on advanced In August 2010, Outpatient Surgery conducted a poll asking
medical technologies. The report states that the advance- readers about their use of surgical glue and the results were as
ments in surgical sealants and glue technology are enabling follows:
these products to increasingly penetrate the existing markets
for sutures and staples, in addition to capturing a caseload of OUTPATIENT SURGERY MAGAZINE READER POLL2
new applications.1 A wide array of wound closure products is “In which types of cases do you use surgical
now in use by both general surgeons and surgeons special- glue instead of sutures?”
izing in gynecologic, orthopedic, gastrointestinal, neurology,
cosmetic, vascular and nearly all other surgical areas. ARTHROSCOPY . . . . . . . . . . . . . . . . . . .28%
ENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1%
Many aspects of prevailing surgical methods (from as recently GENERAL SURGERY . . . . . . . . . . .34%
as 10 years ago) have undergone major changes. The GYNECOLOGY . . . . . . . . . . . .11%
increased use of surgical sealants and glue is one such PLASTICS . . . . . . . . . . . . .26%
change and is primarily attributable to both new technological

Importance of Surgical Glue Knowledge Focusing on Cyanoacrylates
Whereas surgeons select and evaluate the effectiveness of Cyanoacrylates were first used in 1949 after being discovered
closure devices, including surgical glues, it is the responsibility accidentally while researchers were studying refracting indexes
of nurses, physician assistants, residents, interns and students of coatings on glass.3 Cyanoacrylates became popular during
to routinely assist or close the procedure under the surgeon’s the Vietnam War as a hemostat for soldiers wounded in field
direction. Therefore, it is imperative to have thorough knowl- combat. These compounds entered the clinical market during
edge of these materials and their appropriate application and the 1980s and 1990s in dental products, bandages and
use in order to achieve the best performance and results. wound closure adhesives. Today, several cyanoacrylates have
been cleared and/or approved as medical devices by the FDA.
TYPES OF SURGICAL TISSUE ADHESIVES

Surgical glues, also referred to as surgical tissue adhesives or Collagen-based products. Collagen-based adhesives
sealants, are used after a surgery or traumatic injury to bind 3 may be combined with other hemostatic proteins such as
together both deep as well as superficial tissue. These glues thrombin to make an effective internal adhesive.
provide a chemical bond to hold tissue together for healing
and serve as a barrier to stop the flow of bodily fluids. Certain
physicians use surgical glues in conjunction with, or as and 4 Hydrogels. Hydrogels are synthetic polyethylene glycol
(PEG) polymers commonly used in lung and thoracic surgery
alternative to, sutures and staples. for their ability to seal air leaks. Due to their physical prop-
erties, they are unsuitable as an incision site closure or glue.
Including surgical closure glues, there are several main types
of surgical glues approved for various surgical applications: Cyanoacrylates. Cyanoacrylates are compounds ideally
Fibrin sealants. Fibrin sealants are a type of surgical

5 suited—because of their physical properties when “set
up”—to close topical incisions, minor lacerations or an inci-
1 adhesive derived from both human and animal blood prod-
ucts. Ingredients in the fibrin sealant interact during appli-
sion site. The subcutaneous tissue is closed with sutures
and the glue is used only to close the dermal and epidermal
cation to form a clot. Fibrin sealants are effective for use in incisional defects. These compounds are very commonly
cardiovascular surgery, lung surgery, the closure of dura, used on laparoscopic incisions and are much stronger than
and to seal spleen and liver lacerations. Fibrin sealants are all the internal glues discussed above. Cyanoacrylates are
not suitable for external or topical use. also able to withstand the external environment while the
incision heals naturally underneath the glue line. In general,
2 Glutaraldehyde-based glues. Glutaraldehyde glues are

protein-based compounds that are crosslinked by
cyanoacrylates are waterproof, flexible and require
no secondary dressing. Cyanoacrylates are not bio-
glutaraldehyde, in situ, to make a strong and bioabsorbable absorbable and must be restricted to external and tem-
internal seal. These glues are not suitable for external or porary applications.
topical use.
Stick with OctylSeal™
Flexible wound closure that’s easy on your budget
Introducing Medline’s OctylSeal high viscosity
tissue adhesive for closure of simple wounds
• Flexible structure moves with the skin, minimizing the Indications for use
chance of cracking Topical application only to hold closed easily approximated
• Acts as a barrier to microbial penetration as long as the edges of wounds from surgical incisions, including punc-
adhesive film remains intact tures from minimally invasive surgery and simple, thoroughly
• 40 percent more glue per container than most other cleansed trauma-induced lacerations. OctylSeal may be
tissue adhesives (0.7 grams versus 0.5 grams) used in conjunction with, but not in place of deep dermal
• Easy, versatile application – interchangeable tips (swab sutures. Available by prescription only.
and nozzle) included in every package; violet color for
easier identification on skin
• Metal tube instead of glass ampule means no risk of
broken glass entering the wound
To learn more about OctylSeal,
call 847-643-4526.
©2010 Medline Industries, Inc. Medline is a registered trademark and OctylSeal is a trademark of Medline Industries, Inc.
Table 1. Octyl versus butyl cyanoacrylates
Octyl Butyl
No need to refrigerate Needs refrigeration
Cures or polymerizes as a smooth Cures or polymerizes as a rough
surface and an even film surface
Sets up with a flexible “glue” line at Sets up with a brittle “glue” line at
the application site. the application site.
Two main types: octyls and butyls. There are, in essence,

two main types of cyanoacrylates approved as medical tissue Potential benefits of surgical wound
adhesives. One type is N-butyl-2-cyanoacrylate (simply called closure with cyanoacrylates6
butyl in most cases) and the second type is 2-octyl- 1. Quicker wound closure
cyanoacrylate (Simply called octyl).4 2. Comparable/better scar cosmesis than sutures
or staples
The difference between the two types is in the nature of the 3. Occlusive microbial barrier
chemical chains present in the ester groups of the molecules.
4. Non-invasive – less tissue trauma and reduced
The molecules are sometimes referred to as monomers. In inflammatory reaction
contrast, the adhesive that is “set up” on skin post application
5. No secondary dressings required
is the polymer. A butyl cyanoacrylate contains a short chain
6. Easy-to-use/quick learning curve
(4 carbon length) portion in its structure. An octyl cyanoacry-
late contains a longer chain (8 carbon length) portion. 7. Ease of wound visualization
8. Reduced risk of needle-stick injury associated
The polymer film resulting from the use of a butyl glue is con- with suturing
sidered to be more rigid than the film resulting from the set up 9. Cost-effective
of an octyl glue on skin, and far less flexible. Thus, butyls are
more prone to cracking and splitting under tension and flex-
ure of the skin, limbs and joints during normal movement. In
summary, a butyl film provides only strength, but very little flex- Determining How to Close the Wound
ibility, while the octyl film seems to balance both tensile In determining the appropriate type of product to close any
strength and flexibility without fissures or cracks appearing in surgical procedure, surgeons take into account many factors
the film. based upon the desired goals.
Since both types of cyanoacrylate adhesives have FDA 1. Reason for the surgery
approval,4 how does a surgeon select the preferred product? 2. Location of where and how the injury occurred
Many factors can play into the surgeon’s decision, though top- (if applicable)
ping the list seem to be the features and benefits of each type 3. Location of the wound
of adhesive that appeals to the surgeon, the product type the 4. Length of the surgical procedure
surgeon trained on, and the product brand that the hospital
stocks. Table 1 compares octyl and butyl cyanoacrylates and Surgical wound closure using a cyanoacylate is best suited for
shows the factors that may play into the clinicians preference wounds that are not subject to significant stress or flexion.
in product choice. Many surgeons follow this rule of thumb: if the skin requires
more than simple pulling together with forceps or fingers to
Most surgeons find that surgical glues offer a fast,
simple and effective means of surgical wound closure
achieve approximation of the wound, then deeper sutures
and/or subcutaneous sutures should be used before the glue
is applied.5 Octyl cyanoacylates appear to work better on
areas of flexion as compared to butyl cyanoacylates, because
they set up with a flexible “glue line” and maintain their micro-
bial barrier.
The best results are obtained when the wound incision is clean
and dry with total hemostasis prior to the application of the
skin adhesive. Cyanoacrylate adhesives close the skin by
forming a polymerized layer across the top of the skin, creat-
ing a a bridge between the skin edges. Therefore, it is impor-
tant for best results to obtain edge-to-edge apposition while Trauma
the glue sets over the wound.
If the procedure is a routine, elective surgery and not caused

SKIN GLUE – TOP TIPS6
by a trauma, surgical glue should be considered. If an injury • Make sure the wound is clean and dry
took place outdoors or on a playground, for example, where • Stop bleeding prior to application
there are potential contaminants, it is best not to consider sur- • Apply glue over tightly and correctly approximated
gical glue. The duration of surgery may affect the potential for wound edges
infection, and surgical glue should be used with caution. • Hold until glue/tissue adhesive is dry
• No further dressings required, although secondary
Benefits of Using Surgical Tissue Adhesives dressing will not harm incision site and may provide
Many surgeons prefer coverage of the suture line with a additional microbial barrier protection
cyanoacrylate surgical glue as opposed to a dressing because • Ensure patient/post-op staff know glue was used and
the glue allows the incision line to be easily visible.6 Once com- know wound site care
fortable with the technique, most surgeons find that surgical • Provide patient information/instructions at discharge
glues offer a fast, simple and effective means of surgical
wound closure, particularly for smaller surgical incisions. In
addition, cosmetic results are superior. Patients are pleased Microbes and Surgical Tissue Adhesives
with the waterproof and microbial barrier nature of glue, Recent in vitro studies have shown that 2-octyl-cyanoacrylate
especially octyl glues, which are resistant to cracking and is an effective microbial barrier for the first 72 hours after
allow patients to shower soon after the procedure. Additional application.3
benefits of using a surgical glue are the lack of visible dress-
ings or sutures and the absence of procedures to remove A key aspect of using surgical glues is that the skin formed
sutures or staples.5 with 2-octyl-cyanoacrylate is effective against gram-positive

and gram-negative bacteria including Staphylococcus epi-
dermis, S. aureus, Escherichia coli, Pseudomonas aeruginosa,
and Enterococcus faecium. The adhesive creates a protective
layer for the wound and keeps the area moist, resulting in
faster epithelialization. In this way, the system of closure and
protection of the wound using surgical glue can result in
reduced costs and better management in the postoperative
phase.3
Cyanoacrylate skin adhesives may potentially reduce the risk

of surgical site infections (SSIs) by:7
1. Forming an occlusive, impermeable, waterproof barrier Linear
2. Prevention of translocation of local skin flora
3. Reducing post-operative wound dressing changes
4. Improving hygiene by allowing patients to shower Proper application of surgical glue can be learned quickly and
easily; the method is not particularly challenging.
Wound Site Care
To allow proper care and management of the incision site As the process for the surgical glue to ”set up” and protect
closed with surgical glue, it is imperative to communicate the incision site happens in about a minute, the use of surgi-
effectively regarding glue use at handoff in the immediate cal glue can save valuable time and improve both patient out-
post-operative period. Incisions closed with glue typically do comes and patient satisfaction. Patients report more
not produce drainage because in general, the use of glue is postoperative comfort, appreciate the ability to see the inci-
restricted to non-draining wounds. sion and like being able to bathe immediately following the
procedure.
If the incision appears to be opening, the edges should be
pushed together, and then butterfly-type bandages may be Surgical glues are relatively inexpensive, comprising only
applied to hold the edges together. The surgeon may apply a small fraction of the overall costs associated with most sur-
additional surgical glue to the wound as needed prior to dis- geries. There is no need for a secondary dressing or dressing
charge from the hospital. Surgical glues will slough off naturally changes, which adds to costs of treatment. Use of glue also
as normal skin grows to heal the incision site. may eliminate follow-up visits related to post op care and
suture removal. Based upon these myriad factors, the use of
Best practice requires providing education and training on surgical glues is likely to continue growing, and new innova-
surgical wound care to the patient and family prior to tions in the technology will continue to emerge.
discharge so that proper care is extended at home. Postop-
erative evaluation has shown good patient satisfaction when
using surgical glues.3 References
1. Surgical Sealant and Glue New Uses and Penetration of Traditional Wound Closure,
Hemostasis. MedMarket Diligence, LLC. October 11, 2010. Available at:
http://www.prlog.org/10991463-surgical-sealant-and-glue-new-uses-and-penetration-
Perioperative personnel need to know how to care for inci-
of-traditional-wound-closure-hemostasis.html. Accessed November 8, 2010.
sions closed with glue and should be able to communicate to 2. InstaPoll. In which types of cases do you use surgical glue instead of sutures? Outpatient
Surgery E-Weekly, August 17, 2010. Available at: www.outpatientsurgery.net.
patients and their families the methods to properly care for and Accessed November 9, 2010.
maintain the incision site at home. 3. Silvestri A, Brandi C, Grimaldi L, Nisi G, Brafa A, Calabro M, et. al. Octyl-2-cyanoacrylate
adhesive for skin closure and prevention of infection in plastic surgery. Aesthetic Plastic
Surgery. 2006;30(6):695-699.
4. Petrie EM. High strength surgical adhesives. Available at: http://www.specialchem4adhe-
New Uses and Improved Outcomes sives.com/home/editorial.aspx?id=3043. Accessed November 18, 2010.
The key to the successful use of surgical glue is that surgeons 5. Liversedge NH. Get stuck in! Hands on experiences with surgical skin glue. Obs & Gynae
News. 2007;14(1):24-28.
should precisely apply the products to the appropriate surgi- 6. Malangoni MA, Cheadle WG, Dodson TF, Dohmen PM, Jones D, Kushagra K, et al.
Roundtable discussion. New opportunities for reducing risk of surgical site infections.
cal wounds. Both surgeons and other clinicians will need to Surgical Infections. 2006;7 Suppl 1:S23-39.
perfect their technique for applying and using surgical glues. 7. Non-invasive closure of laparoscopic surgical incisions. Available at: http://www.admed-
sol.com/Doc/LBL%20Clinical%20Update.pdf. Accessed November 18, 2010.
CE Test Questions
Stuck Like Surgical Glue:

NEW USES AND IMPROVED OUTCOMES
CE Test
True/False 8. Patients tend to prefer surgical glue over sutures or
1. The use of surgical sealants and glues is growing at staples because __________________.
a rate of 10 to 15 percent per year. T F a. It allows them to lightly wash or shower right
after surgery
2. Recent in vitro studies have shown that b. There is no need for required follow up for removal
2-octyl-cyanoacrylate is an effective microbial barrier c. They provide more postoperative comfort
for the first 72 hours after application. T F d. All of the above
3. Butyl cyanoacrylates cure or polymerize as a smooth 9. Glutaraldehyde glues are used in the repair of
surface. T F _________________.
a. Simple skin lacerations
4. Octyl cyanoacrylates require refrigeration. T F b. Aortic dissections
c. Massive head wounds
5. Cyanoacrylate adhesives first entered the clinical d. Laparoscopic surgical incisions
market in the 1960s. T F
10. Surgical adhesives derived from both human and
Multiple Choice animal blood products are called
6. Which of the following is one of the factors surgeons _____________________.
take into account when determining the appropriate a. Fibrin sealants
type of product to close a surgical incision? b. Collagen-based compounds
a. Patient’s age c. Cyanoacrylates
b. Skin temperature d. None of the above
c. Ability to approximate wound edges
d. None of the above
7. Which type of surgical glue is commonly used in lung

and thoracic surgery?
a. Cyanoacrylates
b. Glutaraldehyde glues
c. Hydrogels
d. Fibrin sealants
Submit your answers at

www.medlineuniversity.com Courses approved for continuing education by the Florida Board
and receive 1 FREE CE credit of Nursing and the California Board of Reigistered Nursing.

PROVEN 99.999%
BACTERIAL REDUCTION
Medline BIOGUARD® Barrier Dressings
A new product for your infection control program No toxicity

Medline BIOGUARD® barrier dressings are specifically Medline BIOGUARD® barrier dressings are non-toxic,
designed to help protect wounds from more than 12 allowing them to be used safely on all wounds.
types of bacteria, including methicillin-resistant Staphy-
lococcus aureus (MRSA). The active component is a Medline BIOGUARD® barrier products act as a physical
cationic polymer called Poly (diallyl dimethyl ammonium barrier to outside contaminants and do not act on the
chloride) (pDADMAC). surface or the interior of the wound nor do they contain
antimicrobial agents that act on the body. These dressings
No leaching are not intended as a treatment for clinical infection.
Unlike similar cationic biocides (such as PHMB – If signs of clinical infection are present, consult a physician.
the active component in the competitor’s dressings), Available by prescription only.
pDADMAC is permanently bound to the barrier
dressing. It keeps working at the same rate for
the life of the dressing – without leaching.
No resistance
Lack of leaching helps prevent the potential
To request a sample of BIOGUARD®
for resistant strain formation.
contact your Medline sales
representative or e-mail
ProductSupportPrimaryCare@medline.com
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. BIOGUARD is a registered
trademark of Derma Sciences, Inc. US Patent No. 7,045,673 and 7,709,694 and 7,790,217 and foreign counterparts.
NIMBUS technology is licensed by Quick-Med Technologies, Inc. NIMBUS is a registered trademark of Quick-Med
Technologies, Inc. Covidien is a registered trademark of Covidien.
Special Feature
product spotlight
INTRODUCING MEDLINE BIOGUARD® BARRIER DRESSINGS
Proven 99.999% bacterial reduction for your infection
control program
Medline BIOGUARD is a new line of gauze-based dressings with a >5-log

(99.999%) average reduction of more than 12 common pathogens,
including MRSA, vancomycin-resistant Enterococcus faecium and
Pseudomonas aeruginosa. The active component is a non-toxic, high
molecular weight cationic polymer called Poly (diallyl dimethyl ammonium
chloride) or p-DADMAC contained within the dressings.
Unlike PHMB, the active ingredient in the competitor’s barrier dressing,

p-DADMAC is permanently bound to the dressing. So it keeps working at
the same rate for the life of the dressing. Lack of leaching helps prevent
bacteria from growing and spreading in the dressing, reducing the potential
for resistant strain formation.
Time magazine Innovation Leader Dr. Greg Schultz developed the patented
technique for bonding p-DADMAC to the gauze dressings.1 A biochemist
with an interest in wound care, Dr. Schultz serves on the board of direc-

product spotlight
tors for the National Pressure Ulcer Advisory Panel (NPUAP)2 and on the Reference
1. S Morrissey. Epidemiology: forging the future:
editorial boards of several journals in the areas of ocular and skin wound microbe-busting bandages. Time. 2006; 167(12). Posted
March 12, 2006. Available at: www.time.com/time/maga-
healing.3
zine/article/0,9171,1172215,00.html.
2. National Pressure Ulcer Advisory Panel Board of Directors
Medline BIOGUARD® dressings are intended for use with: 2010. Available at: www.npuap.org/about.htm.
• Exuding wounds Accessed November 9, 2010.
3. University of Florida website. Biochemistry and Molecular
• First and second degree burns Biology. Gregory Schultz, PhD. Available at:
• Surgical wounds www.med.ufl.edu/IDP/BMB/bmbfacultypages/gschultz.html.
• Securing and preventing movement of a primary dressing 4. Data on file.
• Wound packing
Bioguard is a registered trademark of Derma Sciences, Inc.
The dressings are available in many sizes and types, including rolls,
sponges, packing strips, non-adherent pads and conforming bandages.
Contact your Medline representative for further details.
Medline BIOGUARD barrier products act as a physical barrier to outside

contaminants and do not act on the surface or the interior of the wound
nor do they contain antimicrobial agents that act on the body. These dress-
ings are not intended as a treatment for clinical infection. If signs of clinical
infection are present, consult a physician. Available by prescription only.
Medline BIOGUARD Comparative Efficacy Study

Laboratory testing4 comparing the effectiveness of Medline BIOGUARD
dressing versus Covidien AMD dressing showed the same log reduction
against MRSA, Pseudomonas aeruginosa (PA) and VRE. The efficacy
remains the same at 24 and even after 48 hours. All results indicate >5-log
reduction of broad spectrum microbes.
Efficacy of Medline BIOGUARD® and Covidien AMD After 24 and 48 Hours*

6
Antibacterial Activity (Log Reduction)
0
Methicillin-resistant Pseudomonas aeruginosa (PA) Vancomycin-resistant
Staphyloccus aureus (MRSA) Enterococcus faecium (VRE)
Medline Bulkee II BIOGUARD® Covidien® Kerlix AMD™

Gauze Bandage Roll Antimicrobial Large Roll
*Tested at an Independent third party laboratory
BioCon™- 500
Bladder Scanner
Safely Measures
Bladder Volume
Minimize unnecessary catheterization
Research has shown that 80 percent of urinary tract
infections acquired at healthcare facilities are associated
with an indwelling urethral catheter.1 This type of infection
is known as CAUTI, or catheter-associated urinary tract
infection. What’s more, Medicare no longer reimburses
for treatment of CAUTI if it happens while a patient is
hospitalized, giving hospitals a major incentive to prevent it.
But how?
Avoiding unnecessary catheter use is a primary strategy

for preventing CAUTI, and clinical guidelines recommend
the consideration of alternatives to catheterization.2
Bladder scanners can be used in place of a urinary
catheter to assess bladder volumes, and many
catheterizations can be avoided.3
To learn more about CAUTI

prevention and the BioCon-500, visit
www.erasecauti.com/alternatives.asp
or contact your Medline
sales representative.
1. Lo E, Nicolle L, Classen D, Arias A, Podgorny K, Anderson DJ, et al. SHEA/IDSA

practice recommendation: strategies to prevent catheter-associated urinary tract
infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29:S41-S50.
2. Stokowski, LA. Preventing catheter-associated urinary tract infections. Medscape
Nursing Perspectives. February 3, 2009.
3. Stevens E. Bladder ultrasound: avoiding unnecessary catheterizations. Med/Surg
Nursing. 2005; 14(4):249-253.

Medline is a registered trademark of Medline Industries, Inc.
BioCon-500 is a trademark of Mcube Technology Co., Ltd.
What did we do after
designing a revolutionary
new catheter tray system?
We found THREE more ways

to make it even better.
We’re obsessed with engineering new and better Combined with the previous innovative tray redesign
technology for healthcare workers. So after we and comprehensive ERASE education, these three
revolutionized the outdated Foley catheter tray with new features help to improve patient safety and quality,
a unique, one-layer system design, we immediately while reducing avoidable costs associated with waste
turned our attention to addressing how we could and urinary tract infections.
make it even easier to use. We studied how the
tray was being used in the field. The result was To learn about the ERASE CAUTI system, as well as
three more great improvements. other strategies for minimizing the risk of CAUTI, sign
up for a free Innovation in the Prevention of CAUTI
webinar at www.medline.com/erase/webinar.
1 Real photography on the outside –
so you know exactly what’s inside
A photo on the package helps identify the
contents of the kit, serves as an educational
tool for the clinician and can be used to
discuss the procedure with the patient.
Also, the label opens up to a booklet
with step-by-step instructions and
helpful tipsfor the clinician.
2 A revised checklist for the

medical record
The reformatted checklist is smaller,
making it easier to place in the paper chart
or attach to the electronic medical record.
3 Education you’ll want to present

to your patient
There’s nothing like the new Patient
Education Care Card. Designed to look
and feel like a “Get Well Soon” card, it
tells patients about catheterization so
they know you are providing them the
best care possible.
Ventilator-associated pneumonia (VAP)
is a hospital-acquired infection that occurs in up
to 27 percent of all mechanically ventilated
patients. 1 It is specifically defined as an airway
infection that develops more than 48 hours after a
patient is intubated.2
Among ICU patients, nearly 90 percent of episodes

of hospital-acquired pneumonia occur during
mechanical ventilation.1 Because half of all episodes
of VAP occur within the first four days of mechani-
cal ventilation, it is especially critical to prevent the
condition all together.1 Reducing mortality due to
ventilator-associated pneumonia requires an
organized process that guarantees early recognition
Five Step of pneumonia and consistent application of

evidence-based practices.2
The Institute for Healthcare Improvement (IHI)

advocates use of a bundle approach to help fight
Approach VAP. The ventilator bundle is a series of interventions

related to ventilator care that, when implemented
together, achieves significantly better outcomes.2
The five components of the (IHI) Ventilator
for Avoiding Bundle are:2

1. Elevating the head of the bed 30 degrees
2. Daily “sedation vacations” and assessment
of readiness to extubate
VAP
3. Peptic ulcer disease prophylaxis
4. Deep vein thrombosis prophylaxis
5. Daily oral care with chlorhexidine
References
1. Kollef MH. What is ventilator-associated pneumonia and why is it
important? Respiratory Care. 2005;50(6):714-724. Available at:
www.rcjournal.com/contents/06.05/06.05.0714.pdf. Accessed
November 4, 2010.
2. Implement the Ventilator Bundle. Institute for Healthcare
Improvement (IHI) website. Available at: www.ihi.org/IHI/Topics/Criti-
calCare/IntensiveCare/Changes/ImplementtheVentilatorBundle.htm.
Patient Safety
Tips for Complying with the

VAP Prevention Bundle
1. Elevating the Head of the Bed 30 Degrees 3. Peptic Ulcer Disease Prophylaxis
• Implement a mechanism to ensure head-of-the-bed • Include peptic ulcer disease prophylaxis as part of
elevation, such as including this intervention on your ICU order admission set and ventilator order
nursing flow sheets and as a topic at set. Make application of prophylaxis the default
multidisciplinary rounds. value on the form.
• Create an environment where respiratory therapists • Include peptic ulcer disease prophylaxis as an item
work collaboratively with nursing to maintain for discussion on daily multidisciplinary rounds.
head-of-the-bed elevation. • Empower pharmacy to review orders for ICU
• Involve families in the process by educating them patients to ensure that some form of peptic ulcer
about the importance of head-of-the-bed elevation disease prophylaxis is in place at all times.
and encourage them to notify clinical personnel
when the bed does not appear to be in the 4. Deep Venous Thrombosis Prophylaxis
proper position. • Include deep venous prophylaxis as part of your
• Use visual cues to easily identify when the bed is ICU order admission set and ventilator order set.
in the proper position. Make application of prophylaxis the default value
• Include this intervention on order sets for initiation on the form.
and weaning of mechanical ventilation, delivery of • Include deep venous prophylaxis as an item for
tube feedings, and provision of oral care. discussion on daily multidisciplinary rounds.
• Empower pharmacy to review orders for ICU
2. Daily “Sedation Vacations” and Assessment patients to ensure that some form of deep venous
of Readiness to Extubate prophylaxis is in place at all times.
• Implement a protocol to lighten sedation daily at
an appropriate time to assess for neurological 5. Daily Oral Care with Chlorhexidine
readiness to extubate. Include precautions to • Educate registered nurses (RNs) about the rationale
prevent self-extubation such as increased supporting good oral hygiene and its potential
monitoring and vigilance during the trial. benefit in reducing ventilator-associated pneumonia.
• Include a “sedation vacation” strategy in your overall • Develop a comprehensive oral care process that
plan to wean the patient from the ventilator; if you includes the use of 0.12% chlorhexidine oral rinse.
have a weaning protocol, add “sedation vacation” • Schedule chlorhexidine as a medication, which then
to that strategy. provides a reminder for the RN and triggers oral
• Assess that compliance daily during care process delivery.
multidisciplinary rounds.
Source: www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Changes/Implement-
• Consider implementation of a sedation scale
theVentilatorBundle.htm
(e.g., the Riker Scale) to avoid oversedation.

VAPREVENT SYSTEM:
Making it easier to avoid
Ventilator-Associated Pneumonia
Evidence-based innovation in oral care
Easy to identify
which mouthwash
the kit contains
Strong
built-in IV
pole hanger
IHI Checklist
of activities
to help
reduce VAP
Compliance
at a glance –
clearly labeled
and sequenced
in the order
they should
be used
Thumb grip
for easy
dispensing
VAPrevent is a comprehensive oral care system modeled after the guidelines of
the Institute for Healthcare Improvement (IHI) Ventilator Bundle. It’s designed to
address ventilator-associated pneumonia (VAP)—the second most common
healthcare-associated infection1, affecting up to 40 percent of ventilator patients.2
The VAPrevent System brings you the three Ps to better oral care: the right products
combined with a comprehensive educational program at a value-added price.
Product
Only Medline features these three options for oral care: IHI-recommended
chlorhexidine gluconate (CHG), the alcohol-free moisturizing of Biotene®,
or the proven antisepsis of hydrogen peroxide. Color-coded packaging
allows for quick identification, thorough caregiver education and simple
compliance. The system is designed to dispense each kit one-at-a-time
in the right order at the right time.
Record
start time,
date and
patient
information
Easy
identification
of oral care Suction Toothbrush
frequency & Catheter Kit
Program
Products are only as beneficial as knowing how to use them appropriately.
Clear visual That’s why we also developed the Medline VAP Program, which helps build
identification your staff’s knowledge and clinical skills with educational modules for novice
of kit and experienced clinicians, as well as an online interactive competency for oral
components
care. We help you implement the program, and then provide you with 90-
day reports to help you track your incidence of VAP.
Price
All this – and a lower price! The cost of the VAPrevent System is five to 10
percent lower than competitors, who offer less comprehensive systems.
To schedule your evaluation of the VAPrevent System,

contact your Medline representative or call
1-800-MEDLINE (633-5463).
References
1 Bingham M, Ashley J, De Jong M, Swift C. Implementing a unit-level intervention to reduce the probability
of ventilator-associated pneumonia. Nursing Research. 2010; 59(1): S40-S47.
2 Trouillet J, Chastre J, Vuagnat A, Joly-Guillou M, Combaux D, Dombret M, et al. Ventilator-associated
pneumonia cased by potentially drug-resistant bacteria. Am J Respir Crit Care Med. 1998. 157(2):531-539.
Caring for Yourself
Get Set for

WINTER ILLNESS
SEASON
In much of the Northern Hemisphere, this is prime time Colds are usually distinguished by a stuffy or runny nose and
for colds, influenza (flu), and other respiratory illnesses. sneezing. Other symptoms include coughing, a scratchy
throat, and watery eyes. No vaccine against colds exists
While contagious viruses are active year-round, fall and winter because they can be caused by many types of viruses. Often
are when we’re all most vulnerable to them. This is due in large spread through contact with mucus, colds come on gradually.
part to people spending more time indoors with others when
the weather gets cold. The Food and Drug Administration Flu comes on suddenly, is more serious, and lasts longer than
(FDA) regulates medicines and vaccines that help fight colds. The good news is that yearly vaccination can help pro-
winter illnesses. tect you from getting the flu. Flu season in the United States
generally runs from November to April.
Colds and Flu
Most respiratory bugs come and go within a few days, with no Flu symptoms include fever, headache, chills, dry cough, body
lasting effects. However, some cause serious health problems. aches, fatigue, and general misery. Like colds, flu can cause a
Although symptoms of colds and flu can be similar, the two stuffy or runny nose, sneezing, and watery eyes. Young children
are different. may also experience nausea and vomiting with flu.
Prevention Tips
Get vaccinated against flu. According to the Centers for
Disease Control and Prevention (CDC):
• More than 200,000 people in the United States are
hospitalized from flu-related complications each year,
including 20,000 children younger than age 5.
• Flu-associated deaths number in the thousands each
year. Between 1976 and 2006, the estimated number of
flu-related deaths every year ranged from about 3,000
to about 49,000.
Tips for Avoiding
Flu vaccine, available as a shot or a nasal spray, remains the
best way to prevent and control influenza. The best time to get WINTER BUGS:
a flu vaccination is from October through November, although
getting it in December and January is not too late. A new flu • Get vaccinated against flu
shot is needed every year because the predominant flu viruses
change every year.
• Wash your hands often
• Limit exposure to infected people
All people 6 months of age and older should be vaccinated.
However, you should talk to your health care professional
• Keep stress in check
before getting vaccinated if you • Eat right
• have certain allergies, especially to eggs
• have an illness, such as pneumonia • Sleep right
• have a high fever • Exercise
• are pregnant
Flu vaccination for health care workers is urged because During last flu season, two different vaccines were needed; one
unvaccinated workers can be a primary cause of outbreaks in to prevent seasonal influenza and another to protect against
health care settings. Certain people are more at risk for devel- the 2009 H1N1 flu virus. This year’s seasonal flu vaccine pro-
oping complications from flu; they should be immunized as tects against three strains of influenza, including the 2009
soon as vaccine is available. These groups include: H1N1 flu virus.
• people 65 and older
• residents of nursing homes or other places that house Also, a vaccine specifically for people 65 years and older is
people with chronic medical conditions such as diabetes, available this year. Called Fluzone High-Dose, this vaccine
asthma, and heart disease induces a stronger immune response and is intended to better
• adults and children with heart or lung disorders, protect the elderly against seasonal influenza.
including asthma
• adults and children who have required regular medical This vaccine—which was approved by FDA in 2009—was
follow-up or hospitalization during the preceding year developed because the immune system typically becomes
because of chronic metabolic diseases (including diabetes), weaker with age, leaving people at increased risk of seasonal
kidney dysfunction, a weakened immune system, or flu-related complications which may lead to hospitalization
disorders caused by abnormalities of hemoglobin and death.
(a protein in red blood cells that carries oxygen)
• young people ages 6 months to 18 years receiving long-term Wash your hands often. Teach children to do the same. Both
aspirin therapy, and who as a result might be at risk for colds and flu can be passed through coughing, sneezing, and
developing Reye’s syndrome after being infected with contaminated surfaces, including the hands.
influenza (See aspirin information in the section “Taking
OTC Products.”) Note that only one vaccine is needed CDC recommends regular washing of your hands with warm,
for the 2010-2011 influenza season. soapy water for about 15 seconds.

3 Things You Can Do:
1. Wash your hands often with soap 2. Get vaccinated against the flu. 3. Choose over-the-counter medicines
and warm water. that treat only your specific symptoms.
FDA says that while soap and water are undoubtedly the first Here are other steps to consider:
choice for hand hygiene, alcohol-based hand rubs may be • First, call your doctor. This will ensure that the best course
used if soap and water are not available. However, the agency of treatment can be started early.
cautions against using the alcohol-based rubs when hands are • If you are sick, try not to make others sick too. Limit your
visibly dirty. This is because organic material such as dirt exposure to other people. Also, cover your mouth with a
or blood can inactivate the alcohol, rendering it unable to tissue when you cough or sneeze, and throw used tissues
kill bacteria. into the trash immediately.
• Stay hydrated and rested. Fluids can help loosen mucus
Try to limit exposure to infected people. Keep infants away and make you feel better, especially if you have a fever.
from crowds for the first few months of life. This is especially Avoid alcohol and caffeinated products. These may
important for premature babies who may have underlying dehydrate you.
abnormalities such as lung or heart disease. • Know your medicine options. If you choose to use medicine,
there are over-the-counter (OTC) options that can help
Practice healthy habits. relieve the symptoms of colds and flu.
• Eat a balanced diet.
• Get enough sleep. If you want to unclog a stuffy nose, then nasal decongestants
• Exercise. It can help the immune system may help. Cough suppressants quiet coughs; expectorants
better fight off the germs that cause illness. loosen mucus so you can cough it up; antihistamines help stop
• Do your best to keep stress in check. a runny nose and sneezing; and pain relievers can ease fever,
headaches, and minor aches.
Also, people who use tobacco or who are exposed to
secondhand smoke are more prone to respiratory illnesses and In addition, there are prescription antiviral medications
more severe complications than nonsmokers. approved by FDA that are indicated for treating the flu. Talk to
your health care professional to find out what will work best
Already Sick? for you.
Usually, colds and flu simply have to be allowed to run their
course. You can try to relieve symptoms without taking medi- Taking OTC Products
cine. Gargling with salt water may relieve a sore throat. And a Be wary of unproven treatments. It’s best to use treatments
cool-mist humidifier may help relieve stuffy noses. that have been approved by FDA. Many people believe that
products with certain ingredients—vitamin C or Echinacea, for
example—can treat winter illnesses.
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Unless FDA has approved a product for treatment of specific
symptoms, you cannot assume that the product will treat those
symptoms. Tell your health care professionals about any
supplements or herbal remedies you use.
Read medicine labels carefully and follow directions. People

Some medicine labels may refer to aspirin as salicylate or
with certain health conditions, such as high blood pressure,
salicylic acid. Be sure to educate teenagers, who may take
should check with a health care professional before taking a
OTC medicines without their parents’ knowledge.
cough and cold medicine. Some medicines can worsen
underlying health problems.
When to See a Doctor
See a health care professional if you aren’t getting any better or
Choose appropriate OTC medicines. Choose OTC medi-
if your symptoms worsen. Mucus buildup from a viral infection
cines specifically for your symptoms. If all you have is a runny
can lead to a bacterial infection.
nose, only use a medicine that treats a runny nose. This can
keep you from unnecessarily doubling up on ingredients, a
With children, be alert for high fevers and for abnormal behavior
practice that can prove harmful.
such as unusual drowsiness, refusal to eat, crying a lot, holding
the ears or stomach, and wheezing.
Check the medicine’s side effects. Certain medications such
Signs of trouble for all people can include
as antihistamines can cause drowsiness. Medications can
• a cough that disrupts sleep
interact with food, alcohol, dietary supplements, and each other.
• a fever that won’t go down
• increased shortness of breath
The safest strategy is to make sure your health care profes-
• face pain caused by a sinus infection
sional knows about every product you are taking, including
• worsening of symptoms, high fever, chest pain, or a
nonprescription drugs and any dietary supplements such as
difference in the mucus you’re producing, all after
vitamins, minerals, and herbals.
feeling better for a short time
Check with a doctor before giving medicine to children.

Cold and flu complications may include bacterial infections
Get medical advice before treating children suffering from cold
(e.g., bronchitis, sinusitis, ear infections, and pneumonia) that
and flu symptoms. Do not give children medication that is
could require antibiotics.
labeled only for adults.
Remember: While antibiotics are effective against bacterial

Don’t give aspirin or aspirin-containing medicines to chil-
infections, they don’t help against viral infections such as the
dren and teenagers. Children and teenagers suffering from
cold or flu.
flu-like symptoms, chickenpox, and other viral illnesses
shouldn’t take aspirin.
Find this and other Consumer Updates at
Reye’s syndrome, a rare and potentially fatal disease found www.fda.gov/ForConsumers/ConsumerUpdates
mainly in children, has been associated with using aspirin to Sign up for free e-mail subscriptions at www.fda.gov/con
treat flu or chickenpox in kids. Reye’s syndrome can affect the
blood, liver, and brain. Article courtesy of the Food and Drug Administration (FDA).
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Caring for Yourself
8 Principles
For Achieving Inner Peace
by Wolf J. Rinke, PhD, RD, CSP
Travel alerts, seemingly never ending natural and manmade 2. Think empowering thoughts
disasters, cranky patients bugging you…stress accelerat- As a man thinkest, so he becomes, says
ing at logarithmic speed! We certainly live in a very unsettling the Bible. And yet most of the time we
and stressful time. A time where achieving inner piece are totally inattentive to our thoughts.
seems totally out of reach. And yet I have found that you It’s almost like they run amok—totally
can attain it by relentlessly practicing the eight principles out of control—doing their own thing. To
that follow. achieve inner peace requires us to first
become aware of our thoughts—instead
1. Be honest of just letting them ruminate at the sub-
BP, politicians, clergy … do I need to conscious level. Second we must ask ourselves: is this a
say more? But before you get too smug, thought that empowers me and makes me stronger, or does
better look at the face in the mirror. it make me feel mad, bad or sad? And third we must be-
Study after study has shown that most come aware that at any one nanosecond our minds can
people lie. We inflate our resumes, hold only one thought. It can be a positive thought that gives
fudge our accomplishments and exag- us inner peace and improves our quality of life, or it can be
gerate even inconsequential events. a negative thought that does just the opposite. It’s so sim-
And when we lie there is no trust, and ple, yet difficult, to develop this powerful new awareness
without trust you can’t have solid relationships, without and transform it into a habit.
relationships there is no love, and without love you won’t
have inner peace. Call me old-fashioned; I believe there is 3. Take advantage of the
no excuse for lying … none. There is not even a good rea- abundance all around you
son for exaggerating. Because if you do, you will have to When we are struggling and having trou-
talk from the head, always checking your memory to make ble making ends meet, it is really difficult
sure you are consistent. And who can keep track of that, to see the abundance. What we see
when most of us have trouble remembering where we put instead—almost oppressively—is scarcity.
our car keys. Only by getting in the habit of always telling I know firsthand. Having been born right
the truth—especially if it is at your own expense—will you be after World War II in Germany, with my
able to talk form the heart and that will set you free. This in parents losing all their earthly posses-
turn will enhance your leadership skills because people sions—yes, everything—we had less than scarcity, we had
follow people they can trust. And it will put you on the fast desperation. Finding enough food and shelter to keep us
track in any endeavor. It will also enrich your personal rela- alive is what consumed my parents. Then some 17 years
tionships and, most importantly, will get you to like and later—when I immigrated to the United States—scarcity,
respect yourself—the foundation for achieving inner peace. although not as extreme, reared its ugly head again. Basi-

8 Principles For Achieving Inner Peace
cally I only spoke a few words of English, had $20 in my pocket So begin right now to become your own best friend, because if
and the proverbial shirt on my back. And I certainly had trouble it is not you, who is it going to be? In addition to taking really
finding all “the milk and honey” that supposedly was just wait- great care of your thoughts, also take extraordinary care of your
ing for me. However, it was all around me, and over time body. And if you want to avoid psychosomatic illnesses—which,
I learned to find it by internalizing a powerful concept that I as you probably know, account for the majority of illnesses in
learned from several different mentors: If you want more of this country—then you must eat right—which means you learn
something, you have to give it first. I know it sounds counterin- to stop when it tastes the best. Get adequate rest—seven to
tuitive. (By the way, lots of things are…otherwise men would eight hours of sleep is a great start—and do 25-30 minutes of
ride sidesaddle. If that didn’t at least make you smile, you’re aerobic exercise three times per week, alternating with strength
taking this much too seriously.) Here is how it works: If you want training for the other three days. (Go ahead and take Sunday
more love in your life, give more love. If you want to be happier, off.) It also means that you don’t put stuff into your body that
make others happy. If you want people to trust you, give does not belong there—read drugs and nicotine. (Please don’t
unconditional trust. Of course the only way you can take yawn. This is important. You only will be given one body—a the
advantage of this principle is to internalize the next one. one you’ve got is it. So treat it accordingly.)
4. Take really great care of #1 first 5. Become your own creator

Gotcha! Especially if you are a cynic. Those Movie directors, such as James
who are cynics immediately translate this Cameron of Avatar, are geniuses at cre-
into selfishness, conceit and greed. Nothing; ating exciting “realities.” You can be your
however, could be further from the truth. own “creator” once you realize that there is
(Why do you suppose that in an emergency, no reality. There is only perception. (No, I
you are told to put your oxygen mask on haven’t lost it.) Let me explain with a won-
first, before you help anyone else, even your derful story: A young man was interviewing
own child?) for his dream job. He had done his home-
work. He spent hours on the Internet learning all he could about
It’s also important to remember that you can’t give away what the hospital of his choice and the people he was going to be
you don’t own. Going back to the previous paragraph. If you interviewing with. He had read the last three annual reports and
want to love someone you must first love yourself, if you want knew the hospital’s mission, vision and core values by heart.
to be happier you must choose to be happy. It you want to trust In short he was ready to ace this interview. On the big day, he
someone…I’m sure by now you’re catching on. entered the impressive lobby of the hospital and had to check
in with the security guard to get his visitor badge. Wanting to
Achieving inner peace requires you to begin to love who you leave no stone unturned he said to the elderly gentleman behind
are, not who you ought to be…by someone else’s standard, the desk, “Sir, I’m interviewing for my dream job today. Tell me
whether that’s your parents, spouse or friend. The unvarnished about the people at this hospital. What are they like?”
fact is that at this very nanosecond you are who you are. And The elderly man replied with a question. “Tell me young man,
no wishing, hoping or praying is going to change that one iota. what were the people like at the last hospital you worked for?”
Now, who you will become in the future will be determined by “Oh, they were deceitful, unsupportive and mean. There simply
your thoughts (see Principle #2), which in turn will drive the was no vestige of teamwork or joy. In fact that’s why I left.”
actions you take. “Well,” the security guard answered, “I believe you will find the
same kind of people here.”
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Just about an hour later the scene repeated itself all over again. us. And then, we wonder why our life stinks. Part of what we
Except this time it was a young lady who was also interviewing carry around in our bag is resentment, hate and blame. All of
for the same job. She, too, had done her homework and these emotions will attack our souls and diminish the quality of
wanted to make a great impression. She also asked the secu- our spirit and our physiology.
rity guard, “What are the people like around here?”
In turn, he asked, “What were they like where you came from?” Instead, go ahead pay tribute to your past. Visit it. And then
The vivacious young lady answered, “Oh, I just loved the people toss it in the trash. You can make that happen by taking own-
at my former hospital. They were kind, supportive and hard- ership of all that is going on in your life. Your life is not a func-
working. Everyone worked together as a team. We cared so tion of what other people have done to you; it is today what it
much for each other that I developed some of the best friend- is because of the choices you have made in the past. And if
ships. It’s really a shame that my husband is relocating to this your feelings of resentment, hate and blame are attributed to
area. I just hate to leave all those wonderful people behind.” the actions of others, then you have to wait for those people to
“Well,” the wise elderly man answered, “I believe you will find change—which may never happen. And don’t even try to
the same kind of people here.” change them! Think about how many of us have difficulty
changing ourselves, let alone others. Instead live by the axiom:
6. Let go of the past If it is to be it is up to me. Once you’ve done that, you are ready
It’s amazing how much we mental energy to take it to the next level by substituting the emotions of love,
we spend in a place over which we have empathy and kindness for resentment, hate and blame, which
absolutely no control—the past. It was Dr. will put you on the fast track to inner peace.
Wayne Dyer who likened our past to a bag
of manure that we carry around with us. We And while you are at it, force yourself to get off your case, quit
keep putting more and more manure into living in the past, and become future-oriented by learning from
the bag. Once in a while we put the bag every action. If an action gives you the results you desired, keep
down, reach in and smear manure all over doing it. If the action did not accomplish the intended result,
review what happened; make a commitment to do it differently 8. Never give up on your dreams
in the future, then quit doing it and let it go. No wait, I mean The purpose of life is not to make it safely to
really let it go. Get on with your life by refocusing your thoughts the grave. Pursue your dreams no matter
on the only moment you and I have any control over, the now. how late or how “weird.” Let me share an
example. Doris Haddock had a passion. She
7. Kill your ego felt that Congress needed to get off their
Ego, right along with greed and envy, is one duff and change the campaign finance
of the most powerful destroyers of inner laws! Unlike most of us; however, Doris did
peace. A look at history confirms that these not sit around and complain and whine.
emotions are responsible for more evil. Instead, Doris started to walk from
Think Napoleon, Stalin and Hitler—and more Pasadena, Calif.; walking 10 miles a day, every day. Fourteen
corporate catastrophes. Think Toyota’s and months and 3,200 miles later she arrived in Washington, DC.
even venerable Johnson & Johnson’s recent Now, here comes the startling part of the story. Doris, better
recalls—as well as relationship killers. And known as Granny D, had a severe case of arthritis, wore a brace
yet we can get rid of our ego with just five and turned 90 years “young” while on the trail. And for an added
powerful phrases expressed liberally and from the heart: measure, she was arrested twice demonstrating for her beliefs.
• You are right about that. Any time you get into a conflict, Why? Because she had a dream and a passion. So whatever
use this phrase and you will have no more conflict— you do, don’t ever give up on your dreams, it’ll make you
guaranteed! cranky. Instead, get off your butt and act on your dreams today,
• I’ve made a mistake. This phrase helps you get off your and you, too, will be on the road to achieving the most coveted
high horse gracefully. All human beings make mistakes— of all possessions—inner peace.
and since you are a…I think you get it. There is only one
omnipotent force in the universe—and it is not you. So © 2010 Wolf J. Rinke
quit defining unrealistic expectations for yourself.
• I changed my mind. You are an evolving human being,
one who is like red wine and gets better all the time. That Dr. Wolf J. Rinke, RD, CSP is a keynote
means you have to let go of your past beliefs. (Remember speaker, seminar leader, management con-
that the only person who can change his/her mind is the sultant, executive coach and editor of the free
electronic newsletter Read and Grow Rich,
one who has one.)
available at www.easyCPEcredits.com. In
• I don’t know. Admit it. You don’t know everything. It lets
addition he has authored numerous CDs,
other people know that you have high levels of self-esteem.
DVDs and books including Make It a Winning
(Only people who are OK inside of their own skin can admit Life: Success Strategies for Life, Love and
they don’t know everything.) Business, Winning Management: 6 Fail-Safe
• Let’s agree to disagree. The phrase to use if all else fails. Strategies for Building High-Performance Organizations and Don’t
By the way, do try all five of these at home; the positive Oil the Squeaky Wheel and 19 Other Contrarian Ways to Improve
results will astound you. Your Leadership Effectiveness; available at www.WolfRinke.com.
His company also produces a wide variety of quality pre-approved
continuing professional education (CPE) self-study courses, avail-
able at www.easyCPEcredits.com, including his Beat the Blues:
How to Manage Stress and Balance Your Life, approved for 28
CPEUs, from which this article was extracted. Reach him at
WolfRinke@aol.com.

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Special Feature
PGD2
Pink Glove Dance: The Sequel
From Halifax, Novia Scotia to San Francisco, Califor- Pink Gloves for a Cause
nia, Medline traveled across North America in 2010 Our goal is to create a Pink Glove Nation – that is, get
showcasing the spirit of breast cancer survivors and as many people as possible talking about breast can-
caregivers who performed in the Pink Glove Dance: cer and to raise awareness for early detection. To that
The Sequel. To see videos of Pink Glove Dancers in end, partial proceeds from our pink gloves and other
action visit www.pinkglovedance.com. pink ribbon products are donated to the National
Breast Cancer Foundation (NBCF) to help fund mam-
Thank you, Pink Glove Dancers, for welcoming us to mograms for women who cannot afford them.
your city!
• New York, NY • La Jolla, CA Medline presents a donation check to the NBCF
• Chicago, IL • Portland, OR each year during the Breast Cancer Awareness Break-
• San Francisco, CA • New Orleans, LA fast at the Association of periOperative Nurses
• Indianapolis, IN • Denver, CO (AORN) Congress.
• Minneapolis, MN • Halifax, Novia Scotia
• Richmond, VA • Plano, TX
• Tallahassee, FL • Baltimore, MD
• Newark, NJ
SAVE THE DATE!
Medline’s Breast Cancer
Awareness Breakfast
AORN Congress
March 19 - 24, 2011
Philadelphia, PA
Providence St. Vincent
Medical Center. Portland, OR
New York City Survivors at Times Square. New York, NY
The Medical Center of Plaino. Plano, TX

Pink Glove Dance: The Sequel
San Francisco Survivors at the Golden Gate Bridge. San Francisco, CA
Providence St. Vincent Medical Center. Portland, OR
University of Minnesota Medical Center, Fairview. Minneapolis, MN
HCA Johnston – Willis Hospital. Richmond, VA
Tallahassee Memorial Healthcare, Inc. Tallahassee, FL
Indiana University Melvin and Bren Simon Cancer Center. Indianapolis, IN

Healthy Eating
Nutrition
Information
Servings: 6
Calories: 749
Fat: 19.5 g
Sodium: 1427 mg
Crock Pot Chili Fiber: 21.8 g
1 lb. lean ground beef 1 green pepper, chopped 1 15-ounce can kidney beans
1 lb. lean ground turkey 4 teaspoons minced garlic 1 15-ounce can spicy chili beans
4 teaspoons chili powder 1 16-ounce can tomato sauce 1 bottle beer
1 teaspoon ground cumin 1 16-ounce can diced tomatoes 1 teaspoon black pepper (or to taste)
1 large onion, chopped 1 15-ounce can chili with beans Hot sauce to taste
2 jalapeno peppers, chopped 1 6-ounce can tomato paste
Directions: recipe in Medline’s 2010 Chili Cookoff. She offers product

Place ground beef and ground turkey in a large skillet, along with expertise for Medline customers, sales representatives and cus-
1 teaspoon chili powder and 1 tsp. ground cumin. Cook until tomer service reps in the areas of diabetic testing, diagnostics,
crumbled and brown. Drain and place in crock pot. sharps containers, over-the-counter medications, enterals, oral
care, ReadyBath and wet wipes.
Spray empty skillet with cooking spray. Saute onion, garlic,
jalapenos and green pepper until tender. Place in crock pot. Add Jennifer originally found her chili recipe in one of her husband’s
tomato sauce, diced tomatoes, beer, chili with beans and fitness magazines, and they have tweaked it a little over the
tomato paste. Simmer 20 minutes on high setting. years to get it just right.
Add kidney beans, chili beans, 3 teaspoons chili powder, pepper “It’s a healthier chili recipe, made with lean meat,” she said. You’ll
and hot sauce and simmer at least 30 minutes. also notice that the onions and peppers are sautéed with cooking
spray rather than oil.
“I find the longer it simmers, the better the
taste, so after the last round of ingredients Jennifer has always enjoyed cooking, having learned by watching
are added, I let it simmer on low for 6 to 8 her mother from the age of six. Her favorite meals include
hours,” Jennifer said. seafood with lots of butter and garlic.
Senior Product Specialist Jennifer In addition to cooking, Jennifer, who lives on Illinois’ Chain
Sutschek, who has worked Medline’s O’Lakes with her husband and two children, enjoys water
corporate headquarters in Mundelein, Ill. sports, such as boating, and in the winter months, she
since 1998, won second place for this enjoys snowmobiling and skiing.
Forms & Tools
The following pages contain

practical tools for implementing
patient-focused care practices
at your facility.
AORN Surgical Time Out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99

Surgical Safety
SCOAP Surgical Safety Checklist - Ambulatory Surgery . . . . . . .100

SCOAP Surgical Safety Checklist . . . . . . . . . . . . . . . . . . . . . . . .101
Wrong-Site Surgery Prevention Tool . . . . . . . . . . . . . . . . . . . . . .103
Medicare & the New Healthcare Law . . . . . . . . . . . . . . . . . . . . .105

Patient Education
Tips for Safer Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109

Caring for Your Surgical Incision at Home . . . . . . . . . . . . . . . . . .111

The benefits of counting
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The SmartSponge® System takes the worry

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There’s no greater relief than getting an accurate surgical

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single surgery. And because it is the only FDA-approved
system that uses radio-frequency identification, it uniquely
identifies each sponge , so you can use the SmartWand-DTX™
to find missing sponges below, beside or inside a patient
A quick demonstration of how the ClearCount SmartSponge

System can make your time in the O.R. a little less stressful.
Call your Medline representative for details.
SmartSponge is a registered trademark and SmartWand-DTX is a trademark of ClearCount
Medical Sloutions.
Surgical Time Out Forms & Tools
I COMMIT TO SUPPORT
TIME OUT
FOR EVERY PATIENT, EVERY TIME
NAME: _______________________________________
DATE: ________________________________________
The use of Time Out is recommended by the Association of periOperative Registered Nurses (AORN),
the Joint Commission Universal Protocol, and the World Health Organization (WHO).
For more information on Time Out and how it can save patient lives, visit aorn.org.

Forms & Tools Surgical Checklist
Ambulatory
Ambulatory Surgery
Surgery V
Version
ersion 1.1
1.1
Step 1: P
Step Prior
rior to
to Incision
Incision
ALL
ALL TEAM
TEAM MEMBERS
MEMBERS STOP
STOP AACTIVITY
CTIVITY AND
AND BEGIN
BEGIN CHECKLIST
CHECKLIST
Team
Team Members
Members introduce
introduce themselves
themselves (w
(when
hen personnel
personnel h
have
ave c
changed)
hanged)
Introduce patient,
Introduce p verify
atient, v erify consent, procedure
consent, p rocedure
Confirm
Confirm site marked
site m arked and
and iiff there
there iis
sas
single orr multiple
ingle o operative
multiple o perative ffield
ield
Anesthesia
Anesthesia T
Team
eam Reviews
Reviews
Airway
Airway iissues
ssues o
orr other
other p
patient-specific
atient-specific co
concerns
ncerns ((special
special m
meds,
eds, health
health conditions
conditions affecting
affecting rrecovery,
aff ecovery,
etc.)
etc.)
Patient
Patient a llergies reviewed
allergies reviewed N/A
N/A
Antibiotics
Antibiotics given
given within
within 60
60 mins
mins before
before incision
incision N/A
N/A
Surgeon
Surgeon R
Reviews
eviews
Brief
Brief d
description
escription of
of p
procedure
rocedure and
and a
anticipated
nticipated d
difficulties
ifficulties
Describe
Describe iimplants needed,
mplants n eeded, unusual
unusual iinstruments
nstruments OR s
supplies
upplies N/A
N/A
Confirm
Confirm that
that essential
essential imaging
imaging is
is displayed
displayed and
and correctly
correctly oriented
oriented N/A
N/A
Nursing
Nursing T
Team
eam R
Reviews
eviews
Confirm
Confirm th
that
at supplies
supplies a
and
nd iimplants
mplants a
are
re av
available
ailable N/
N/AA
If
If using
using an
an iimplant,
mplant, confirm expiration
confirm expiration dates
dates N/A
N/A
Step 2: P
Process
rocess C
Control
ontrol
IF PR
PROCEDURE
OCEDURE IS
IS EXPECTED
EXPECTED TO
TO B
BEE LONGER
LONGER T
THAN
HAN ONE
ONE HO
HOUR:
UR:
Active
Active warming
warming iin
n place
place N/A
N/A
Glucose
Glucose checked
checked for
for diabetic
diabetic patients
patients N/A
N/A
VTE
VTE p
prophylaxis
rophylaxis N/A
N/A
Step 3
3:: Debriefing—At
Debriefing—At Com
Completion
pletion of Case
Case
(Surgeon
(Surgeon and
and Nursing)
Nursing) Before
Before closure:
closure: Confirm
Confirm that
that instrument,
instrument, sponge,
sponge, a
and
nd n
needle
eedle c
counts
ounts c
correct
orrect
If
If counts
counts incorrect,
incorrect, confirm
confirm x
x-ray
-ray n
negative
egative
(S
(Surgeon
urgeon a
and
nd N
Nursing)
ursing) Confirm
Confirm s
specimen,
pecimen, llabel
abel & instructions
instructions to p
pathologist
athologist N/A
N/A
((All)
All) C onfirm n
Confirm ame o
name off p rocedure
procedure
((All)
All) E
Equipment
quipment issues
issues to be addressed? No Yes,
be addressed? Yes, a
and
nd response
response p
plan
lan formulated
formulated (Who/When)
(Who/When)
((All)
All) W
What
hat could
could h
have
ave b
been
een b etter? Nothing
better? Nothing So
Something,
mething, with
with plan
plan to address
address (Who/
(Who/ W
When)
hen)
(Surgeon
(Surgeon and
and Anesthesia)
Anesthesia) Key
K ey c
concerns
oncerns fo
forr rrecovery
ecovery (e
(e.g.,
.g., p
plan
lan for
for p
pain
ain management,
management,
nausea/vomiting)
n ausea/vomiting)
Adapted
Adapted from
from tthe
he WHO
WHO ""Safe
Safe S
Surgery
urgery Saves
Saves Li
Lives"
ves" campaign
campaign an
andd the
the WWASCA/Proliance
ASCA/Proliance Surgeons
Surgeons S
Surgical Checklist
urgical Checklist
SCOAP iiss a program
SCOAP program of the
the Foundation
Foundation for
for Health Care
Health Care Quality
Quality
www.scoapchecklist.org
w ww.scoapchecklist.org rrev
ev 1/
1/19/2010
19/2010

Surgical Checklist Forms & Tools
SCOAP
SCOAP Surgical
Surgical Checklist
Checklist Version
Version 3.7
(July
3. 7
(July 2010)
2010 )
Before
Before Skin
Skin Incision:
I n c is io n :
Briefing
Briefing
All
A lll Te
Al T eam M
Team Mee m bers
Mem b er
e rs
r N u r s i ng
Nu n g/
Nursing/Techg / T e ch
c h reviews:
r e v ie w s : A n e s th
An t h es
Anesthesia e s i a reviews:
r e v ie w s :
A tt
t te
tending S
((Attending
(A u r g e on
Surgeon o n Leads)
L e a ds
ds): Equipment issues
Equipment issues (instruments
(in s tru m e n ts Air
irw
way or
Airway or other
other concerns
concerns
E ach p
Each erson introduces
person introduces self self ready,
ready, trained
trained on,
on, requested
re q u e s te d Special meds
Special m eds
by
by nname
ame and
and rolero le implants
implants available,
available, gasgas tanks
tanks full)
full) ((beta
beta blockers,
blockers, etc.)
e tc .)
Surgeon, A
Surgeon, nesthesia team
Anesthesia team and and Sharps management
Sharps management plan plan Allergies
Allergies
N u rs e c
Nurse onfirm patient
confirm patient (at (at least
le a s t 2 Other patient
Other patient concerns
c o n c e rn s Conditions affecting
Conditions affecting recovery
re c o v e ry
identifiers), site,
identifiers), site, procedure
p ro c e d u re
Personnel exchanges:
Personnel exchanges: timing, timing,
plan ffor
plan or announcing
announcing changes change s
Description of
Description of procedure
procedure and and
anticipated
anticipated difficulties
d iffic u ltie s
Expected duration
Expected duration o off procedure
p ro c e d u re
Expected blood
Expected blood loss loss & blood
blood availability
availability
Need ffor
Need or instruments/supplies/IV
in s tru m e n ts /s u p p lie s / IV
access
access b beyond
eyond tthosehose normally
n o rm a lly
used
u sed for
o the
he p procedure
ocedu e
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team
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m em be a and
nd Invitation
nv a on to o speak
speak up
up
a any
at any timeme in n the
he procedure
p ocedu e
Process Control
Process Control
A cases:
All cases case expected
If case expec ed to
o be
be 1h ou add:
hour, add
S ur
u rg
r g e o n reviews
Surgeon ev ews (as
as applicable):
app cab e S u r g eo
Su
Surgeon e o n reviews:
ev ew s
Essen a imaging
Essential mag ng displayed;
d sp a y e d G ucose checked
Glucose checked foro diabetics
d abe cs
gh and
right and left
e confirmed
con m ed nsu n protocol
Insulin p o oco initiated
n a ed if needed
neede d
An b o c prophylaxis
Antibiotic p ophy ax s given
g ven in n DVT PE chemoprophylaxis
DVT/PE chemop ophy ax s and/or
and o mechanical
m echan ca
as 60
last 60 m nu es
minutes p ophy ax s plan
prophylaxis p an in
n place
p ace
Ac ve w
Active a m ng in
warming n place
p a ce pa en on
If patient on beta
be a blocker,
b ocke post-op
pos o p
Spec a instruments
Special ns umen s and/or
and o implants
m p an s p an formulated
plan o m u a ed
Re dos ng plan
Re-dosing p an for
o antibiotics
an b o cs
Spec a y spec c checklist
Specialty-specific check s
Just Before
Just Before C lo s u re o
Closure off O p e ra tiv e F
Operative ie ld
Field
No Retained
No Retained O bjects
Objects
A ttt en
At e nd
Attendingd ng
n g Su
S u r g e on
Surgeon o : Nu
u rs
ur s ng Te
T e ch
Nursing/Tech ch:
Pe o m m
Perform e hod ca visual
methodical v sua and
and physical
p h y s ca A music,
All mus c conversation,
conve sa on and
and distractions
d s ac ons halted
ha ed
sweep
s of the
w eep o he wound
w ound Pe o m preliminary
Perform p e m na y count
coun of
o
needles/sponges/instruments
need es sponges ns um en s
Show Surgeon
Show Su geon and
and Anesthesia
Anes hes a all
a sponges
sponges and
and
laps
aps in
n holders
ho de s (“Show
Show Me
Me Ten”)
Ten
A fte r S
After kin Closure
Skin C lo su re C omplete:
Complete: e:
No Retained
No Retained Objects,
Objects, Debriefing,
Debriefing, C are Transition
Care Transition
A Te
All T e a m Me
Team M e m bers
Mem b er
e rs
r s ((Attending
A t te
t e nd ng
n g Su
S u r g e on
Surgeon o n Leads)
L e a ds
d s)
s : Su
urgeon a
ur
Surgeon and A n es
e st
s t h es
nd Anesthesia es a:
Con m final
Confirm na needles/sponges/
need es sponges instruments
ns umen s count
coun correct
co ec Key concerns
Key conce ns for
o patient
pa en recovery
e co v e y
Nu s ng Tech show
Nursing/Tech show Surgeon
Su geon andand Anesthesia
Anes hes a all
a sponges
sponges and
and laps
aps in
n Wha is
What s the
he plan
p an for
o pain
pa n management?
m anage m en ?
holders
h o de s (“Show
Show MeMe Ten”)
Ten Wha is
What s the
he plan
p an for
o prevention
p even on of o PONV?
P O NV ?
C on m n
Confirm ame of
name o procedure
p ocedu e Does patient
Does pa en need
need special
spec a monitoring
mon o ng (timeme
If s pec m en c
specimen, on m label
confirm abe and
and instructions
ns uc ons (e.g.,
e g orientation
o en a on of
o in
n RR,
RR ICU,
CU tele?)
e e?
specimen,
s pec m en 1 12
2 lymph
ymph nodes
nodes foro colon
co on CA)
CA pa en has
If patient has elevated
e eva ed blood
b ood glucose,
g ucose plan
p an for
o
Equ pmen issues
Equipment ssues too be
be addressed?
a d d e sse d ? insulin
nsu n drip
d p formulated
o m u a ed
Response planned
Response p anned (who/when)
w h o w hen pa en on
If patient on beta
be a blocker,
b ocke post-op
pos op continuation
con nua on
W ha c
What ou d have
could have been
been better?
be e ? plan
p an formulated
o m u a ed
A gn ng pract ce w th po cy to mprove pat ent care 101

Improvement
m p ov em en p planned
anned (who/when)
w h o w hen
ARGLAES® IN THE OR
ANTIMICROBIAL SILVER TECHNOLOGY
Use silver to fight bacteria and surgical site infections

Arglaes provides: The Arglaes family of products has something
for every incision:
• Antimicrobial protection for up to 7 days
• Moist wound healing • Arglaes Film is ideal for managing bacterial penetration
• Fewer dressing changes on post-op incision and line sites.
• Non-attaining assay • Arglaes Island features a calcium alginate pad for fluid
• Transparency for wound monitoring management in addition to controlled-release silver.
To schedule a FREE demonstration of Arglaes

in your OR, contact your Medline representative,
call 1-800-MEDLINE or visit www.medline.com.
Arglaes is a registered trademark of Giltech Limited Corporation.
Facility name:
Date:
Wrong-Site Surgery Prevention Observational Monitoring Tool

Perform 10 unannounced observations of operating room (OR) cases, preferably orthopedic with laterality, spinal, eye, and other procedures on extremities. Exclude cardiac and upper abdominal surgeries.
For each blank box, indicate: Yes if element/action was completed as described, No if element/action was not completed as described, or N/A if not applicable. Document time in minutes where indicated.
Scheduling/Consent (a standardized form is suggested) CASE CASE CASE CASE CASE CASE CASE CASE CASE CASE
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10
Exact description of procedure was on OR schedule (including site, level, side, digit)
Exact description of procedure was on consent (including site, level, side, digit)
Consent was completed (including exact procedure, all required signatures, dates)
Preoperative Verification (a standardized checklist is suggested) CASE CASE CASE CASE CASE CASE CASE CASE CASE CASE
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10
Verification and documentation were completed independently by at least two providers
Verification included OR schedule
Verification included consent

Verification included history and physical (H&P)
Verification included patient's understanding of the procedure

Site Marking CASE CASE CASE CASE CASE CASE CASE CASE CASE CASE
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10
Wrong-Site Surgery
Duration for the surgeon to complete the verification process and marking process
(MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES)
OR staff member marking the site used his or her initials
Site marking occurred after reconciliation of all documents (schedule, consent, H&P)
Site marking occurred before administration of sedative and/or anesthesia

Site marking included discussion with patient
Site marking was visible after patient was positioned, prepped, and draped
Site marking was confirmed by intraoperative imaging, if for vertebrae, ribs, or ureters
Forms & Tools

2010 Pennsylvania Patient Safety Authority Page 1
104
Time-Out (a standardized tool is suggested) CASE CASE CASE CASE CASE CASE CASE CASE CASE CASE
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10
Forms & Tools
Duration to complete the time-out

(MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES) (MINUTES)
The OR Connection
A separate time-out was conducted prior to regional or local anesthesia, if applicable
The final time-out was conducted after patient was positioned, prepped, and draped
All documents (schedule, consent, H&P) were verified during time-out
Diagnostic, radiology, and pathology results were verified during time-out
Surgeon was engaged during time-out—all work stopped and verbal acknowledgement occurred
Anesthesia provider was engaged during time-out—all work except ventilation stopped and verbal
acknowledgement occurred
Nurses were engaged during time-out—all work stopped and verbal acknowledgement occurred
Wrong-Site Surgery
Surgeon encouraged the entire surgical team to speak up if there were any concerns
OR Turnover CASE CASE CASE CASE CASE CASE CASE CASE CASE CASE
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10
All patient information and specimens were removed from the OR before the next patient arrived
Revised August 2010
Adapted with permission from the Health Care Improvement Foundation
MS10211_PUB_810A
2010 Pennsylvania Patient Safety Authority Page 2
Patient Handout - Medicare Forms & Tools
CENTERS FOR MEDICARE & MEDICAID SERVICES
MAY 2010
Medicare and the New Health Care Law —

What it Means for You
A Message from Kathleen Sebelius,
Secretary of Health & Human Services
The Affordable Care Act passed by Congress and signed by President
Obama this year will provide you and your family greater savings and
increased quality health care. It will also ensure accountability
throughout the health care system so that you, your family, and
your doctor—not insurance companies—have greater control
over your care.
These are needed improvements that will keep Medicare
strong and solvent. Your guaranteed Medicare benefits won’t
change—whether you get them through Original Medicare or
a Medicare Advantage plan. Instead, you will see new benefits
and cost savings, and an increased focus on quality to ensure
that you get the care you need.
This brochure provides you with accurate information about
the new services and benefits to help you and your family now
and in the future.
The Centers for Medicare & Medicaid Services (the federal
agency that runs the Medicare, Medicaid, and Children’s Health
Insurance Program) will continue to provide you with up-to-date
information about these new benefits and will ensure that your personal
information is safe.
Remember—rely on your trusted sources of information when it comes
to accurate information about Medicare, and don’t hesitate to call
1-800-MEDICARE or go on-line at Medicare.gov if you have questions
or concerns. Don’t give your personal Medicare information to anyone
who isn’t a trusted source.

Forms & Tools Patient Handout - Medicare
HEALTH CARE LAW
What Stays the Same

The guaranteed Medicare benefits you currently receive will remain the same. During open enrollment
this fall, you will continue to have a choice between Original Medicare and a Medicare Advantage plan.
Medicare will continue to cover your health costs the way it always has, and there are no changes in
eligibility. But, there are some important benefits that you and your family can take advantage of starting
this year. Look for more details in your Medicare and You Handbook coming this fall.
Improvements in Medicare You Will See Right Away

More Affordable Prescription Drugs
• If you enter the Part D “donut hole” this year, you will receive a one-time, $250 rebate check if you
are not already receiving Medicare Extra Help. These checks will begin mailing in mid-June, and will
continue monthly throughout the year as beneficiaries enter the
coverage gap.
• Next year, if you reach the coverage gap, you will receive a 50%
discount when buying Part D-covered brand-name prescription drugs.
• Over the next ten years, you will receive additional savings until the
coverage gap is closed in 2020.
Important New Benefits to Help you Stay Healthy

• Next year you can get free preventive care services like colorectal
cancer screening and mammograms. You can also get a free annual
physical to develop and update your personal prevention plan based
on current health needs.
Improvements to Medicare Advantage

• Today, Medicare pays Medicare Advantage insurance companies over
$1,000 more per person on average than Original Medicare. These
additional payments are paid for in part by increased premiums by all
Medicare beneficiaries—including the 77% of seniors not enrolled in a
Medicare Advantage plan.
• The new law levels the playing field by gradually eliminating Medicare
Advantage overpayments to insurance companies.
• If you are in a Medicare Advantage plan, you will still receive guaranteed Medicare benefits.
• Beginning in 2014, the new law protects Medicare Advantage members by taking strong steps to ensure
that at least 85% of every dollar these plans receive is spent on health care, rather than administrative costs
and insurance company profits.
106 The OR Connection Aligning practice with policy to improve patient care 106
Patient Handout - Medicare Forms & Tools
HEALTH CARE LAW
Improvements in Medicare You Will See Soon

Better Access to Care
• Your choice of doctor will be preserved.
• The law increases the number of primary care doctors, nurses, and physician assistants to provide better
access to care through expanded training opportunities, student loan forgiveness, and bonus payments.
• Support for community health centers will increase, allowing them to serve some 20 million new patients.
Better Chronic Care

• Community health teams will provide patient-centered care so you won’t have to see multiple
doctors who don’t work together.
• If you’re hospitalized, the new law also helps you return home successfully—and avoid going back—by
helping to coordinate your care and connecting you to services and supports in your community.
Improvements Beyond Medicare That You and Your Family Can Count On
Improves Long-Term Care Choices
• New tools and resources in the Elder Justice Act, which was included in
the new law, will help prevent and combat elder abuse and neglect, and
improve nursing home quality.
• The new law creates a new voluntary insurance program called CLASS
to help pay for long-term care and support at home.
• Individuals on Medicaid will receive improved home- and community-
based care options, and spouses of people receiving home- and community-
based services through Medicaid will no longer be forced into poverty.
Helps Early Retirees

• To help offset the cost of employer-based retiree health plans, the new law creates a program to preserve
those plans and help people who retire before age 65 get the affordable care they need.
Helps People with Pre-existing Conditions

• The new law provides affordable health insurance through a transitional high-risk pool program for
people without insurance due to a pre-existing condition.
• Insurance companies will be prohibited from denying coverage due to a pre-existing condition for
children starting in September, and for adults in 2014.
• Insurance companies will be banned from establishing lifetime limits on your coverage, and use of
annual limits will be limited starting in September.
Expands Health Coverage for Young People

• Young people up to age 26 can remain on their parents’ health insurance policy starting in September.

Forms & Tools Patient Handout - Medicare
HEALTH CARE LAW
The New Law Preserves and Strengthens Medicare

New Tools to Fight Fraud and Protect Your Keeps Medicare Strong and Solvent
Medicare Benefits • Over the next 20 years, Medicare spending will
• The new law contains important new tools to help continue to grow, but at a slightly slower rate as
crack down on criminals seeking to scam seniors a result of reductions in waste, fraud, and abuse.
and steal taxpayer dollars. This will extend the life of the Medicare Trust
Fund by 12 years and provide cost savings to
• It reduces payment errors, waste, fraud, and those on Medicare.
abuse to make Medicare more efficient and return
savings to the Trust Fund to strengthen Medicare • In 2018, seniors can expect to save on average
for years to come. almost $200 per year in premiums and over $200
per year in co-insurance compared to what they
• You are an important resource in the fight against would have paid without the new law.
fraud. Be vigilant and rely only on your trusted
sources of information about your Medicare • Upper-income beneficiaries ($85,000 of annual
benefits. income for individuals or $170,000 for married
couples filing jointly) will pay higher premiums.
• Call 1-800-MEDICARE if you have any questions This will impact about 2% of Medicare
or want to report something that seems like fraud. beneficiaries.
For More Information

For more information about the new health care law now, visit
www.medicare.gov. If you have any questions, call 1-800-MEDICARE
(1-800-633-4227) or your State Health Insurance Assistance Program (SHIP).
Visit www.medicare.gov or call 1-800-MEDICARE to get their telephone
number. TTY users should call 1-877-486-2048. If you need help in a language other than English or
Spanish, say “Agent” at any time to talk to a customer service representative.
Visit the Eldercare Locator at www.eldercare.gov to find out how to access home- and community-
based services and benefits counseling, transportation, meals, home care, and caregiver support services.
You can also call 1-800-677-1116. The Eldercare Locator, a public service of the U.S. Administration on
Aging, is your first step for finding local agencies in every U.S. community.
CMS Product No. 11467

Patient Handout Forms & Tools
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110
The Patient Handout Forms & Tools
OR Connection
Caring for Your Surgical Incision at Home

The following are general guidelines. Consult your surgical team for more specific instructions.
Bathing and Showering

Most incisions should be kept dry for several days after surgery, except for incisions closed
with surgical glue. It is usually safe to allow glued incisions to get wet while showering or
bathing. It is important, however, to dry the area around the incision carefully after washing.
Physical Activity and Exercise

Avoid any activity that pulls on the edges of the incision or puts pressure on it. Walking and
other light activities are encouraged to restore normal energy levels and digestive functions.
Do not, however, participate in sports, engage in sexual activity or lift heavy objects until after
your postoperative checkup.
Aspirin
Avoid aspirin or over-the-counter medications containing aspirin for a week to 10 days after
Never miss an issue of The OR Connection! surgery. Aspirin interferes with blood clotting and makes it easier for bruises to form near
the incision.
Subscriptions are free and signing up is a snap!
Sun Exposure
Subscribing to The OR Connection guarantees that you’ll To subscribe, simply go to www.medline.com/orconnection. As an incision heals, the new skin that forms over the cut is very sensitive to sunlight and
continue to receive this info-packed magazine and won’t miss You will need to provide: will burn more easily than normal skin and lead to worse scarring. Keep the incision area
out on our industry updates and articles addressing on-the- Your name covered from direct sun exposure for three to nine months in order to prevent burning and
job issues and tips on caring for yourself! Facility and position severe scarring.
Mailing address
E-mail address General Hygiene
Infection is the most common complication of surgical procedures. It is important, therefore,
to minimize the risk of an infection when caring for your incision at home.
We also welcome any suggestions you might have on how we can continue to improve
The OR Connection! Love the content? Want to see something new? Just let us know!
Observe the following precautions:
• Wash your hands carefully after using the toilet and after touching or handling trash;
pets and pet
Content Key equipment; dirty laundry and anything else that is dirty or has been used outdoors
We've coded the articles and information in this magazine to indicate which patient care • Ask family members, close friends, and others to wash their hands before contact
initiatives they pertain to. Throughout the publication, when you see these icons you'll with you
know immediately that the subject matter on that page relates to one or more of the • Avoid contact with family members and others who are sick or recovering from a
following national initiatives: contagious illness
• IHI's Improvement Map • Stop smoking (smoking slows down the healing process)
• Joint Commission 2009 National Patient Safety Goals
• Surgical Care Improvement Project (SCIP)
We've tried to include content that clarifies the initiatives or gives you ideas and tools Adapted from www.surgeryencyclopedia.com/Fi-La/Incision-Care.html
for implementing their recommendations. For a summary of each of the initiatives,
see pages 10 and 11.

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VOLUME 5, ISSUE 4

Pink Glove Ad YES!

©2010 Medline Industries, Inc. Medline and

Caring for Your Surgical Incision at Home

Bathing and Showering

Physical Activity and Exercise

Aligning practice with policy to improve patient care 111

Perioperative Advisory Board SPECIAL FEATURES

Aligning practice with policy to improve patient care 3

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Soft and shimmery.

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The results are in!

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©2010 Medline Industries, Inc.

What our readers said:

Awareness! Hope! While in the OR I told

Celebrating the lives of two of our nurses

Pink Glove Dance It is a fun but touching video that shows

Aligning practice with policy to improve patient care 7

My mother had breast cancer, so it Shows how much healthcare workers

It energizes you and makes you want to

Aligning practice with policy to improve patient care 9

1 IHI Improvement Map

2 Joint Commission 2011 National Patient Safety Goals

3 Surgical Care Improvement Project (SCIP)

IHI Improvement Map: 73 Processes to Transform Hospital Care

1. Anticoagulation Management 1. Central Line Bundle

2. Essential Care for Frail Older Patients 2. CA-UTI

Joint Commission 2011 National Patient Safety Goals

To learn more about National Patient Safety Goals, go to www.jointcommission.org.

Surgical Care Improvement Project (SCIP): Target Areas

Aligning practice with policy to improve patient care 11

A statewide steering committee will spearhead the New

Ways to improve hand-off communication Hospitals and Healthcare Systems Participating

Educate and coach, which includes organizations teaching

Aligning practice with policy to improve patient care 13

Strategies for Thriving in the

What to expect from healthcare reform

Deborah Adler, Trent Haywood,

Aligning practice with policy to improve patient care 15

“A fair number of you probably don’t recognize the kind of con-

Mount Sinai is operating at 95 percent capacity, and they are

Trent T. Haywood, MD, JD

Dale Bratzler, DO, MPH

Mikel Gray, PhD, FNP, CUNP, CCCN, FAANP, FAAN

Gray Gawande Atul Gawande, MD, MPH

Aligning practice with policy to improve patient care 17

©3M 2010. All rights reserved.

To learn more about AORN, including group and indi-

Aligning practice with policy to improve patient care 19

Conversation with Dr. Peter J. Pronovost

Doctor Leads Quest for Safer

What got you started on your crusade

Aligning practice with policy to improve patient care 21

• Assembly in dedicated clean rooms

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