OR Manager - January 2018 - 10

Regulations
Continued from page 9
Contribute
an arti cle to
OR Manager
What does GREAT
look like?
Leaders oft en ask themselves
and their staff s this questi on
when tackling a tough issue.
Finding the answer can
mean a world of diff erence
in your OR. Many OR
managers have shared their
" success stories " with us-
process improvements, cost
savings, or workfl ow changes
that have made their jobs
more rewarding.
What's your story?
Your colleagues would
like to hear it!
HLD, sterilization most common
deficiency
The most common condition-level deficiency
is with infection prevention and
mainly high-level disinfection (HLD) and
sterilization. It can seem minor, like a
documentation issue, but if there are
two or three different observations of
deficiency, it usually rises to a condition
level, notes Rosing.
In the past, Joint Commission surveyors
seemed to not know a lot about
high-level disinfection or sterilization,
but that has changed, he says. The
Joint Commission has gone to great
lengths to educate the surveyors.
Surveyors still make mistakes,
though, and OR managers should be
alert to pointing a mistake out if they
think the surveyor is wrong or doesn't
understand how they have explained a
process, says Rosing. " Right then and
there is the best time to try and ferret
that out and make the correction by
having a courteous conversation on
what your process or the requirement
actually is, " he says.
Hospital staff performing HLD or
sterilization activities need thorough
competency validation and frequent
assessment for continuing compliance.
" All i's must be dotted and all
t's crossed, all
Rosing.
the time now, " says
One area of caution, he says, is that
vendors often hold in-services for the
staff on areas such as how to process
their endoscopes or how to run their
washer or sterilizer.
To share your experience
with OR Manager readers,
send an arti cle to Elizabeth
Wood, Editor, OR Manager,
ewood@accessintel.com.
For a copy of the Author Guidelines,
visit www.ormanager.com
The vendors are very careful in the
documentation they provide not to claim
they have validated competency. " They
don't want to take that risk, " he says.
" They'll say: 'We educated. We provided
this material.' They may even provide a
competency check-off form, but if you
read the document, it usually will not
say anything about competency validation. "
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OR Manager | January 2018
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The Joint Commission is aware of
this, and if surveyors examine a file that
only has paperwork from a vendor that
only attests to having provided education,
they will catch that, he says.
" You want to be careful to have an
overlay process where you or someone
in your area who is qualified in the task
is validating the competency of others, "
he adds.
IC findings on the rise
Findings are on the rise for the infection
control (IC) Standard IC.02.02.01 EP2,
which says: " The hospital implements
infection prevention and control activities
when doing the following: Performing
intermediate and high-level disinfection
and sterilization of medical equipment,
devices, and supplies. "
In 2009, 15% of hospitals were cited
on this standard, and that had risen to
70% as of late 2017, says Rosing. This
usually also triggers a condition-level
finding.
Several guidelines offer steps hospitals
should consider following to be in
compliance with this EP:
* AAMI (Association for the Advancement
of Medical Instrumentation/
American National Standards Institute)
ST 58 for high-level disinfection,
ST 79 for sterilization, and ST
91 for endoscope cleaning
* AORN Guideline for processing flexible
endoscopes
* CDC Guideline for disinfection and
sterilization in healthcare facilities,
2008
* Multisociety guideline on reprocessing
flexible GI endoscopes
* SGNA (Society of Gastroenterology
Nurses and Associates) Standards
of infection prevention in reprocessing
flexible gastrointestinal endoscopes.
One
point of contention among these
guidelines is endoscope hang time,
says Rosing. In 2015, SGNA definitively
said hang time is 7 days-if an endoscope
isn't used in 7 days, it should be
DECEMBER
2017
Volume 33
Number 12
IN THIS ISSUE
The monthly publication for OR decision makers
Patient safety
OR Business Management
Conference
San Antonio to host 2018
OR Business Management
Conference
Leadership
Just culture creates a safe,
positive environment
Sterilization & infection
prevention
Latest steam sterilization
standard available
from AAMI
20
ECRI Institute Perspectives
Violence in healthcare
facilities-Know your risks 22
18
7
Greater vigilance needed to combat
ureteroscope contamination
A
new study by Ofstead & Associates
(St Paul, Minnesota) is the
latest to raise concerns about
infections associated with endoscopic
procedures.
The study, which focused on ureteroscopes,
found that the techniques
used to clean and sterilize or highlevel
disinfect flexible ureteroscopes
are not sufficient and leave behind
contamination including debris, residue,
and bacteria.
Process improvement
Remote video auditing: A path to
compliance and safety
Ambulatory
Surgery Centers
Peer review inspires high
performance from providers 26
OR Manager 2017 Index
29
P
erioperative services leaders
seeking to improve safety
and efficiency without sacrificing
quality may want to turn to remote
video auditing (RVA), which is being
successfully used in hospital ORs and
ambulatory surgery centers (ASCs).
" We've seen improved patient
safety, efficiency, and cleaning processes, "
says Sheldon Newman, MD,
executive vice chairman of the department
of anesthesiology at Long Island
Jewish Medical Center/Northwell in
New Hyde Park, New York. " That's a
win-win all the way around. "
Northwell has been using RVA from
Arrowsight, Inc, Mount Kisco, New York,
since 2010, first to improve handwashing
adherence in the ICU and later for
surgical safety monitoring in the OR.
With RVA, offsite auditors watch
time-stamped video feeds from ORs
and assess whether specific metrics
are met. Aggregate real-time feedback
is transmitted to the OR via monitors in
easy view of staff and physicians.
" We can look at every case every
day instead of having someone just
spot check compliance with safety measures, "
Dr Newman says.
That feedback has paid off. Dr NewContinued
on page 13
Continued on page 6
" Our study provides evidence that
contaminated ureteroscopes are
being used, with unknown implications
for patients, " lead researcher
Cori L. Ofstead, MSPH, told OR Manager.
Ofstead, an epidemiologist, has
published numerous studies on endoscope
reprocessing and contamination.
This study adds ureteroscopes
to the list of devices that threaten
patient safety.
Continued
Continued on page 8
page 8
NOVEMBER
2017
Volume 33
Number 11
IN THIS ISSUE
The monthly publication for OR decision makers
Education
Externships help suss out
nurses best suited to the OR 13
Leadership
Skill plus will equals successful
OR leadership succession 17
Success stories
Improved communication tools
put PACU visitors at ease
21
Ambulatory Surgery Centers
Track ASC metrics to produce
a healthy bottom line
Walk the talk: Words matter
when it comes to patient
safety
Patient safety
25
29
CMUNRO SCALE created to facilitate
risk assessment for pressure injuries
I
Coming in
December
Get ready for the
2018 OR Business
Management Conference,
January 30-February 2
in San Antonio!
n 2016, after 10 years of research
and validation, Cassendra Munro's
Pressure Ulcer Risk Assessment
Process improvement
Scale for Perioperative Patients (Munro
Scale) was made available for use
in the perioperative setting and was
added to the AORN Prevention of Pressure
Ulcers Tool Kit.
The Munro Scale assesses a paPACU
patient flow improves with
CRNA assistance
Success stories
tient's risk level for each phase of
surgery: preoperative, intraoperative,
and postoperative. Each phase of the
assessment results in a risk score of
low, medium, or high, with a cumulative
score at the end. That score is documented
and communicated to the inpa17
IN
THIS ISSUE
The monthly publication for OR decision makers
tient unit nurse for continuation of care.
With validation of the scale ongoSalary/Career
Survey
Efficiency efforts improve
staff satisfaction with
turnover time
Ambulatory
Surgery Centers
ing and while waiting for the scale to
be integrated into existing electronic
health records (EHRs), OR managers
are using the scale to educate staff on
risk factors for pressure injuries, but
they haven't implemented it yet, Cassendra
Munro, MSN, RN, CNOR, told
OR Manager. The only EHR in which the
scale has been integrated is AORN's
Syntegrity, notes Munro, who is Magnet
and professional practice manager,
Providence Health and Services, Santa
Monica, California.
D
21
ASC leaders like their jobs despite
stagnant salaries
CMS proposes delay for mandatory
implementation of OAS
CAHPS Survey
25
Human resources
29
Successful onboarding of surgeons
makes good business sense
P
Coming in November
Highlights of the 2017
OR Manager Conference
erioperative staff complete a
thorough orientation to ease
their transition into a new job,
but what about surgeons? How are they
onboarded into a new OR? This isn't an
academic question-effective onboarding
is key to the success, including financial
success, of the OR.
" To have someone walk through the
door ready to do surgery but not have
what they need affects staff morale,
patient care, scheduling, surgeon satisfaction,
overall operations, and revenue, "
says Jon Brickman, MS, CRCST,
director of perioperative operations for
University of Chicago Medicine (UCM) in
Chicago. UCM developed an onboarding
program that has helped integrate new
surgeons into the team and launch expanded
service lines.
Unfortunately, a negative first experience
happens too often, says Michael
Goldfarb, MD, FACS, a general surgeon
in private practice in Long Branch, New
Jersey, and chair of the Surgeon Workforce
Subcommittee of the American
College of Surgeons (ACS) Governors
Surgical Care Delivery Workgroup. " I've
seen what a terrible job many systems
do with onboarding. "
Dr Goldfarb collaborated with the
Continued on page 12
Continued on page 6
Continued on page 10
Continued on page 6
OR leaders report strong job satisfaction
but weak compensation
espite continued challenges
ranging from declining reimbursements
to finding qualified
staff, most OR leaders (71%) are
satisfied with their jobs, according to
the 2017 annual OR Manager Salary/
Career Survey. However, they are less
inclined to view some parts of that job
favorably.
Slightly more than half (55%) are
satisfied with their total compensation,
perhaps partly because 71% of them
hadn't
received a raise in the past
12 months. When raises did come,
they averaged a modest 3.07%, compared
with 3.38% last year and 3.4%
in 2015, but consistent with predicted
nationwide raises of only 3% for 2017.
These financial effects come at a time
when OR leaders are seeing their scope
widen. This year, they reported overseeing
an average of 117.27 employees,
up significantly from 95.4 last year and
Continue
page 8
Continued on page 7
Celebrating three decades of OR leader
education, networking
M
ore than 1,350 perioperative
nurse leaders from across the
US and other countries gathered
in Orlando, Florida, October 2-4 for
the 30th annual OR Manager Conference.
The celebration of this milestone
anniversary coincided with the inaugural
postanesthesia care unit (PACU) Manager
Summit, which brought together
more than 250 leaders.
Many participants attended both
events, soaking up sun and a wealth
of new knowledge from conference sessions,
posters, and the largest-ever exhibit
hall with nearly 200 booths.
The interactive hybrid OR exhibit
enabled OR leaders to examine technology
options up close and discuss
their needs with manufacturers. Hybrid
OR Steering Committee members
provided programs designed for both
" newbies " and those with hybrid OR
experience.
Continue
Continued on page 7
page 8
OCTOBER
2017
Volume 33
Number 10
OR Manager Conference
http://www.ormanager.com http://www.ormanager.com
OR Manager - January 2018

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