AORN Surgical Conference & Expo 2014 Speaker Interviews
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ach year, AORN strives to provide the very best in perioperative nursing education at its annual conference. The Surgical Conference & Expo 2014 experience will be no different. Attendees will receive continuing education that focuses on current issues and trends, evidence-based practice and research, and health care initiatives relative to the advancement of perioperative practice.
Several of the distinguished speakers from the 2014 schedule have graciously agreed to participate in interviews about their upcoming sessions to provide a sample of the extensive educational offerings from which attendees will be able to choose in Chicago, Illinois, this March. Additional interviews will be published in the February issue of the AORN Journal.
Innovations in trauma managementdCynthia L. Kildgore, MHA, BSN, RN, CNOR; Karen M. Hickey, MSN, BSN, RN AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2014?
Cynthia L. Kildgore
Karen M. Hickey
In a level 1 trauma facility, perioperative staff must be able to have a patient in an OR and ready for surgery within five minutes of notification. During the session “Got Trauma? Innovations in Trauma Management: Balancing Access and Resource Utilization,” Cynthia L. Kildgore and Karen M. Hickey will describe the process of handling trauma patients at Vanderbilt University Medical Center in Nashville, Tennessee. Kildgore is the director of Perioperative Services VOR, Gynecologic Surgery, Medical Center East (MCE), and Hickey is the perioperative manager of Patient Care Gynecologic Surgery, MCE, at Vanderbilt University Medical Center.
Kildgore: Approximately 15 years ago, as a level 1 trauma center, we had an identified, dedicated OR trauma room that was available 24 hours a day, 365 days a year. This resulted in a loss of income from perioperative services when the room was not used but kept available for trauma patients. We reevaluated our process for handling trauma room prioritization, and we developed an algorithm that allows us to have a floating trauma room in any OR at any time. This concept means that at any given moment any OR can serve as a trauma room. This concept allows managers to assess which rooms and staff members are available and determine the best room to serve the specific needs of an incoming patient. Initially, both our surgeons and staff members were skeptical this process would be successful and were opposed to this new concept. However, it has worked well and its use has progressed from an essentially manual process using landline telephones and pagers to an automated process that tracks ORs, staff members, and patients in a large multi-room OR that handles 120
http://dx.doi.org/10.1016/j.aorn.2013.11.009
Ó AORN, Inc, 2014
January 2014
Vol 99 No 1
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January 2014 Vol 99 No 1
to 140 procedures per day in addition to our trauma cases. AORN Journal: Why would you recommend that Conference attendees come to your session? Hickey: It demonstrates how creative thinking and using clinical decision support through technology can increase efficiency, reduce cost, and decrease risk. By automating the trauma room identification process, we are able to track open rooms, OR staff, and resources without requiring managers to do this via a continual manual process throughout the day. Automation standardizes and speeds the process while eliminating variations in decision making. This session describes a new system many nurses could customize to their own facility. It also demonstrates an innovative process and technological solution to improve the perioperative workflow. AORN Journal: How does this topic apply to different nurse roles (eg, staff RN, educators, leaders/managers)? Kildgore: Staff RNs require an education process to learn to accommodate the reality of being assigned an unexpected trauma patient when one arrives in the OR. Managers and educators assess staff competencies to be aware of staff members’ abilities, or lack thereof, so that we can scan available rooms and match the most appropriate room and staff member skill set to the incoming trauma patient. We have our own perioperative education department that is responsible for all OR education, and the trauma algorithm has been incorporated into our perioperative orientation curriculum. We do a lot of cross training, and the expectation is for all our RNs to be able to circulate and scrub. This requires training new hires and our current RNs who lack this experience.
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EXPO SPEAKER INTERVIEWS Managers have the detailed experience and knowledge to manage the algorithm and help with room setup and running the case if necessary. It took us about 90 days originally to get the program up and running in a 19-room OR that did not have [information technology] capabilities to our current 35-plus-room computerized OR that is state-of-the-art. AORN Journal: What are some exciting innovations that are occurring in trauma management? Hickey: Vanderbilt developed a trauma management algorithm for prioritizing trauma cases and is now developing a new CDS [clinical decision support] tool to streamline and automate our process of trauma case placement. We have also applied our trauma model to the management and placement of obstetrical patients with emergenciesdsuch as severe fetal distress or life-threatening maternal complicationsdwith great success. The new CDS system we are currently working on will track patients, ORs, and staff members throughout the day and identify the most appropriate rooms for trauma cases. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice setting? Kildgore: Attendees will be able to return home and implement this algorithm in their ORs, whether it is a simple system (eg, manual, pagers) or a system that is as high-tech as Vanderbilt’s. Hickey: We also want attendees to be inspired and motivated to take a second look at their own work processes and consider alternative paths or new technology to improve their nursing practice and patient care processes.
EXPO SPEAKER INTERVIEWS
www.aornjournal.org
Finding balance as you care for othersdPhyllis S. Quinlan, PhD, RN-BC
The profession of nursing has withstood endless demands from numerous internal and external sources. This relentless pressure often causes nurses to question their career choice and challenges their ability to connect with the joy of practicing. During the Phyllis S. Quinlan session “Finding Balance as You Care for Others: Put Your Own Oxygen Mask on First,” Dr Phyllis S. Quinlan will inform attendees of the risks, signs, and symptoms of compassion fatigue and, in doing so, strengthen their resilience. Dr Quinlan has practiced in a variety of settings during her 30-plus-year career, including the emergency department, acute care, and subacute care. Dr Quinlan is the founder of MFW Consultants to Professionals, Queens County, New York, and currently works to promote balanced living and a healthy work environment, blending traditional personal coaching practices with Eastern philosophy and vibrational healing modalities. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2014? Dr Quinlan: The topic I’m going to present is how to maintain a balance between rendering care as a professional caregiver and good self-care. It really is a presentation to raise awareness of the dangers of compassion fatigue. Compassion fatigue is something that I experienced at one point. My life seemed to have become unmanageable; I had lost the joy in practicing nursing. I found it difficult to get through the day
without being extremely exhausted, and I wasn’t sure what was wrong. I started doing some research and stumbled upon post-traumatic stress syndrome, known as “compassion fatigue.” Once I started reading about it and becoming more aware of the signs, symptoms, and personality traits that can lend themselves to predisposing nurses to compassion fatigue, a lot of things fell into place. Having been through that, I want to do something to help my friends and colleagues reestablish a link with the joy of why they went into this profession and reestablish a link with themselves so that they can have sustainable compassion to give them a satisfying, sustainable career. AORN Journal: Why would you recommend that Conference attendees come to your session? Dr Quinlan: In San Diego in March 2013, I connected with more than 60 nurses when I was conducting career counseling there. I coached 60 nurses in three very intense days. I could see a common need where people had lost their way in the profession. Nurses have outside forces influencing and wearing on them. The stress of practicing amidst financial changes in the industry, intense regulatory and governmental oversight, ever-increasing downsizing, right-sizingdit’s just so very intense. Each of us went into the profession to take care of people and to make a difference. All of this other stuff that’s laid onto the profession is something that I don’t think a new graduate ever anticipated, let alone was prepared for. This is a resounding theme in nursing. In my session, I will redirect attendees to take better care of themselves and to be aware of the fact that by virtue of being caregivers, their tendency is to put themselves last. I often reference the airline industry and their instructions to put your own oxygen mask on first. Metaphorically, this is true in nursing as
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well, because unless you take good care of yourself, you have nothing to offer anybody else, let alone sustain your own ability to provide care to others. AORN Journal: How does the topic apply to different nurse roles (eg, staff RN, educator, leader/manager)? Dr Quinlan: Again, it comes down to what makes someone go into a caring profession, what makes someone choose nursing as a profession. There are a variety of different reasonsdpeople will say it’s a calling, people will say that they’ve never seen themselves doing anything else, other people will reference that they want to make a difference. If we really drill down to it, what we have here is an individual who is rare among people. This individual actually feels good when helping another individual who is vulnerable. It’s a gift to be a caregiver. It’s a gift to be blessed with the ability to render care because people can feel compassion, but not everybody can mobilize that compassion into caregiving. That’s the common denominator among all caregivers and all RNs regardless of their practice area. This is not about any one particular specialization in nursing. I am looking to raise awareness in all caregivers about the common set of characteristics, tendencies, and temperaments that can predispose them to develop compassion fatigue. AORN Journal: What are some exciting innovations that are occurring in addressing and preventing compassion fatigue? Dr Quinlan: Last year, I was affiliated with the National Healthcare Career Network. They asked me to participate in a series of webinars dedicated to helping nurses shape their future and anchor their changes of being all they can be in that industry. The webinar series, “Take Charge of Your Career,”
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EXPO SPEAKER INTERVIEWS includes five or six webinars dedicated to several topics, and AORN has participated in these webinars, as have many other professional organizations. The success of these webinars started us thinking about what else we could do to reach nurses, to not only guide nurses in professional growth, but also to celebrate nursing and the extraordinary things that nurses do but really feel is just ordinary day-to-day work. We came up with the idea of the series “Nursing Success TV,” which was launched on October 14 and has been well received so far. These are small web-based television vignettes, and there is a brief career coaching time and a segment called “Ask Dr Phyllis.” After I go through some career coaching, the next step is to celebrate one nurse who has done some extraordinary things in contributing to patient care or his or her profession. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice settings? Dr Quinlan: Hopefully, they will begin to understand that compassion fatigue is real and that the core of why people have chosen to go into the profession of caring, the characteristics of the individuals who choose to do this, are very unique characteristics that are indeed gifts. I would also like to be able to create an awareness that if you don’t honor your gift, things can start to unravel and you can lose connection with the reason you’ve devoted so much of your life to the profession of caring or the profession of nursing. Once I have raised the level of awareness about the personality traits that have a tendency to contribute to compassion fatigue, it will empower nurses to be able to protect themselves. For those nurses who have indeed found themselves caught up in compassion fatigue, it will empower them to be able to start back on the road to being able to reconnect with the joy of practicing.
EXPO SPEAKER INTERVIEWS
www.aornjournal.org
Large-scale disclosure of patient harmsdDavid Sine, DrBE, CSP, ARM, CPHRM
Handling notifications to patients after large-scale events, such as exposures to improperly sterilized surgical instruments, is a complex and challenging issue. Whether the exposure arose from a failed sterilization, reuse of a device, a mass supply or drug contamination, or David Sine other source, the end result is that the patients need to be identified, contacted, and usually retested. How does one determine how many patients are enough to trigger this response? Where should the line be drawn on notification and testing? What if the patients do not want to be tested or simply do not want to know that they may have been part of an unintended exposure to a disease? During the session “Large-Scale Disclosure of Patient Harms,” Dr David Sine will look at the ethical dilemmas presented in the large-scale exposure situation, including the psychological effects of disclosing to one patient versus thousands. Using stories from recent events, lessons will be shared on defining the exposure population and outlining the logistics of notification. The session will examine the tipping point of where to draw the line to determine which patients and members of the public to tell, what to tell, and how to help OR nurse managers, physicians, and other organizational leaders deal with the ramifications and ethics of a large exposure. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2014? Dr Sine: I became aware of the complexity of large-scale disclosures when, as a risk manager, I
became involved in the initial HCV [hepatitis C virus] look-back programs that affected our nation’s blood supply. If you recall, that involved determining which patients may have received contaminated blood or blood products and, years after the fact, contacting them or their primary care physicians regarding follow-up testing. Obviously, the challenges of disclosure then were much the same as they are today with concerns for patient confidentiality, patient safety, therapeutic privilege, risk management, and biomedical ethics all convening simultaneously on the issue. AORN Journal: Why would you recommend that Conference attendees come to your session? Dr Sine: The central point of the presentation is that you don’t have to be a large-scale organization to face the challenges of a large-scale disclosure. This can happen to any organization at any time, and there should be a response plan in place. If you don’t have a response plan already in place, this presentation is for you. AORN Journal: How does this topic apply to different nurse roles (eg, staff RN, educator, leader/manager)? Dr Sine: Disclosure events cut across the health care organization and can involve clinical managers, IT [information technology] personnel, EHR [electronic health record] managers, pharmacists, OR managers, central sterile supply managers, clinical ethicists, and risk managers. These are complex, dynamic events that evolve rapidly and can and will involve a host of roles in the health care organization. AORN Journal: What are some exciting innovations that are occurring in large-scale disclosure of patient harms?
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Dr Sine: The major difference in today’s disclosure and that of just a few years ago has to be social media, which can work for you or against you, depending on how tech-savvy you are. Social media today will always be an element in large-scale disclosure and needs to be planned for and used to an organization’s advantage to promote patient safety.
EXPO SPEAKER INTERVIEWS AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice settings? Dr Sine: We will use some case studies of largescale disclosure events to gain familiarity with several tools and gain insight into how those tools can be implemented at the facility level.
Writing for the AORN JournaldDonna S. Watson, MSN, RN, CNOR, FNP-BC The AORN Journal is the number one member benefit identified by AORN members in recent surveys. The mission of the AORN Journal is to provide perioperative RNs with clinical information and evidence they can use to improve their practice and advocate for patients Donna S. Watson who are undergoing surgical or other invasive procedures. During the session “The Write Stuff: Writing for the AORN Journal,” Donna S. Watson will discuss the benefits of writing for the AORN Journal, give an overview of the authorship process, and identify resources that are available to AORN Journal authors. Watson has been a member of the AORN Journal Editorial Board since 2009. She is also a perioperative nurse with 33 years of experience, with a focus on perioperative clinical practice, administration, and research. She is currently director, Society and Patient Advocacy Programs, at Covidien, and a nursing student in the PhD program at Washington State University, Spokane, Washington. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2014? D. Watson: I am on the AORN Journal Editorial Board, and we have had discussions about how we encourage members to participate in writing as a 32 j AORN Journal
way to contribute to the nursing profession. This session was one of the many ideas we had to encourage writers to get involved, write for the Journal, and at the same time influence practice by writing about what they are doing clinically or researching in any type of clinical practice setting. Writing for the Journal certainly makes a difference by increasing awareness and also, from a professional standpoint, helping to contribute to the science and evidence-based practice of nursing. AORN Journal: Why would you recommend that Conference attendees come to your session? D. Watson: This program is tailor-made for the person who is interested in or curious about writing. Also, we have some experienced writers who are curious about the AORN Journal process. The intent is to increase awareness, provide total transparency in terms of the review process, give some tips and tricks on writing, and, most importantly, increase awareness of the mentoring and coaching that is available not only from within the AORN Journal Editorial Board but also within the AORN Publications staff. AORN Journal: How does this topic apply to different nurse roles (eg, staff RN, educator, leader/manager)? D. Watson: In terms of writing for publication, I look at it from a perspective of professional development, which is applicable to an RN who is a staff nurse, manager, or educator. From a publication standpoint, it is always exciting to see a manuscript that you’ve written on best practices or
EXPO SPEAKER INTERVIEWS research be published, but most importantly, from a practice standpoint, publishing can make a difference in influencing the practice of others. RNs at a staff level can use publication for professional development. For managers, there’s always a need for management-related articles, especially when we’re moving into health care reform with the Affordable Care Act and its fiscal implications. Any type of manuscript is very helpful for those who are facing some of the same challenges that the writer has faced. Their solutions may offer them other options that they have not considered. Another important aspect is that, as a researcher, obviously you want to contribute to the science of nursing. Publication allows an avenue to disseminate research because the AORN Journal is the premier journal for perioperative practice. It’s very important that nurse researchers publish that research and its outcomes to the correct audience. The Journal is an excellent venue, and this session offers more information about the publication process and demonstrates the mentoring and coaching that we can offer our authors. AORN Journal: What are some exciting innovations that are occurring in writing for publication in the AORN Journal? D. Watson: Well, I think in general there are two movements out there. One is the continued
www.aornjournal.org
need for the hard copy of the Journal, which members receive every month. I know personally I enjoy sitting down and reading it. However, innovations include the movement toward online manuscripts. With online manuscripts, authors can also insert videos of an actual procedure to illustrate the concepts being presented. Additionally, from a clinical aspectdfor example, the article may deal with positioningdit is possible to embed a video on how to correctly position the patient. What electronic publishing does for us as readers is increase all of the various learning domains, including affective, psychomotor, and cognitive, and allow us more innovative options to present and illustrate the written material. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice settings? D. Watson: Attendees will leave with an understanding of the process of writing for the premier perioperative journal. They can take the skills and information that they receive during this session and apply them in any type of everyday setting. For example, this session can help improve attendees’ skills, whether it’s writing a policy, a procedure, charting, or any kind of written effort. This is a skills-enhancing seminar.
Implementing a comprehensive unit-based safety program (CUSP) in a Canadian ORd Louis M. Watson, BSN, BSc, RN, CRNE
Louis M. Watson
Surgical site infections in the general surgical population are a significant public health issue. A high rate of surgical site infections at one Canadian hospital prompted a proactive method to address the potential harm to patients through a comprehensive unit-based safety program
(CUSP) initiative. During the session “Challenges and Successes of Implementing a Comprehensive Unit-Based Safety Program (CUSP) in a Canadian OR,” Louis M. Watson will discuss the difficulties and successes of the program, as well as how perioperative nurses can contribute as proactive members of safety improvement teams and help initiate changes that safeguard patients from avoidable harm. Watson entered nursing in 1998. He is currently a full-time student pursuing a master’s degree in AORN Journal j 33
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health science technology and policy at Carleton University, Ottawa, Canada. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2014? L. Watson: I was working on a research proposal to investigate surgical site infections in the OR, looking at the available evidence and how we can minimize these infections. I had a meeting with a surgeon, Dr Moloo, and I was hoping he’d collaborate with me on the research. It turned out that he told me about his proposal, which was for a comprehensive unit safety article for a CUSP, and asked if I would be interested in helping him as an RN. That’s how I got involved. We started the CUSP project, and I became the first RN involved in the project at the hospital. The first CUSP team was general surgery in the colorectal program because their surgical site infection rate was high. AORN Journal: Why would you recommend that Conference attendees come to your session? L. Watson: I would recommend that they come to my session because I am going to show the impact an RN can have on changes in the OR by implementing a CUSP, working in a team, and accepting the fact that the way we currently do things isn’t necessarily the right way. I’m going to show n
what a CUSP is, how to measure what you implement through something called NSQIP [National Surgery Quality Improvement Program], n the five steps of a CUSP, n how to conduct a comprehensive literature search (what is the evidence on current practices to prevent surgical site infections), and n how to use basic statistics (to support the argument when you implement change). n
I will also show attendees how to plan and implement research within their units with regard 34 j AORN Journal
EXPO SPEAKER INTERVIEWS to evidence-based practice, how to apply the evidence and institute changes in the OR, and how to measure the impact of implementing a CUSP in a unit, as well as give an overview of the strategies to implement a CUSP. Attendees will leave my presentation feeling empowered and equipped with the knowledge that one RN can change the whole culture in the OR. AORN Journal: How does this topic apply to different nurse roles (eg, staff RN, educator, leader/manager)? L. Watson: The roles in a CUSP are numerous, and every role is important. The nurse manager can support the CUSP process, manage resources, share survey results with the staff, help assign project leaders to interventions, and assist in scheduling executive walk-arounds. The average RN in the OR can step up and become a project leader or a “unit champion,” as we like to call them. Their role is to encourage unit staff to get involved, which is one of the biggest challenges of implementing anything in an OR. They can obtain staff feedback; help manage the documentation of the CUSP program, whether paper based or electronic; and act as educators, taking what evidence we have found and helping to implement that. They can help mentor other staff members who want to become project leaders, assist where appropriate in setting up meetings, contact key people, help identify resources, and help others use the online available tools for CUSP implementation. There’s also a role for a patient safety coordinator, which RNs can fill as well. AORN Journal: What are some exciting innovations that are currently occurring in unit-based practice? L. Watson: In my hospital, we started with just one CUSP team for general surgery. Now, every department in the hospital has its own CUSP team. Based on the raw data over the 10 months since we
EXPO SPEAKER INTERVIEWS started the CUSP, our infection rates have dropped by 1%, which is great. In the OR, we’ve formed a CUSP task force, which is an extension of the CUSP teams. The task force is composed of the surgical champion for the department, an RN champion, an anesthesia champion, a nurse manager, and a nurse educator. We meet once a month and decide what changes we are going to implement and why. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice settings? L. Watson: They’ll learn infection control, and they’ll learn the results of what we did with our CUSP initiative. We looked at n n
infection control; skin preparation;
www.aornjournal.org n n n n n n n
hypothermia; contamination of bowel content into the wound; antibiotic timing, selection, and redosing, length of the case; coordination of care; use of the preoperative evaluation form; and improved surgical posting accuracy, such as procedure name and duration, which is essential in figuring out antibiotics and hypothermia.
Attendees will learn about improving communication; implementing teamwork tools; using equipment and supplies better and according to evidence-based practice; implementing policies and protocols; and standardizing care, protocols, and policies across the unit. Finally, they will learn that ongoing education with supportive data is crucial to preventing patient harm in the OR.
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ach year, AORN strives to provide the very best in perioperative nursing education at its annual conference. The Surgical Conference & Expo 2014 experience will be no different. Attendees will receive continuing education that focuses on current issues and trends, evidence-based practice and research, and health care initiatives relative to the advancement of perioperative practice.
Several of the distinguished speakers from the 2014 schedule have graciously agreed to participate in interviews about their upcoming sessions to provide a sample of the extensive educational offerings from which attendees will be able to choose in Chicago, Illinois, this March. Additional interviews will be published in the February issue of the AORN Journal.
Innovations in trauma managementdCynthia L. Kildgore, MHA, BSN, RN, CNOR; Karen M. Hickey, MSN, BSN, RN AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2014?
Cynthia L. Kildgore
Karen M. Hickey
In a level 1 trauma facility, perioperative staff must be able to have a patient in an OR and ready for surgery within five minutes of notification. During the session “Got Trauma? Innovations in Trauma Management: Balancing Access and Resource Utilization,” Cynthia L. Kildgore and Karen M. Hickey will describe the process of handling trauma patients at Vanderbilt University Medical Center in Nashville, Tennessee. Kildgore is the director of Perioperative Services VOR, Gynecologic Surgery, Medical Center East (MCE), and Hickey is the perioperative manager of Patient Care Gynecologic Surgery, MCE, at Vanderbilt University Medical Center.
Kildgore: Approximately 15 years ago, as a level 1 trauma center, we had an identified, dedicated OR trauma room that was available 24 hours a day, 365 days a year. This resulted in a loss of income from perioperative services when the room was not used but kept available for trauma patients. We reevaluated our process for handling trauma room prioritization, and we developed an algorithm that allows us to have a floating trauma room in any OR at any time. This concept means that at any given moment any OR can serve as a trauma room. This concept allows managers to assess which rooms and staff members are available and determine the best room to serve the specific needs of an incoming patient. Initially, both our surgeons and staff members were skeptical this process would be successful and were opposed to this new concept. However, it has worked well and its use has progressed from an essentially manual process using landline telephones and pagers to an automated process that tracks ORs, staff members, and patients in a large multi-room OR that handles 120
http://dx.doi.org/10.1016/j.aorn.2013.11.009
Ó AORN, Inc, 2014
January 2014
Vol 99 No 1
AORN Journal j 27
January 2014 Vol 99 No 1
to 140 procedures per day in addition to our trauma cases. AORN Journal: Why would you recommend that Conference attendees come to your session? Hickey: It demonstrates how creative thinking and using clinical decision support through technology can increase efficiency, reduce cost, and decrease risk. By automating the trauma room identification process, we are able to track open rooms, OR staff, and resources without requiring managers to do this via a continual manual process throughout the day. Automation standardizes and speeds the process while eliminating variations in decision making. This session describes a new system many nurses could customize to their own facility. It also demonstrates an innovative process and technological solution to improve the perioperative workflow. AORN Journal: How does this topic apply to different nurse roles (eg, staff RN, educators, leaders/managers)? Kildgore: Staff RNs require an education process to learn to accommodate the reality of being assigned an unexpected trauma patient when one arrives in the OR. Managers and educators assess staff competencies to be aware of staff members’ abilities, or lack thereof, so that we can scan available rooms and match the most appropriate room and staff member skill set to the incoming trauma patient. We have our own perioperative education department that is responsible for all OR education, and the trauma algorithm has been incorporated into our perioperative orientation curriculum. We do a lot of cross training, and the expectation is for all our RNs to be able to circulate and scrub. This requires training new hires and our current RNs who lack this experience.
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EXPO SPEAKER INTERVIEWS Managers have the detailed experience and knowledge to manage the algorithm and help with room setup and running the case if necessary. It took us about 90 days originally to get the program up and running in a 19-room OR that did not have [information technology] capabilities to our current 35-plus-room computerized OR that is state-of-the-art. AORN Journal: What are some exciting innovations that are occurring in trauma management? Hickey: Vanderbilt developed a trauma management algorithm for prioritizing trauma cases and is now developing a new CDS [clinical decision support] tool to streamline and automate our process of trauma case placement. We have also applied our trauma model to the management and placement of obstetrical patients with emergenciesdsuch as severe fetal distress or life-threatening maternal complicationsdwith great success. The new CDS system we are currently working on will track patients, ORs, and staff members throughout the day and identify the most appropriate rooms for trauma cases. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice setting? Kildgore: Attendees will be able to return home and implement this algorithm in their ORs, whether it is a simple system (eg, manual, pagers) or a system that is as high-tech as Vanderbilt’s. Hickey: We also want attendees to be inspired and motivated to take a second look at their own work processes and consider alternative paths or new technology to improve their nursing practice and patient care processes.
EXPO SPEAKER INTERVIEWS
www.aornjournal.org
Finding balance as you care for othersdPhyllis S. Quinlan, PhD, RN-BC
The profession of nursing has withstood endless demands from numerous internal and external sources. This relentless pressure often causes nurses to question their career choice and challenges their ability to connect with the joy of practicing. During the Phyllis S. Quinlan session “Finding Balance as You Care for Others: Put Your Own Oxygen Mask on First,” Dr Phyllis S. Quinlan will inform attendees of the risks, signs, and symptoms of compassion fatigue and, in doing so, strengthen their resilience. Dr Quinlan has practiced in a variety of settings during her 30-plus-year career, including the emergency department, acute care, and subacute care. Dr Quinlan is the founder of MFW Consultants to Professionals, Queens County, New York, and currently works to promote balanced living and a healthy work environment, blending traditional personal coaching practices with Eastern philosophy and vibrational healing modalities. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2014? Dr Quinlan: The topic I’m going to present is how to maintain a balance between rendering care as a professional caregiver and good self-care. It really is a presentation to raise awareness of the dangers of compassion fatigue. Compassion fatigue is something that I experienced at one point. My life seemed to have become unmanageable; I had lost the joy in practicing nursing. I found it difficult to get through the day
without being extremely exhausted, and I wasn’t sure what was wrong. I started doing some research and stumbled upon post-traumatic stress syndrome, known as “compassion fatigue.” Once I started reading about it and becoming more aware of the signs, symptoms, and personality traits that can lend themselves to predisposing nurses to compassion fatigue, a lot of things fell into place. Having been through that, I want to do something to help my friends and colleagues reestablish a link with the joy of why they went into this profession and reestablish a link with themselves so that they can have sustainable compassion to give them a satisfying, sustainable career. AORN Journal: Why would you recommend that Conference attendees come to your session? Dr Quinlan: In San Diego in March 2013, I connected with more than 60 nurses when I was conducting career counseling there. I coached 60 nurses in three very intense days. I could see a common need where people had lost their way in the profession. Nurses have outside forces influencing and wearing on them. The stress of practicing amidst financial changes in the industry, intense regulatory and governmental oversight, ever-increasing downsizing, right-sizingdit’s just so very intense. Each of us went into the profession to take care of people and to make a difference. All of this other stuff that’s laid onto the profession is something that I don’t think a new graduate ever anticipated, let alone was prepared for. This is a resounding theme in nursing. In my session, I will redirect attendees to take better care of themselves and to be aware of the fact that by virtue of being caregivers, their tendency is to put themselves last. I often reference the airline industry and their instructions to put your own oxygen mask on first. Metaphorically, this is true in nursing as
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well, because unless you take good care of yourself, you have nothing to offer anybody else, let alone sustain your own ability to provide care to others. AORN Journal: How does the topic apply to different nurse roles (eg, staff RN, educator, leader/manager)? Dr Quinlan: Again, it comes down to what makes someone go into a caring profession, what makes someone choose nursing as a profession. There are a variety of different reasonsdpeople will say it’s a calling, people will say that they’ve never seen themselves doing anything else, other people will reference that they want to make a difference. If we really drill down to it, what we have here is an individual who is rare among people. This individual actually feels good when helping another individual who is vulnerable. It’s a gift to be a caregiver. It’s a gift to be blessed with the ability to render care because people can feel compassion, but not everybody can mobilize that compassion into caregiving. That’s the common denominator among all caregivers and all RNs regardless of their practice area. This is not about any one particular specialization in nursing. I am looking to raise awareness in all caregivers about the common set of characteristics, tendencies, and temperaments that can predispose them to develop compassion fatigue. AORN Journal: What are some exciting innovations that are occurring in addressing and preventing compassion fatigue? Dr Quinlan: Last year, I was affiliated with the National Healthcare Career Network. They asked me to participate in a series of webinars dedicated to helping nurses shape their future and anchor their changes of being all they can be in that industry. The webinar series, “Take Charge of Your Career,”
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EXPO SPEAKER INTERVIEWS includes five or six webinars dedicated to several topics, and AORN has participated in these webinars, as have many other professional organizations. The success of these webinars started us thinking about what else we could do to reach nurses, to not only guide nurses in professional growth, but also to celebrate nursing and the extraordinary things that nurses do but really feel is just ordinary day-to-day work. We came up with the idea of the series “Nursing Success TV,” which was launched on October 14 and has been well received so far. These are small web-based television vignettes, and there is a brief career coaching time and a segment called “Ask Dr Phyllis.” After I go through some career coaching, the next step is to celebrate one nurse who has done some extraordinary things in contributing to patient care or his or her profession. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice settings? Dr Quinlan: Hopefully, they will begin to understand that compassion fatigue is real and that the core of why people have chosen to go into the profession of caring, the characteristics of the individuals who choose to do this, are very unique characteristics that are indeed gifts. I would also like to be able to create an awareness that if you don’t honor your gift, things can start to unravel and you can lose connection with the reason you’ve devoted so much of your life to the profession of caring or the profession of nursing. Once I have raised the level of awareness about the personality traits that have a tendency to contribute to compassion fatigue, it will empower nurses to be able to protect themselves. For those nurses who have indeed found themselves caught up in compassion fatigue, it will empower them to be able to start back on the road to being able to reconnect with the joy of practicing.
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Large-scale disclosure of patient harmsdDavid Sine, DrBE, CSP, ARM, CPHRM
Handling notifications to patients after large-scale events, such as exposures to improperly sterilized surgical instruments, is a complex and challenging issue. Whether the exposure arose from a failed sterilization, reuse of a device, a mass supply or drug contamination, or David Sine other source, the end result is that the patients need to be identified, contacted, and usually retested. How does one determine how many patients are enough to trigger this response? Where should the line be drawn on notification and testing? What if the patients do not want to be tested or simply do not want to know that they may have been part of an unintended exposure to a disease? During the session “Large-Scale Disclosure of Patient Harms,” Dr David Sine will look at the ethical dilemmas presented in the large-scale exposure situation, including the psychological effects of disclosing to one patient versus thousands. Using stories from recent events, lessons will be shared on defining the exposure population and outlining the logistics of notification. The session will examine the tipping point of where to draw the line to determine which patients and members of the public to tell, what to tell, and how to help OR nurse managers, physicians, and other organizational leaders deal with the ramifications and ethics of a large exposure. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2014? Dr Sine: I became aware of the complexity of large-scale disclosures when, as a risk manager, I
became involved in the initial HCV [hepatitis C virus] look-back programs that affected our nation’s blood supply. If you recall, that involved determining which patients may have received contaminated blood or blood products and, years after the fact, contacting them or their primary care physicians regarding follow-up testing. Obviously, the challenges of disclosure then were much the same as they are today with concerns for patient confidentiality, patient safety, therapeutic privilege, risk management, and biomedical ethics all convening simultaneously on the issue. AORN Journal: Why would you recommend that Conference attendees come to your session? Dr Sine: The central point of the presentation is that you don’t have to be a large-scale organization to face the challenges of a large-scale disclosure. This can happen to any organization at any time, and there should be a response plan in place. If you don’t have a response plan already in place, this presentation is for you. AORN Journal: How does this topic apply to different nurse roles (eg, staff RN, educator, leader/manager)? Dr Sine: Disclosure events cut across the health care organization and can involve clinical managers, IT [information technology] personnel, EHR [electronic health record] managers, pharmacists, OR managers, central sterile supply managers, clinical ethicists, and risk managers. These are complex, dynamic events that evolve rapidly and can and will involve a host of roles in the health care organization. AORN Journal: What are some exciting innovations that are occurring in large-scale disclosure of patient harms?
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Dr Sine: The major difference in today’s disclosure and that of just a few years ago has to be social media, which can work for you or against you, depending on how tech-savvy you are. Social media today will always be an element in large-scale disclosure and needs to be planned for and used to an organization’s advantage to promote patient safety.
EXPO SPEAKER INTERVIEWS AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice settings? Dr Sine: We will use some case studies of largescale disclosure events to gain familiarity with several tools and gain insight into how those tools can be implemented at the facility level.
Writing for the AORN JournaldDonna S. Watson, MSN, RN, CNOR, FNP-BC The AORN Journal is the number one member benefit identified by AORN members in recent surveys. The mission of the AORN Journal is to provide perioperative RNs with clinical information and evidence they can use to improve their practice and advocate for patients Donna S. Watson who are undergoing surgical or other invasive procedures. During the session “The Write Stuff: Writing for the AORN Journal,” Donna S. Watson will discuss the benefits of writing for the AORN Journal, give an overview of the authorship process, and identify resources that are available to AORN Journal authors. Watson has been a member of the AORN Journal Editorial Board since 2009. She is also a perioperative nurse with 33 years of experience, with a focus on perioperative clinical practice, administration, and research. She is currently director, Society and Patient Advocacy Programs, at Covidien, and a nursing student in the PhD program at Washington State University, Spokane, Washington. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2014? D. Watson: I am on the AORN Journal Editorial Board, and we have had discussions about how we encourage members to participate in writing as a 32 j AORN Journal
way to contribute to the nursing profession. This session was one of the many ideas we had to encourage writers to get involved, write for the Journal, and at the same time influence practice by writing about what they are doing clinically or researching in any type of clinical practice setting. Writing for the Journal certainly makes a difference by increasing awareness and also, from a professional standpoint, helping to contribute to the science and evidence-based practice of nursing. AORN Journal: Why would you recommend that Conference attendees come to your session? D. Watson: This program is tailor-made for the person who is interested in or curious about writing. Also, we have some experienced writers who are curious about the AORN Journal process. The intent is to increase awareness, provide total transparency in terms of the review process, give some tips and tricks on writing, and, most importantly, increase awareness of the mentoring and coaching that is available not only from within the AORN Journal Editorial Board but also within the AORN Publications staff. AORN Journal: How does this topic apply to different nurse roles (eg, staff RN, educator, leader/manager)? D. Watson: In terms of writing for publication, I look at it from a perspective of professional development, which is applicable to an RN who is a staff nurse, manager, or educator. From a publication standpoint, it is always exciting to see a manuscript that you’ve written on best practices or
EXPO SPEAKER INTERVIEWS research be published, but most importantly, from a practice standpoint, publishing can make a difference in influencing the practice of others. RNs at a staff level can use publication for professional development. For managers, there’s always a need for management-related articles, especially when we’re moving into health care reform with the Affordable Care Act and its fiscal implications. Any type of manuscript is very helpful for those who are facing some of the same challenges that the writer has faced. Their solutions may offer them other options that they have not considered. Another important aspect is that, as a researcher, obviously you want to contribute to the science of nursing. Publication allows an avenue to disseminate research because the AORN Journal is the premier journal for perioperative practice. It’s very important that nurse researchers publish that research and its outcomes to the correct audience. The Journal is an excellent venue, and this session offers more information about the publication process and demonstrates the mentoring and coaching that we can offer our authors. AORN Journal: What are some exciting innovations that are occurring in writing for publication in the AORN Journal? D. Watson: Well, I think in general there are two movements out there. One is the continued
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need for the hard copy of the Journal, which members receive every month. I know personally I enjoy sitting down and reading it. However, innovations include the movement toward online manuscripts. With online manuscripts, authors can also insert videos of an actual procedure to illustrate the concepts being presented. Additionally, from a clinical aspectdfor example, the article may deal with positioningdit is possible to embed a video on how to correctly position the patient. What electronic publishing does for us as readers is increase all of the various learning domains, including affective, psychomotor, and cognitive, and allow us more innovative options to present and illustrate the written material. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice settings? D. Watson: Attendees will leave with an understanding of the process of writing for the premier perioperative journal. They can take the skills and information that they receive during this session and apply them in any type of everyday setting. For example, this session can help improve attendees’ skills, whether it’s writing a policy, a procedure, charting, or any kind of written effort. This is a skills-enhancing seminar.
Implementing a comprehensive unit-based safety program (CUSP) in a Canadian ORd Louis M. Watson, BSN, BSc, RN, CRNE
Louis M. Watson
Surgical site infections in the general surgical population are a significant public health issue. A high rate of surgical site infections at one Canadian hospital prompted a proactive method to address the potential harm to patients through a comprehensive unit-based safety program
(CUSP) initiative. During the session “Challenges and Successes of Implementing a Comprehensive Unit-Based Safety Program (CUSP) in a Canadian OR,” Louis M. Watson will discuss the difficulties and successes of the program, as well as how perioperative nurses can contribute as proactive members of safety improvement teams and help initiate changes that safeguard patients from avoidable harm. Watson entered nursing in 1998. He is currently a full-time student pursuing a master’s degree in AORN Journal j 33
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health science technology and policy at Carleton University, Ottawa, Canada. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2014? L. Watson: I was working on a research proposal to investigate surgical site infections in the OR, looking at the available evidence and how we can minimize these infections. I had a meeting with a surgeon, Dr Moloo, and I was hoping he’d collaborate with me on the research. It turned out that he told me about his proposal, which was for a comprehensive unit safety article for a CUSP, and asked if I would be interested in helping him as an RN. That’s how I got involved. We started the CUSP project, and I became the first RN involved in the project at the hospital. The first CUSP team was general surgery in the colorectal program because their surgical site infection rate was high. AORN Journal: Why would you recommend that Conference attendees come to your session? L. Watson: I would recommend that they come to my session because I am going to show the impact an RN can have on changes in the OR by implementing a CUSP, working in a team, and accepting the fact that the way we currently do things isn’t necessarily the right way. I’m going to show n
what a CUSP is, how to measure what you implement through something called NSQIP [National Surgery Quality Improvement Program], n the five steps of a CUSP, n how to conduct a comprehensive literature search (what is the evidence on current practices to prevent surgical site infections), and n how to use basic statistics (to support the argument when you implement change). n
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EXPO SPEAKER INTERVIEWS to evidence-based practice, how to apply the evidence and institute changes in the OR, and how to measure the impact of implementing a CUSP in a unit, as well as give an overview of the strategies to implement a CUSP. Attendees will leave my presentation feeling empowered and equipped with the knowledge that one RN can change the whole culture in the OR. AORN Journal: How does this topic apply to different nurse roles (eg, staff RN, educator, leader/manager)? L. Watson: The roles in a CUSP are numerous, and every role is important. The nurse manager can support the CUSP process, manage resources, share survey results with the staff, help assign project leaders to interventions, and assist in scheduling executive walk-arounds. The average RN in the OR can step up and become a project leader or a “unit champion,” as we like to call them. Their role is to encourage unit staff to get involved, which is one of the biggest challenges of implementing anything in an OR. They can obtain staff feedback; help manage the documentation of the CUSP program, whether paper based or electronic; and act as educators, taking what evidence we have found and helping to implement that. They can help mentor other staff members who want to become project leaders, assist where appropriate in setting up meetings, contact key people, help identify resources, and help others use the online available tools for CUSP implementation. There’s also a role for a patient safety coordinator, which RNs can fill as well. AORN Journal: What are some exciting innovations that are currently occurring in unit-based practice? L. Watson: In my hospital, we started with just one CUSP team for general surgery. Now, every department in the hospital has its own CUSP team. Based on the raw data over the 10 months since we
EXPO SPEAKER INTERVIEWS started the CUSP, our infection rates have dropped by 1%, which is great. In the OR, we’ve formed a CUSP task force, which is an extension of the CUSP teams. The task force is composed of the surgical champion for the department, an RN champion, an anesthesia champion, a nurse manager, and a nurse educator. We meet once a month and decide what changes we are going to implement and why. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice settings? L. Watson: They’ll learn infection control, and they’ll learn the results of what we did with our CUSP initiative. We looked at n n
infection control; skin preparation;
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hypothermia; contamination of bowel content into the wound; antibiotic timing, selection, and redosing, length of the case; coordination of care; use of the preoperative evaluation form; and improved surgical posting accuracy, such as procedure name and duration, which is essential in figuring out antibiotics and hypothermia.
Attendees will learn about improving communication; implementing teamwork tools; using equipment and supplies better and according to evidence-based practice; implementing policies and protocols; and standardizing care, protocols, and policies across the unit. Finally, they will learn that ongoing education with supportive data is crucial to preventing patient harm in the OR.
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