AORN Surgical Conference & Expo 2015 Speaker Interviews
E
ach year, AORN strives to provide the very best in perioperative nursing education at its annual meeting. The Surgical Conference & Expo 2015 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 2015 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. Additional speaker interviews will be published in the February issue of the AORN Journal.
Leading and championing changedKevin Eikenberry
Every day, nurse leaders face the challenge of leading change efforts in their facility, with perioperative teams, and in one-on-one situations. In his interactive session “Change Happens! Understanding, Leading, and Championing Change,” Kevin Kevin Eikenberry Eikenberry will discuss the drivers and resistors of change. Contrary to popular belief, Eikenberry suggests that teams do not resist changedindividuals resist being changed. Eikenberry is chief potential officer of The Kevin Eikenberry Group, a leadership and learning consulting company dedicated to helping organizations, teams, and individuals reach their potential. He is also the creator and content developer of “The Remarkable Leadership Learning System,” a continual leadership development process focused on developing the competencies of remarkable leaders worldwide. As a leadership expert, two-time best-selling author, speaker, consultant, and trainer, Eikenberry’s philosophy in
business and in life is that every person and every organization has extraordinary potential. AORN Journal: How did you become interested in the issue you will be presenting at the OR Executive Summit (ORES) of the AORN Surgical Conference & Expo 2015? Eikenberry: I’ve been studying the dynamics of organizational and personal change for more than 20 years. I’ve looked at it through many lensesdas a coach to leaders, a consultant to leaders and leadership teams trying to create a variety of organizational changes, a writer of change and leadership topics, a leader of my growing team, and a human. Change is a fascinating topic, and the more I learn about how and why people change, the more fascinated and the more effective I become as a leader. Effectiveness aside, the fact that the rate of change continues to accelerate makes this topic an important one for us as individuals and for the hospitals and organizations we work in. AORN Journal: Why would you recommend that ORES attendees come to your session?
http://dx.doi.org/10.1016/j.aorn.2014.10.021
12 j AORN Journal January 2015 Vol 101 No 1
Ó AORN, Inc, 2015
EXPO SPEAKER INTERVIEWS Eikenberry: they are
I hope attendees will join me if
n
dealing with personal change, leading groups through changes, n responding to a request to implement three more changes right about the time the first change is starting to gel, or n sensing their team’sdor their owndoverload and frustration. n
If any of these experiences are true for ORES nurse leaders, then the hour we spend together will be one of the best of the entire conference. During my session, I will provide real-life tools and approaches to understanding and dealing with these challenges. AORN Journal: How can OR nurse leaders demonstrate excellence in leading change efforts? Eikenberry: This is a great question. The answer is more complex than this interview format permits, but in short, when OR nurse leaders can truly
www.aornjournal.org
understand and articulate the purpose and reason for change, they improve their ability to inspire their team members to commit to the work required to succeed with that change effort. It may sometimes be difficult for OR nurse leaders to lift their head above the chaos of the current work moment, but our nurse leaders must be able to do just that, especially in times of change. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice setting? Eikenberry: I don’t want to say too much here, because I want everyone to join me! I will say this: in the 60 minutes that I have with attendees, they will learn how to implement change more effectively and help their teams deal with the increasing rate of change in the perioperative setting. Leading change is one of the most important roles that OR nurse leaders can play if they are to support the needs of the organization, their personnel, and ultimately the patients. I look forward to working with everyone who joins me.
Success in complex cardiac caredAngela B. Rowden, MSN, RN, CGRN; Eric R. Skipper, MD, FACS; Jill Spence, BSN, RN
Providing cardiac care has become increasingly complex as a result of rapidly changing technology that requires surgical teams to continually adapt to new procedures. Facilities are faced with the challenge of educating all members of the cardiac Angela B. Rowden surgery team about the evolving needs of cardiac care as well as orienting new members of the team. At the same time, surgical teams are expected to provide high-quality
care and improve patient outcomes. During the session “Complex Cardiac Care: Preparing the Team for Patient Success,” Angela B. Rowden, Dr Eric R. Skipper, and Jill Spence will share methods they have instituted to make it easier to keep up with new technologies and demands. These presenters are part of a team of perioperative cardiac care providers who will describe the changes they made in educating team members, validating their competencies, and improving care of patients undergoing cardiac surgery Rowden is manager of cardiovascular perioperative services at Carolinas HealthCare System in Charlotte, North Carolina, and Dr Skipper is
AORN Journal j 13
January 2015 Vol 101 No 1
chief of adult cardiothoracic surgery and Spence is clinical supervisor of cardiovascular perioperative services at Carolinas Medical CentereSanger Heart and Vascular Institute in Charlotte, North Carolina. These presenters share the belief that with the right education, training, and orientation, current competencies of cardiovascular team members can be maintained and new team members can be added successfully. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2015? Rowden: We became interested in presenting when we realized that we shared a passion and interest in innovative cardiac technologies. Our team had to solve the problem of training and maintaining competencies of team members faced with the challenge of learning and providing new and complex cardiac care. Changes made to our methods of education and implementation of new technologies have led to increased rates of heart transplant survival and decreased rates of mortality and morbidity. Our team continues to witness the significant positive effects of new technologies that expand our cardiac services and add to the quality of life of our patients. The team is proud of the care they provide, and we wanted to share our success and lessons learned with a larger audience. AORN Journal: Why would you recommend that conference attendees come to your session? Rowden: We believe that a multidisciplinary focus on patient care is imperative to providing the excellent outcomes that we are seeing. Beginning in the office setting, where the patients are first seen, and moving through the planning and
14 j AORN Journal
EXPO SPEAKER INTERVIEWS implementation of perioperative care, many hands and minds touch the patient. We have learned that a well-planned course of care makes a difference, and we believe that attendees will benefit from the insights we share. AORN Journal: How can nurses of all levels (staff, educator, leader) demonstrate excellence in complex cardiac care? Rowden: Attendees in every nurse role can listen and take ideas for best practices back to their institutions. Leaders can use the information to inspire their teams to strive to provide cardiac care that incorporates our suggestions, nurse educators can apply this information to their teaching methods, and staff RNs can use the information to better plan the care they provide to patients undergoing cardiac procedures. All nurses can help one another share in the passion of owning their individual practices and yet working collaboratively as a team. This allows all team members to feel the excitement of providing complex cardiac care resulting in excellent outcomes. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice setting? Rowden: We will share tools that we have implemented to improve methods of education to learn new procedures. One example is an endovascular code rupture algorithm for aortic dissections. We will also present several strategiesd some related to hands-on skills labs and TeamSTEPPSÒ trainingdthat attendees can use for process improvement in perioperative care and for sustaining high-performing teams that must keep pace with innovative technology and advances in complex patient care.
EXPO SPEAKER INTERVIEWS
www.aornjournal.org
Flexible scopes, rigid rulesdLynne A. Thomas, BSN, RN, CGRN, CFER
Managing protocols for the use and care of flexible endoscopes presents several challenges for perioperative personnel. During the session “Flexible Scopes, Rigid Rules,” Lynne A. Thomas will explain that the responsibility for care, traceLynne A. Thomas ability, and maintenance of flexible endoscopes involves multifaceted, fragmented, and often confusing processes. This session will demystify some of the decontamination, disinfection, and sterilization issues surrounding these complex surgical devices. Thomas has worked for more than 30 years in endoscopy nursing and is vice president of education, regulation, and compliance at Integrated Medical Systems, a division of the STERIS Corporation, in Birmingham, Alabama. She is the past president of the American Board for Certification of Gastroenterology Nurses, formerly known as the Certification Board for Gastrointestinal Nurses and Associates. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2015? Thomas: I am a long-time active advocate for safe patient outcomes that stem from endoscopic devices and their cycle of use. In that capacity, I sit on the American Association for Medical Instrumentation working group responsible for developing a standard for flexible endoscope user groups. AORN Journal: Why would you recommend that conference attendees come to your session? Thomas: Flexible endoscopes have a complex design that makes them difficult to clean and
reprocess while maintaining their functional working order. The cause, effect, and prevention of issues related to these devices in regard to patient safety have been variable. Breaches in the cycleof-use and postuse care processes have led to patient-related complications across the country. Professional societies can have conflicting recommended practices, which contributes to the inconsistency of standardized endoscopy processing. Safe and comprehensive endoscope processing begins in the OR, where thorough understanding of these steps is imperative not just for the end user or reprocessing personnel but also for management and support team members. During my session, I will discuss the risks, benefits, and consequences of some of the fundamental endoscope processing options. AORN Journal: How can nurses of all levels (staff, educator, leader) demonstrate excellence in endoscope processing? Thomas: Excellence begins with nurses who are informed about the appropriate and safe mix of personnel, equipment, time, and supplies required when caring for patients undergoing flexible endoscopy. Creating a culture that is supportive of these elements is the responsibility of all perioperative team members. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice setting? Thomas: What is often perceived as a simple and noninvasive procedure can have significant and dire consequences in this day and age of “superbugs.” I will discuss safety, effectiveness, quality, and risk mitigation related to endoscopy procedures. I will also outline potential business metrics, discuss how to prioritize training of AORN Journal j 15
January 2015 Vol 101 No 1
personnel, identify expectations for accreditation readiness, and describe process validations. Furthermore, to ensure that nurses have tools to implement
EXPO SPEAKER INTERVIEWS in practice, I will provide examples to demonstrate how attendees can perform a self-evaluation of their specific endoscopy environments of care.
Excellence in opioid safetydKenneth Rothfield, MD, MBA; Lynn Razzano, MSN, RN, ONCC; Amy Ketchum, MS, RN, OCNS-C
During the past two years, the media have reported tragedies associated with patients undergoing routine procedures without appropriate opioid monitoring, resulting in progressive respiratory depression and, in some instances, death. Continuous Lynn Razzano electronic monitoringdin particular, pulse oximetry and capnographydhas been underused in patients receiving opioids for pain relief. During the session “Excellence in Opioid Safety: A Partnership to Reduce Harm,” Dr Kenneth Rothfield, Lynn Razzano, and Amy Ketchum will discuss a comprehensive approach to consistent screening and continuous monitoring of patients who receive opioids for pain relief, especially patients who are opioid naive (ie, have had little or no exposure to opioids), have obstructive sleep apnea or preexisting respiratory syndromes, or are very young, adolescent, or elderly. Dr Rothfield is chairman of the department of anesthesiology at Saint Agnes Hospital and an adjunct associate professor in the department of organizational systems and adult health at the University of Maryland School of Nursing in Baltimore, Maryland. Razzano is a clinical nurse consultant for Physician Patient Alliance for Health and Safety in Chicago, Illinois. Ketchum is a clinical nurse specialist at Midwest Orthopedic Specialty Hospital in Franklin, Wisconsin.
16 j AORN Journal
AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2015? Razzano: Reports of pediatric opioid overdose are increasing, and The Joint Commission is talking about opioid safety and alarm fatigue (ie, shutting off or turning down alarms to avoid hearing them all the time) and asking facilities to create a welldefined alarm management process to comply with 2015 accreditation requirements. During the past two years, facilities have addressed this issue by focusing on the safe administration of opioids through the use of pulse oximetry and capnography for all patients to prevent overdose and its consequences. AORN Journal: Why would you recommend that conference attendees come to your session? Razzano: This is a critical clinical topic that is seen in everyday practice. Inadequate monitoring of these patients can occur for many reasons (eg, alarms being turned down or shut off because of alarm fatigue, lack of awareness about the effects of opioid administration). My co-presenters and I will take attendees through a deep dive into opioid risks and safety by reviewing current statistics about the occurrence of opioid overdose and the need to incorporate continuous monitoring for all patients who are prescribed opioids postoperatively for pain control. In addition, we will explore the audience’s current practice of assessing patients before administering opioids and discuss how to
EXPO SPEAKER INTERVIEWS
www.aornjournal.org
perform safe continuous electronic monitoring with patient-specific parameters.
patients most at risk for opioid-related respiratory events.
AORN Journal: How can nurses of all levels (staff, educator, leader) demonstrate excellence in opioid safety?
AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice setting?
Razzano: This topic applies to the staff nurse who, in this hands-on patient care role, is best able to fully assess a patient who will be receiving opioids and to document the patient’s baseline risk of respiratory compromise status. The nurse’s initiation of continuous electronic monitoring before administration of the opioid and use of clear hand-over communication are crucial. The staff nurse establishes excellence in harm prevention and promotes opioid safety. Staff educators develop the competencies, skill sets, and requirements needed to educate nurses and others in the correct application of continuous electronic monitoring. This education includes engaging and teaching patients about why it is important to wear the monitoring equipment and what the alarms or signs and symptoms mean for patients and the clinicians providing their care. Ongoing teaching is critical to empowering patients to speak up. Nurse educators can provide this education to staff nurses and leaders as well as nurse managers who can then educate patients. Nurse leaders and managers should be mentors who are able to demonstrate best practice models in opioid safety. This includes identifying how to recognize increasing sedation and respiratory distress triggers that would elicit an earlier response time and creating patient-specific, age-related competencies to enable team members to identify
Razzano: Our intent is to enable attendees to save patients’ lives and prevent respiratory compromise. This topic is critical to perioperative nurses because they must have an intricate knowledge and understanding of the consequences and potential hazards of opioids regardless of the route of administration. A focus of our presentation will be on the use of patient-controlled analgesia, and we will share several tools and insights that nurses will be able to implement: n
a checklist for safe administration of opioids, how to use PDSA (plan, do, study, act) cycles, n how to safely administer patient-controlled analgesia and sleep apnea checklists so they become a consistent reality in the practice setting, n how to ensure proper ordering of continuous electronic monitoring for the patient receiving opioids, and n how and why to incorporate daily opioid safety rounds and an interdisciplinary alarm management committee. n
Our presentation will also provide insights regarding potential missed care events. Editor’s note: TeamSTEPPS is a registered trademark of the Agency for Healthcare Research and Quality, Rockville, MD.
AORN Journal j 17
E
ach year, AORN strives to provide the very best in perioperative nursing education at its annual meeting. The Surgical Conference & Expo 2015 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 2015 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. Additional speaker interviews will be published in the February issue of the AORN Journal.
Leading and championing changedKevin Eikenberry
Every day, nurse leaders face the challenge of leading change efforts in their facility, with perioperative teams, and in one-on-one situations. In his interactive session “Change Happens! Understanding, Leading, and Championing Change,” Kevin Kevin Eikenberry Eikenberry will discuss the drivers and resistors of change. Contrary to popular belief, Eikenberry suggests that teams do not resist changedindividuals resist being changed. Eikenberry is chief potential officer of The Kevin Eikenberry Group, a leadership and learning consulting company dedicated to helping organizations, teams, and individuals reach their potential. He is also the creator and content developer of “The Remarkable Leadership Learning System,” a continual leadership development process focused on developing the competencies of remarkable leaders worldwide. As a leadership expert, two-time best-selling author, speaker, consultant, and trainer, Eikenberry’s philosophy in
business and in life is that every person and every organization has extraordinary potential. AORN Journal: How did you become interested in the issue you will be presenting at the OR Executive Summit (ORES) of the AORN Surgical Conference & Expo 2015? Eikenberry: I’ve been studying the dynamics of organizational and personal change for more than 20 years. I’ve looked at it through many lensesdas a coach to leaders, a consultant to leaders and leadership teams trying to create a variety of organizational changes, a writer of change and leadership topics, a leader of my growing team, and a human. Change is a fascinating topic, and the more I learn about how and why people change, the more fascinated and the more effective I become as a leader. Effectiveness aside, the fact that the rate of change continues to accelerate makes this topic an important one for us as individuals and for the hospitals and organizations we work in. AORN Journal: Why would you recommend that ORES attendees come to your session?
http://dx.doi.org/10.1016/j.aorn.2014.10.021
12 j AORN Journal January 2015 Vol 101 No 1
Ó AORN, Inc, 2015
EXPO SPEAKER INTERVIEWS Eikenberry: they are
I hope attendees will join me if
n
dealing with personal change, leading groups through changes, n responding to a request to implement three more changes right about the time the first change is starting to gel, or n sensing their team’sdor their owndoverload and frustration. n
If any of these experiences are true for ORES nurse leaders, then the hour we spend together will be one of the best of the entire conference. During my session, I will provide real-life tools and approaches to understanding and dealing with these challenges. AORN Journal: How can OR nurse leaders demonstrate excellence in leading change efforts? Eikenberry: This is a great question. The answer is more complex than this interview format permits, but in short, when OR nurse leaders can truly
www.aornjournal.org
understand and articulate the purpose and reason for change, they improve their ability to inspire their team members to commit to the work required to succeed with that change effort. It may sometimes be difficult for OR nurse leaders to lift their head above the chaos of the current work moment, but our nurse leaders must be able to do just that, especially in times of change. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice setting? Eikenberry: I don’t want to say too much here, because I want everyone to join me! I will say this: in the 60 minutes that I have with attendees, they will learn how to implement change more effectively and help their teams deal with the increasing rate of change in the perioperative setting. Leading change is one of the most important roles that OR nurse leaders can play if they are to support the needs of the organization, their personnel, and ultimately the patients. I look forward to working with everyone who joins me.
Success in complex cardiac caredAngela B. Rowden, MSN, RN, CGRN; Eric R. Skipper, MD, FACS; Jill Spence, BSN, RN
Providing cardiac care has become increasingly complex as a result of rapidly changing technology that requires surgical teams to continually adapt to new procedures. Facilities are faced with the challenge of educating all members of the cardiac Angela B. Rowden surgery team about the evolving needs of cardiac care as well as orienting new members of the team. At the same time, surgical teams are expected to provide high-quality
care and improve patient outcomes. During the session “Complex Cardiac Care: Preparing the Team for Patient Success,” Angela B. Rowden, Dr Eric R. Skipper, and Jill Spence will share methods they have instituted to make it easier to keep up with new technologies and demands. These presenters are part of a team of perioperative cardiac care providers who will describe the changes they made in educating team members, validating their competencies, and improving care of patients undergoing cardiac surgery Rowden is manager of cardiovascular perioperative services at Carolinas HealthCare System in Charlotte, North Carolina, and Dr Skipper is
AORN Journal j 13
January 2015 Vol 101 No 1
chief of adult cardiothoracic surgery and Spence is clinical supervisor of cardiovascular perioperative services at Carolinas Medical CentereSanger Heart and Vascular Institute in Charlotte, North Carolina. These presenters share the belief that with the right education, training, and orientation, current competencies of cardiovascular team members can be maintained and new team members can be added successfully. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2015? Rowden: We became interested in presenting when we realized that we shared a passion and interest in innovative cardiac technologies. Our team had to solve the problem of training and maintaining competencies of team members faced with the challenge of learning and providing new and complex cardiac care. Changes made to our methods of education and implementation of new technologies have led to increased rates of heart transplant survival and decreased rates of mortality and morbidity. Our team continues to witness the significant positive effects of new technologies that expand our cardiac services and add to the quality of life of our patients. The team is proud of the care they provide, and we wanted to share our success and lessons learned with a larger audience. AORN Journal: Why would you recommend that conference attendees come to your session? Rowden: We believe that a multidisciplinary focus on patient care is imperative to providing the excellent outcomes that we are seeing. Beginning in the office setting, where the patients are first seen, and moving through the planning and
14 j AORN Journal
EXPO SPEAKER INTERVIEWS implementation of perioperative care, many hands and minds touch the patient. We have learned that a well-planned course of care makes a difference, and we believe that attendees will benefit from the insights we share. AORN Journal: How can nurses of all levels (staff, educator, leader) demonstrate excellence in complex cardiac care? Rowden: Attendees in every nurse role can listen and take ideas for best practices back to their institutions. Leaders can use the information to inspire their teams to strive to provide cardiac care that incorporates our suggestions, nurse educators can apply this information to their teaching methods, and staff RNs can use the information to better plan the care they provide to patients undergoing cardiac procedures. All nurses can help one another share in the passion of owning their individual practices and yet working collaboratively as a team. This allows all team members to feel the excitement of providing complex cardiac care resulting in excellent outcomes. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice setting? Rowden: We will share tools that we have implemented to improve methods of education to learn new procedures. One example is an endovascular code rupture algorithm for aortic dissections. We will also present several strategiesd some related to hands-on skills labs and TeamSTEPPSÒ trainingdthat attendees can use for process improvement in perioperative care and for sustaining high-performing teams that must keep pace with innovative technology and advances in complex patient care.
EXPO SPEAKER INTERVIEWS
www.aornjournal.org
Flexible scopes, rigid rulesdLynne A. Thomas, BSN, RN, CGRN, CFER
Managing protocols for the use and care of flexible endoscopes presents several challenges for perioperative personnel. During the session “Flexible Scopes, Rigid Rules,” Lynne A. Thomas will explain that the responsibility for care, traceLynne A. Thomas ability, and maintenance of flexible endoscopes involves multifaceted, fragmented, and often confusing processes. This session will demystify some of the decontamination, disinfection, and sterilization issues surrounding these complex surgical devices. Thomas has worked for more than 30 years in endoscopy nursing and is vice president of education, regulation, and compliance at Integrated Medical Systems, a division of the STERIS Corporation, in Birmingham, Alabama. She is the past president of the American Board for Certification of Gastroenterology Nurses, formerly known as the Certification Board for Gastrointestinal Nurses and Associates. AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2015? Thomas: I am a long-time active advocate for safe patient outcomes that stem from endoscopic devices and their cycle of use. In that capacity, I sit on the American Association for Medical Instrumentation working group responsible for developing a standard for flexible endoscope user groups. AORN Journal: Why would you recommend that conference attendees come to your session? Thomas: Flexible endoscopes have a complex design that makes them difficult to clean and
reprocess while maintaining their functional working order. The cause, effect, and prevention of issues related to these devices in regard to patient safety have been variable. Breaches in the cycleof-use and postuse care processes have led to patient-related complications across the country. Professional societies can have conflicting recommended practices, which contributes to the inconsistency of standardized endoscopy processing. Safe and comprehensive endoscope processing begins in the OR, where thorough understanding of these steps is imperative not just for the end user or reprocessing personnel but also for management and support team members. During my session, I will discuss the risks, benefits, and consequences of some of the fundamental endoscope processing options. AORN Journal: How can nurses of all levels (staff, educator, leader) demonstrate excellence in endoscope processing? Thomas: Excellence begins with nurses who are informed about the appropriate and safe mix of personnel, equipment, time, and supplies required when caring for patients undergoing flexible endoscopy. Creating a culture that is supportive of these elements is the responsibility of all perioperative team members. AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice setting? Thomas: What is often perceived as a simple and noninvasive procedure can have significant and dire consequences in this day and age of “superbugs.” I will discuss safety, effectiveness, quality, and risk mitigation related to endoscopy procedures. I will also outline potential business metrics, discuss how to prioritize training of AORN Journal j 15
January 2015 Vol 101 No 1
personnel, identify expectations for accreditation readiness, and describe process validations. Furthermore, to ensure that nurses have tools to implement
EXPO SPEAKER INTERVIEWS in practice, I will provide examples to demonstrate how attendees can perform a self-evaluation of their specific endoscopy environments of care.
Excellence in opioid safetydKenneth Rothfield, MD, MBA; Lynn Razzano, MSN, RN, ONCC; Amy Ketchum, MS, RN, OCNS-C
During the past two years, the media have reported tragedies associated with patients undergoing routine procedures without appropriate opioid monitoring, resulting in progressive respiratory depression and, in some instances, death. Continuous Lynn Razzano electronic monitoringdin particular, pulse oximetry and capnographydhas been underused in patients receiving opioids for pain relief. During the session “Excellence in Opioid Safety: A Partnership to Reduce Harm,” Dr Kenneth Rothfield, Lynn Razzano, and Amy Ketchum will discuss a comprehensive approach to consistent screening and continuous monitoring of patients who receive opioids for pain relief, especially patients who are opioid naive (ie, have had little or no exposure to opioids), have obstructive sleep apnea or preexisting respiratory syndromes, or are very young, adolescent, or elderly. Dr Rothfield is chairman of the department of anesthesiology at Saint Agnes Hospital and an adjunct associate professor in the department of organizational systems and adult health at the University of Maryland School of Nursing in Baltimore, Maryland. Razzano is a clinical nurse consultant for Physician Patient Alliance for Health and Safety in Chicago, Illinois. Ketchum is a clinical nurse specialist at Midwest Orthopedic Specialty Hospital in Franklin, Wisconsin.
16 j AORN Journal
AORN Journal: How did you become interested in the issue you will be presenting at the AORN Surgical Conference & Expo 2015? Razzano: Reports of pediatric opioid overdose are increasing, and The Joint Commission is talking about opioid safety and alarm fatigue (ie, shutting off or turning down alarms to avoid hearing them all the time) and asking facilities to create a welldefined alarm management process to comply with 2015 accreditation requirements. During the past two years, facilities have addressed this issue by focusing on the safe administration of opioids through the use of pulse oximetry and capnography for all patients to prevent overdose and its consequences. AORN Journal: Why would you recommend that conference attendees come to your session? Razzano: This is a critical clinical topic that is seen in everyday practice. Inadequate monitoring of these patients can occur for many reasons (eg, alarms being turned down or shut off because of alarm fatigue, lack of awareness about the effects of opioid administration). My co-presenters and I will take attendees through a deep dive into opioid risks and safety by reviewing current statistics about the occurrence of opioid overdose and the need to incorporate continuous monitoring for all patients who are prescribed opioids postoperatively for pain control. In addition, we will explore the audience’s current practice of assessing patients before administering opioids and discuss how to
EXPO SPEAKER INTERVIEWS
www.aornjournal.org
perform safe continuous electronic monitoring with patient-specific parameters.
patients most at risk for opioid-related respiratory events.
AORN Journal: How can nurses of all levels (staff, educator, leader) demonstrate excellence in opioid safety?
AORN Journal: What tools or insights will attendees leave your session with that they can implement in their practice setting?
Razzano: This topic applies to the staff nurse who, in this hands-on patient care role, is best able to fully assess a patient who will be receiving opioids and to document the patient’s baseline risk of respiratory compromise status. The nurse’s initiation of continuous electronic monitoring before administration of the opioid and use of clear hand-over communication are crucial. The staff nurse establishes excellence in harm prevention and promotes opioid safety. Staff educators develop the competencies, skill sets, and requirements needed to educate nurses and others in the correct application of continuous electronic monitoring. This education includes engaging and teaching patients about why it is important to wear the monitoring equipment and what the alarms or signs and symptoms mean for patients and the clinicians providing their care. Ongoing teaching is critical to empowering patients to speak up. Nurse educators can provide this education to staff nurses and leaders as well as nurse managers who can then educate patients. Nurse leaders and managers should be mentors who are able to demonstrate best practice models in opioid safety. This includes identifying how to recognize increasing sedation and respiratory distress triggers that would elicit an earlier response time and creating patient-specific, age-related competencies to enable team members to identify
Razzano: Our intent is to enable attendees to save patients’ lives and prevent respiratory compromise. This topic is critical to perioperative nurses because they must have an intricate knowledge and understanding of the consequences and potential hazards of opioids regardless of the route of administration. A focus of our presentation will be on the use of patient-controlled analgesia, and we will share several tools and insights that nurses will be able to implement: n
a checklist for safe administration of opioids, how to use PDSA (plan, do, study, act) cycles, n how to safely administer patient-controlled analgesia and sleep apnea checklists so they become a consistent reality in the practice setting, n how to ensure proper ordering of continuous electronic monitoring for the patient receiving opioids, and n how and why to incorporate daily opioid safety rounds and an interdisciplinary alarm management committee. n
Our presentation will also provide insights regarding potential missed care events. Editor’s note: TeamSTEPPS is a registered trademark of the Agency for Healthcare Research and Quality, Rockville, MD.
AORN Journal j 17
