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Outpatient Surgery E-Weekly

OR Excellence Pre-Registration Ends Wednesday

This Wednesday, Sept. 1, is your last chance to participate in Outpatient Surgery Magazine's OR Excellence 2010 Pre-Registration Contest. There's no...

Researchers Predict Anesthesiologist Shortage, CRNA Surplus

A recent analysis of the anesthesia labor market speculates that a current shortfall of providers across the surgical industry could widen in the ne...

A Change of Mind: Anesthesia, Consciousness and the Brain

The brain works through different processes as it transitions between conscious and unconscious states, a finding that bucks commonly held assumptio...

Outpatient Surgery E-Weekly June 9th, 2009

THIS WEEK'S ARTICLES

OR Excellence's Early Bird Prize Winners
Colorado Nurse Indicted for Pain Med Theft
Nevada GI Clinic Sues Anesthesiologist Over Closing
Researchers Rate Eye Protection for Ortho Surgery

NEWS & NOTES

Tip of the week
Communication for efficiency, safety
When morphine causes pain
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LAST WEEK'S E-WEEKLY ARTICLES

New Superbug From India May Go Global
The Case for Admitting Medical Errors
New Implant Coating Prolongs Joint Replacements
InstaPoll: Where Would You Go for Surgery?
News & Notes
OR Excellence's Early Bird Prize Winners

Sheila Tesiny, RN, will enjoy OR Excellence in style. Ms. Tesiny, the outpatient surgery charge nurse at Henry Mayo Newhall Memorial Hospital in Valencia, Calif., won the grand prize in our early bird drawing.

Ms. Tesiny won a free stay in one of the San Francisco Hilton's luxury suites for up to 5 nights during the 1st annual OR Excellence Conference and Exhibits, sponsored by Outpatient Surgery Magazine, to be held in the hotel from Sept. 30 to Oct. 2.

We awarded 2 second prizes, dinner for 2 at the outstanding Le Colonial restaurant, to Jane Klinglesmith, RN, BS, CNOR, of the Rocky Mountain Surgery Center in Englewood, Colo., and to Amy Fox, RN, of the Advanced Eye Surgery Center in Chico, Calif.

Five third prizes, $50 Union Square shopping sprees, went to Sarah McKeever, RN, of Ortmann Healthcare Consultants in Mount Pleasant, S.C.; Carri Balk, RN, of Walla Walla Clinic ASC in Walla Walla, Wash.; Jeannie Beede, RN, of Riverside Park Surgicenter in Jacksonville, Fla.; Greg Noethen, RN, of Parkwest Surgery Center in Knoxville, Tenn.; and Shari Laurion, RN, MS, CNOR, of Speare Memorial Hospital in Plymouth, N.H.

Dan O'Connor

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August 17th E-WEEKLY

Splitting the Dose Improves Bowel Prep Results
First U.S. Natural Orifice Stomach Reduction
Protein May Aid In Joint Repair
InstaPoll: Have You Ever Used a Single-Dose Vial More Than Once?
News & Notes
Colorado Nurse Indicted for Pain Med Theft

Surgical nurse Ashton Paul Daigle has been indicted by a federal grand jury for stealing fentanyl from Boulder Community Hospital in Denver and diverting the pain medication from as many as 350 patients. He faces 108 counts of tampering with a consumer product, 67 counts of creating a counterfeit controlled substance and possibly 70 years in prison.

Mr. Daigle, who is scheduled for sentencing on Oct. 26, obtained the fentanyl by accessing a Pyxis automated medication-dispensing unit at least 108 times between Sept. 24 and Oct. 24, 2008, according to the indictment. He removed safety seals on drug vials and used syringes to take the fentanyl before replacing the drug with a sterile saline solution. The hospital began its investigation when anesthesia providers noticed that surgery patients were reacting as if they had not received any pain medication.

Hospital officials say Mr. Daigle manipulated the facility's antiquated Pyxis dispensers in the surgical department before a facility-wide system upgrade was completed. The systems currently in place at Boulder feature dispensing drawers that allow access to only the exact number of vials requested, and any unused or unopened vials must be placed in a return bin accessed only by the hospital's pharmacy staff, who can now run detailed reports that identify individuals who withdraw unusual amounts of drugs, overuse certain functions of the system or fail to properly check in drugs.

According to Boulder Community Hospital, Mr. Daigle used the needles with which he injected himself to remove and replace the contents of the fentanyl vials. The hospital notified surgery patients who were prescribed fentanyl of the risk for infection, even though Mr. Daigle has tested negative multiple times for HIV and hepatitis B and C.

Daniel Cook

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August 10th E-WEEKLY

How Have You Managed Patient Safety Scenarios?
Pre-Screening for Staph Reduces Ortho SSIs
FDA Proposes Stricter Standards for Device Approval
InstaPoll: When Do You Use Surgical Glue?
News & Notes
Nevada GI Clinic Sues Anesthesiologist Over Closing

A Las Vegas endoscopy center that had its license revoked for unsafe infection control practices is suing the anesthesiologist whom health inspectors cited for reusing syringes and single-dose propofol vials.

The Gastrointestinal Diagnostic Clinic's lawsuit claims that Scott Young, DO, is responsible for the clinic's revoked license, which put it out of business, according to a news report.

The clinic, owned by Luis Tupac, MD, Uday Saraiya, MD, and Enrique Lacayo, MD, was profitable until Clark County health inspectors visited it in February 2008. The inspection was a reaction to the hepatitis C scare that began at another Las Vegas GI center, the Endoscopy Center of Southern Nevada, whose unsafe practices led to a call for more than 50,000 patients to be tested for hepatitis C and HIV. More than 105 cases of hepatitis C have been traced to the Las Vegas clinics owned by Dipak Desai, MD, according to the Southern Nevada District Board of Health.

The Gastrointestinal Diagnostic Clinic, which is not connected to Dr. Desai, is suing Dr. Young and PBS Anesthesia, the firm that employed him at the time, for lost income and damages after the clinic was shut down on March 2008.

Dr. Young entered into a settlement agreement in October 2008 with the Nevada State Board of Osteopathic Medicine that required him to complete infection prevention courses and supply a list of all the patients he treated at the clinic.

Kent Steinriede

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August 3rd E-WEEKLY

Virtual Colonoscopy Lacks Cost Effectiveness, Say Researchers
Study Touts Smaller, Rural Hospitals' Safety
1 in 5 Joint Replacement Patients Lose Weight
InstaPoll: When Do You Test Your Reprocessing Agent?
News & Notes
Researchers Rate Eye Protection for Ortho Surgery

Modern prescription eyeglasses offer minimal protection against splashed debris during orthopedic procedures and should not be considered protective eyewear, according to a study published in the May issue of the Journal of Bone and Joint Surgery.

Researchers at Vanderbilt University Medical Center in Nashville, Tenn., used a mannequin head to measure eye exposure to splashed contamination during a femoral osteotomy performed on a cadaver thigh to compare the level of protection offered by modern prescription glasses, standard surgical telescopic loupes, hard plastic contoured glasses, disposable plastic glasses, a combination face mask and eye shield and no eyewear (as a control group).

They discovered that none of the eye protection options were completely effective. The prescription glasses and the control group saw the highest contamination rates (83%). Other forms of protection proved to be more effective: 50% for the loupes, 30% for the face mask and eye shield, 17% for the hard plastic glasses and 3% for the disposable plastic glasses.

"We did not expect the modern prescription glasses to offer such minimal protection," says head researcher Alfred A. Mansour III, MD, who adds that inexpensive, disposable plastic glasses offered far superior, yet still incomplete, protection and can be placed over most glasses to offer protection to surgeons and operating room personnel exposed to splashed debris.

"It doesn't take being involved in too many orthopedic procedures to realize the amount of splashed debris created from the instruments - oscillating saws, reamers, and others," explains Dr. Mansour. "Many surgeons believe that their own corrective glasses are sufficient to provide protection from splashed debris. We wanted to go beyond their personal opinions and try to place some scientific evidence behind their beliefs."

Daniel Cook

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July 27th E-WEEKLY

N.Y. Hepatitis Outbreaks Linked to Propofol Reuse
Cost Could Deter Patients From Colon Screenings
Athletes Benefit From Arthroscopic Hip Surgery
InstaPoll: Do You Check Your Work E-Mail on Vacation?
News & Notes
News & Notes
  • Tip of the week In an effort to improve its on-time starts, one Colorado surgery center appealed to its surgeons' competitive nature and posted an on-time start board in the hallway by their locker room. This scorecard lists each physician's on-time start percentage, compares them against the facility-wide rate and even times their tardiness. "Some docs are surprised to see how late they really were for a case," writes Sandy Beers, BSN, of the Surgery Center at Printers Park in Colorado Springs. A "We Made You Late" sheet holds staff accountable for on-time starts by listing the reasons OR personnel had delayed the surgeons.

  • Communication for efficiency, safety Clinical errors and medical supply waste are reduced when surgical teams huddle before cases to discuss potential disruptions to a case, according to research conducted at the Mayo Clinic in Rochester, Minn. In a report published in the June 2009 issue of the Journal of the American College of Surgeons, Mayo researchers employed real-time observations to determine the effects of pre-op briefings on intraoperative delays related to missing equipment, lack of procedural knowledge or staff miscommunication. They discovered that pre-op briefings dropped incidents of miscommunication by 53%. Although lack of effective communication never resulted in adverse events, the researchers noted that pre-op gatherings reduced total surgical flow disruptions, limited nurses' trips to the core supply area during surgery and decreased supply waste.

  • When morphine causes pain The paradoxical effect in which prolonged morphine use increases its user's sensitivity to pain may be the result of a drug metabolite of the opioid, according to a study published in the June issue of the journal Anesthesiology. The study, conducted by researchers at Leiden University Medical Center in the Netherlands and at the City University of New York on mice and human subjects, found that the metabolite (called morphine-6 glucuronide, or M6G) acted on pain receptors which were unrelated to the ones which morphine treats.
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    July 20th E-WEEKLY

    Physicians Reluctant to Tattle On Their Own
    Study Uncertain on Most Effective Fix for Rotator Cuffs
    Good News for ASCs Performing Office-Based Services
    InstaPoll: How Do You Keep Fluid Off the Floor?
    News & Notes