2002 AORN Congress in Anaheim, CA
April 21 - 25, 2002

49th AORN Congress News

AORN vs. ASPAN

Association of periOperative Registered Nurses (AORN) Congress
April 21 - 25, 2002 in Anaheim, CA
www.aorn.org/congress

American Society of Perianesthesia Nurses (ASPAN) Conference
April 28 - May 2, 2002 in San Diego, CA
www.aspan.org/PDFfiles/2002_Conf_Brochure.pdf

Attendance: AORN 6000+
ASPAN 1300

Exhibitors: AORN 5700+
ASPAN 100

Due to the larger number of conference attendees at AORN Congress, there was a wider choice of classes. I felt the variety of AORN classes encompassed the entire surgical services area compared to ASPAN. At the ASPAN conference, there were no classes related to intraoperative surgery. At AORN Congress, there were limited classes related to the recovery room. ASPAN offered three choices during the lecture times and some repeat classes like at AORN Congress. If you wanted to receive more credits in the evening, you could go to the video sessions. The video sessions were from previously taped seminars from around the country. There were three one-hour sessions and you could view one or all three. The sessions ran one after the other. Some examples of the ASPAN classes were "Complementary and Alternative Medicine: Assessing Patient Use and Risk," "The Changing Approaches to Breast Cancer Management," "Conscious Sedation," and "Pain Assessment." The focus of the classes was related to recovery phases I or II.

The keynote address and closing ceremony were similar to AORN Congress. But I felt the Opening Ceremony speaker at ASPAN was very inspiring. John Izzo, PhD, spoke about "Awakening the Soul of Our Work." Dr. Izzo's objectives were (1) identify personal values and how they impact professional role or position, (2) identify times in your work that were most fulfilling and energizing moments, (3) identify the higher purpose and the business purpose of your professional role, (4)
describe the "Four Paths" for facilitating spirit in your professional life and (5) identify the factors that produce a genuinely caring work environment. I enjoyed his lecture so much, I purchased a tape of his lecture ($8 instead of $9 at AORN Congress).

A newsletter came out everyday with updates. But the previous days were not available like at Congress. The updates were one page both sides. The bookstore was available only certain times of the day. The bookstore contained ASPAN, CAPA and CPAN pins, cups etc. At the end of the conference, you could purchase an ASPAN Foundation Dream Walk T-shirt, hostess polo shirt (by the way, the hostess polo shirt was complimentary), etc.

The ASPAN hostesses (volunteers) were notified a week before the conference what time they were supposed to work. The hostess meeting was on Saturday or Sunday evening, informing you where to sign in, where to pick up your free shirts, and what times still needed to be covered.

ASPAN had a silent auction which was located just outside the bookstore. They had about 40 - 50 items to be auctioned off. Bidding began on Monday and finished by Wednesday (noon). The items were brought by attendees. Various items were: a Hard Rock Cafe jacket, wine, Palm Pilot (which yours truly got), bags (just what I needed - I did not bid!), clock, and much more.

Both conferences had bags, a conference syllabus, name badge holders and evaluation forms. The ASPAN syllabus did not have page numbers on the bottom,
which made it more difficult to thumb through the syllabus to find
information regarding the class you wanted to take. The ASPAN shoulder bag was available on the first day of class. There were plenty of bags. The bags contained the syllabus, pain management book, evaluation form, etc. Completed evaluation forms were turned in at one time at the ASPAN conference instead of as each sheet was completed like at Congress.

Overall, I felt I learned more at AORN Congress due to the wide variety of
classes. I was far more impressed with the opening and closing speakers of ASPAN. I enjoyed the Silent Auction. Both conferences were well worth my time.

By Sandy Kim
(a true perioperative nurse working in the surgical admit/discharge area at Summit Medical Center in Oakland. Sandy is a member of AORN and ASPAN. Sandy now has enough contact hours and exhibitors’ bags to last a lifetime.)

Mentoring

The concern for the nursing shortage was present throughout Congress week. Recruitment and retention were referred to in the keynote address, discussed in the House of Delegates, and were the subjects of several posters and multiple sessions. We had the opportunity to view again the wonderful Johnson & Johnson recruitment video with the “Join the Ones Who Dare to Care” message that previewed during the Olympics. Yes, the shortage was on everyones’ minds.

And then of course, there were the possible solutions. From “grow your own periop nurse” programs to collegiate post-grad courses to orienting travelers. Everyone was talking about what they were doing to deal with the shortage.

Mentor Everyone!

Last year I was assigned to report on mentoring too. I reported on the passage of “AORN’s Statement on the Inclusion of Perioperative Learning Activities in Undergraduate Nursing Curricula” and the “Resolution on the Responsibility for Mentoring.” The latter is not only directed toward mentoring students, but also directs the perioperative nurse to seek opportunities to mentor other people interested in exploring perioperative nursing as a career, novice periop nurses, peers learning a new procedure or service, new charge nurses or managers, and emerging leaders.

Tone - Up!

Last year, the tone seemed more like planning to avert the anticipated shortage. It was as if “Yes, there is a shortage, and yes, we’ve been through this before.” This year, the tone was up several notches. There is not one OR that has enough staff! The revelation has come. Our facilities cannot hire more staff because there is nobody out there. We are now reacting to (and living with) the fact that we are in the midst of a critical shortage without an end in sight. What was evident this year, is that the shortage will not get better unless each one of us does something about it.

Mentoring = Surviving

It is in this context that mentoring becomes so very important. We must look upon mentoring as necessary for the survival of our specialty and our profession. In the most recent issue of the AORN Journal, Debra Fawcett wrote a wonderful article on mentoring, so I won’t reiterate the definition, characteristics, responsibilities, benefits or how-tos here. I do encourage you to read it, if you haven’t already.

What I will say is that every day, each and every one of us has an opportunity to make good on a promise we made, “to maintain and elevate the standard of our profession.”* Every time we are impatient or too busy to explain what we do or to encourage another, we are contributing to negativity. Every time we complain about the system without offering possible solutions or a willingness to try a proposed solution, we are discouraging others. With so many careers to choose from, who would possibly want to join, or stay with, a group of chronically complaining, over-worked individuals? Rather, let us remember why we became nurses. Let us pause and celebrate those times when we really made a difference, participate in professional development, share what we do, and be happy with who we have turned out to be. Remember, attitude is contagious. Would you want to catch yours? Resolutions about mentoring will not encourage people to try something new or to develop their full potential. Only individuals can do that. You can be that individual. You can make a difference. You can mentor.

*The Florence Nightingale Pledge

By Donna Benotti

Hot Topic - CJD

Exempla Saint Joseph Hospital, Denver, made national news in the spring of 2001 when it was revealed that six patients might have been exposed to the prion that causes Creutzfeld-Jakob Disease (CJD). The speakers for this program, Kathy Devlin, RN, BSN and Marcy Huss, RN, BSN, CNOR, shared the steps their facility took to analyze the occurrence, develop, and execute their action plan. Included in their presentation was an overview of prions with specific implications for neurosurgery, moral and ethical issues, and modifications made to instrument management.

CJD, a degenerative neurological disease, is among the four human prion diseases. Prions are not bacteria or viruses, but are malformed proteins that are able to cause the malformation to occur in new hosts. These agents contain no DNA or RNA and are resistant to most forms of sterilization. Extremely hardy, prions can survive even up to three years in a dry state.

Tissue Degrees

Tissues vary in their degree of infectivity depending on their prion content.
High infectivity: brain and cornea.
Medium: lymph, tonsil, lung, spleen, cerebral spinal fluid.
Low: organs, skin, body fluids.

This noted, when it came to light the Denver hospital had two patients with confirmed diagnoses of CJD, they knew they had a lot of detective work to do. Top priority was communication. Infection Control, Risk Management, Senior Leaders, and all periop staff were notified and kept in the loop throughout the entire process.

During the fact-finding mission, they looked at old schedules and found they had done 38 cases that could have used the instruments. Luckily, they had recently instituted an instrument tracking system, so they were able to identify six cases that had utilized the same instrument trays and peel packs. These instruments were removed from circulation and destroyed.

Experts were consulted. The Colorado Department of Health and Environment and of course the CDC and JCAHO.

I agree with the speakers that it was important to request staff to keep this as a confidential matter until identified patients had been notified. As with all sentinel events, questions were directed to Public Relations so that information was shared sensitively and without compromising patients’ rights. Even so, I’m sure the headline “Mad Cow Disease at Denver hospital” didn’t exactly quell hysteria.

Lessons Learned

St. Josephs now has a policy for suspected CJD cases. They quarantine all instruments until a definite diagnosis is obtained. They use disposables whenever possible, and discard instruments that contact brain tissue. Their instrument tracking system was worth its weight in gold. The speakers were very open to questions and willingly shared what they had learned in the hopes that others could avoid this experience.

Note: Those who attended our chapter’s March program on sterilization received the lasted information, from Kathie Shea, on processing instruments used on suspected CJD patients.

Thank you for the opportunity to represent the chapter at the 49th Congress. It is an exciting experience to see first hand how the Association works. I hope every member considers attending Congress as a delegate.

By Donna Benotti

The Awards Dinner April 20, 2002

The Awards Dinner was a great way to start the Congress week. The dinner was great and there was a lot of networking that took place. We were fortunate to have an old friend and past member of our chapter, Doris Porter, join us at our table.

Michelle Burke was the National Board member at our table. What a nice person she is. She is going to make an excellent Vice President.

The most exciting thing that took place at the awards dinner was our chapter won the newsletter award for the intermediate size chapter. This is the second time we have won this award and it is all due to Mary Ritchie who works very hard to bring us such an excellent newsletter. Thanks Mary.

Cynthia Spry received the Award for Excellence in Perioperative Nursing and Sister Gertrude O’Connor received the Outstanding Achievement in Perioperative Clinical Nursing Education Award. The award for Outstanding Achievement in Perioperative Nursing Management went to Deborah Alpers. The award for Outstanding Achievement in Perioperative Academic Nursing Education was awarded to Lauralie S. Krabell. The Outstanding Achievement in Mentorship was awarded to Florence T. Wilson.

The rest of the awards were as follows:

Chapter of the Year – Gold
Small – AORN of Southwest Louisiana
Medium – AORN of North Central Indiana
Intermediate – AORN of Dayton
Large – AORN Massachusetts Chapter 1

Chapter of the Year – Silver
Medium – AORN of Jefferson Parish
Intermediate – AORN of Omaha Area
Large – AORN of Pittsburgh

Chapter of the Year – Bronze
Medium – AORN of North Harris Montgomery County
Intermediate – AORN of New Orleans

Membership Awards
Small – AORN of Southwest Louisiana
Medium – AORN of North Central Indiana
Intermediate – AORN of New Orleans
Large – AORN of Greater Houston

Newsletter Awards
Small – AORN of Northlake Louisiana
Medium – AORN of the Foothills of North Carolina
Intermediate – AORN of New Orleans and AORN of Alameda County
Large – AORN of Massachusetts Chapter 1

Legislative Awards
Small – AORN of North lake Louisiana (1st)
AORN of Sandusky Area (2nd)
Medium – AORN of Central Indiana (1st)
AORN of Jefferson Parish (2nd)
Intermediate – AORN of Central Ohio (1st )
AORN of the Gulf Coast of Florida (2nd)
Large – AORN of Greater Houston (1st);
AORN of Massachusetts Chapter (2nd)

Chapter Research Awards
Small – AORN of Southwest Louisiana (1st)
AORN of Northlake Louisiana (2nd)
Medium – AORN of Chestmont (1st)
AORN of North Central Indiana (2nd)
Intermediate – AORN of Dayton (1st)
AORN of Omaha Area (2nd)
Large – AORN of Pittsburgh (1st)
AORN of Greater Kansas City Area (2nd)

Outstanding Achievement in Continuing Education
Small – AORN of Southwest Louisiana (1st)
AORN of Northlake Louisiana (2nd)
AORN of the Lower Eastern Shore (3rd)
Medium – AORN of Jefferson Parish (1st)
AORN of North Harris Montgomery County (2nd)
AORN of North Central Indiana (3rd)
Intermediate – AORN of Capital California (1st)
AORN of Omaha Area (2nd)
AORN of Mid Eastern Pennsylvania (3rd)
Large – AORN of Long Island New York (1st)
AORN of Massachusetts Chapter 1 (2nd)
AORN of Greater Cincinnati & Hamilton (3d)

As you can see the majority of the awards went to the East coast and the Mid-west, only two were from the West coast.

By Evelyn Steen

Congress - Overview

Congress 2002, in my opinion, was one of the best AORN has had in a long time. Anaheim is a great place. The majority of the hotels are within walking distance of the convention center, lots of places to eat and a great place for sight seeing.

Lively discussion took place in the House of Delegates and the Forum. There was much discussion on the issues of one member one vote, Past Presidents as delegates, the Golden Gavel and Specialty Assemblies given delegate status, also the extraordinary voter. These were all defeated. The one member one vote was referred back to the Board for further consideration and discussion.

The educational sessions were well diversified. There were sessions geared for both management and clinical interests. Last year our chapter did a research project working with the PNDS. When I saw that Dr. Susie Kleinbeck was speaking at a session about the Perioperative Nursing Data Set – second edition, I had to go to this session. The PNDS vocabulary has been updated to reflect changes in clinical practice and refinements in the term set. Clinical exemplars have been added that give clinicians, educators, managers, and researchers assistance in implementing the PNDS. These exemplars include documentation, care plans, critical pathways, competency assessments, performance appraisals, policies and procedures, job descriptions and educational programs for orientation. The outcome statements now include nursing diagnoses linked to each of them.

The California luncheon was great this year, good food and a terrific speaker. Tricia Hunter, former Assemblywoman to the California State Legislature, spoke to us about “Current Legislative Issues in California.”

There didn’t seem to be as many exhibitors this year, however there was still a large showing. We all came back with a wish list.

All work and no play makes for a boring time, so naturally we had to play. The Nurse/Exhibitors Night was at Disney’s California Adventure. What a great time we had. The park was opened exclusively for Congress attendees and their guests.

These were just some of the highlights of Congress. This is such a great place to network with nurses from all over the country, if you have never been you should really try to go. You will come home rejuvenated and ready to take on the everyday tasks.

By Evelyn Steen

Governance Task Force/One Member One Vote Update

The House of Delegates at Congress in Anaheim was a hot spot for sure this year. As some of you know, many issues were on the agenda. This article will follow up on some of those issues presented in the April 2002 issue of our newsletter.

The One Member One Vote (OMOV) task force recommended permitting all past presidents of the Association who attended Congress to serve as delegates. One big reason for this was to utilize their expertise in the decision making process of AORN. In addition, they recommended the Golden Gavel would have representatives in the House of Delegates (HOD). They didn’t stop there. It was proposed a group of Extraordinary Voters be established as well. All these proposals were withdrawn when it became clear the delegates in the HOD was not in support of any of them. However, they did not withdraw the motion to have representatives from the Specialty Assemblies (two from each) in the HOD. This issue came to a vote and was not favored by the majority. Some of the discussion on this issue concerned the fact that the Specialty Assemblies were created as a medium for people to network within their specialty. It was felt that if people wanted to be delegates, they should be active in their respective chapters. So what about the actual issue of One Member One Vote? Well, the HOD decided against that too. Since there is no actual data on whether OMOV would draw a large number of voters (remember that the Association has approximately 40,000 members, and less than 1% of the membership responded to the survey asking them about the OMOV issue), and if the so called “disenfranchised members” would feel as if they were a part of the Association, the HOD remained unconvinced of the need to change the current system of voting.

One issue which passed was the replacement of standing committees with task forces/committees on an “as needed” basis. The hope is that this will allow more flexibility to maximize volunteer opportunities and the ability to respond to issues in a timely manner. Another issue which was successful in passing was the establishment of a mechanism for the HOD to act between Congresses. It is a bit complicated, but the delegates will be voting by proxy, a Board of Directors meeting will be called and the vote will become official at this meeting. This year-round HOD is supposed to allow the Association to act upon pressing issues quickly.

The Governance Task Force (GTF) has been busy as well. Remember their charge was to “guide AORN through the process and to make recommendations regarding the best governance structure and functionality for AORN.” They recognize members’ needs are changing. There is a great concern about member representation. With five generations of nurses in the membership, it is important to ensure their needs are met. AORN is addressing this in various ways. How can AORN remain viable during times which are rapidly changing? What can we improve? Part of what the GTF did was to create the OMOV task force to look at the issues presented above. The GTF also looks at the bigger picture. What are our strengths and weaknesses? Is there a need to restructure the HOD (this did not happen this year, but I am certain that the issue will be revisited in the future)? The GTF will continue their work this year and make further recommendations regarding the governance of the Association. Remember, this is your organization. Your input is important, and members of the national board want to hear from you.
   
By Sophie Taylor

President’s Report and Congress Report

Dear distinguished colleagues,

It was a pleasure serving you at Congress in Anaheim this year. The arrangements were excellent, and classes were, for the most part, very interesting. The House of Delegates and the Forums were rather chaotic, and we debated some very important issues which I will talk about more in my Congress report.

Congratulations to Mary Ritchie (our newsletter goddess) for the AORN Chapter Newsletter Award for Intermediate-sized chapters! Mary works really hard at editing our newsletter (thank you so much!). The important thing about our newsletter is that it is of a consistently high quality. To keep this quality up, articles are encouraged from the membership.

AORN did a couple of things differently this year, which in my opinion were very innovative and forward thinking. They let student members attend Congress for free. This allowed one of our newest members, Jackie Cummings, to participate and discover what a fantastic organization we have! 

Another new feature was Part I of a two-part leadership seminar (the second will be in Denver this summer). “Nuts and Bolts of Chapter Leadership” was presented by Louis Benson, PhD. The speaker had some concrete ideas for how to conduct meetings, recruit new members, and strategic planning. All this gave me some ideas for what to do in the future. We have to focus our precious energy in a couple of areas. Increasing membership will be at the forefront. Continuing to provide excellent educational sessions at the chapter meetings will also be a priority, as well as keeping current with the developments in the legislative arena. In the fall, I hope to kick off a membership drive. If everyone can bring one person to the September meeting, we would be off to a great start! I would like everyone to sign up as a membership ambassador. Let’s challenge ourselves to bring our chapter membership up to 200! For this to succeed, everyone has to help. Our chapter has a large number of RNs who will be retiring in the next few years. Ask yourselves what makes it hard for you to attend, and if there is anything we can do to help alleviate that.

The nursing shortage and overtime hours makes it hard for tired nurses to volunteer time. Some people have children who need their attention. Would child care during the meeting time be helpful to any of you? Let me know so that we can arrange for a baby sitter. 

Times are changing, and we need to be proactive in order to thrive. We can make it happen, help it happen, and watch it happen!

By Sophie Taylor

Get A Life!

Amanda Gore is a motivational speaker from Australia and she spoke to us on April 23. She was hilarious! She first appeared on stage wearing a wrapped shawl which looked a bit odd. It all became clear once she launched into her folksy talk about the stress from September 11, 2001 and how nervous she’d been. She was in downtown Seattle when she saw an airplane headed straight for a tall glass-encased building. She was terrified. She didn’t know the Seattle airport was one minute away from downtown! The plane was on a normal landing approach! She was fed up with being so ruffled about 9/11 so she bought a “ruffled” shirt to get over it - and to help boost the economy. She whipped off her shawl and the auditorium burst into laughter. The shoulders of her shirt were covered in yellow feathers! And she seemed to derive great enjoyment from those feathers! That “ruffle my feathers” shirt helped her deal with her 9/11 stress in a timely manner. Eighteen months to two years after a major stress is when one gets a stress-related disease. Deal with stress when it happens. Send love to others - it’ll boost both your immune systems.

I’m not a big fan of motivational speakers (I’m cynical). Amanda Gore is an exception. She was so fabulous that a month later, I’m sitting here grinning like a fool looking over my notes and remembering her presentation. She gave the entire presentation wearing Tigger ears. She said you have to do things to generate joy (or similar wording since I was laughing too hard to take notes at that point in her talk). She had a “magic” wand that she waved around and said everyone should have one (she got hers at Target). The Tigger ears (purchased at Disneyland) were for joy givers and there were Eyore ears (also purchased at Disneyland) for joy takers. She recommended everyone take some back home to share with people at work. So here was this motivational speaker wearing a yellow feathered shirt and wearing Tigger ears throughout her one and one-half hour presentation. She waved her arms around a lot and pointed out you shouldn’t do that if you want men to listen to you. She stood like a wooden soldier and spoke in a deep monotone and said that was how to get a man’s attention.

She has four “rules” that are: let go, laugh, love, learn. To keep a strong, healthy heart, you must have a strong sense of purpose and faith; feel happy; and have a strong sense of belonging. The number one predictor of heart problems is an angry, hostile personality. Let go of “stuff.” She liked to send love by saying, “Zoot, zoot, zoot” and moving a finger from her heart to another person’s heart. Zoot, zoot, zoot to you all!

By Mary Ritchie

We Won!

AORN of Alameda County tied AORN of New Orleans for the Intermediate-sized chapter newsletter award. Hooray! We also won the award in 1998. Look for a group photo of the newsletter award winners in the post-Congress Journal.

Thank you to all the members who generously contribute your time and energy to writing articles and reports for the newsletter. I honestly believe a newsletter is only as good as its content. Our newsletter has great content thanks to you members and officers. Keep writing! Thank you to all of you! And thank you to all our advertisers/supporters for making the newsletter a financial success.

By Mary Ritchie

All Kinds of Bugs

I attended an excellent presentation April 24 at 1745 titled “Breaking the Chain of Infection in the OR” by Susan Renee Guerra and Mary Lynne Weemering. I have a special affection for infection control (someone has to love it!) and this presentation didn’t disappoint me. It was great. Here are a few highlights:

E-coli Burger Special

It was discovered in the United Kingdom there was survival of enterococcal bacteria after laundering with a 30 minute wash cycle at 85 degrees C (185 degrees F)! Three strains survived. They still can’t say laundry can infect patients because the possibility is so low. E-coli is the top hospital-acquired pathogen in adults. As few as 50 organisms can cause disease. E-coli is transmitted person to person, by environmental contamination, or by contaminated food. E-coli will remain active for 15 days in contaminated food! Susan Renee Guerra is a vegetarian and she interspersed her presentation with numerous inducements to forego meat. After hearing all about E-coli, I was ready to become a vegetarian (Well - more like a non-meat eater who eats lots of junk food instead!). E-coli was in 29% of meat samples from Federally inspected meat-packing houses. E-coli was in 24% of meat samples from our grocery store shelves. I had vegetarian pizza for dinner that night! I’m back to E-coli burgers but they’re well done!

Botulism

Botulism is more toxic than Sarin nerve gas (the poison that was released in the Tokyo subway a few years ago). It’s the most toxic substance known.

Smallpox

Smallpox is “small sacks.” It used to be “small pokes” as in “a pig in a poke” which means a pig in a bag or sack. (I love language/word origins!) Great pokes (sacks) is syphilis. There is no cure for smallpox. Patients must be kept in respiratory isolation and care providers must wear N95 respirator masks. Smallpox is the most serious biothreat.

Anthrax

Anthrax is acquired in three ways - cutaneous, inhalation, and GI.

Hepatitis B

Hepatitis B can survive one week on surfaces. It’s been documented that Hepatitis B was transmitted by anesthesiologists using the same syringe on different patients (I assume this means IV).

CJD

Creutzfeldt-Jakob Disease (CJD) has claimed 102 lives in the United Kingdom (UK). The UK (as of April 2002) requires instrument tracking due to CJD and the difficulty in killing prions. AORN has a procedure in the “Standards and Recommended Practices” for treating instruments contaminated with CJD so I won’t go into that here except to say to use all disposables where possible (and incinerate them) and to use no power equipment. The brain, spinal cord, and eye tissue are at highest risk for CJD. The World Health Organization (WHO) gave guidelines for CJD but you shouldn’t follow these. They tell you to soak instruments in lye and then put them in an autoclave. This will ruin the autoclave and produce a dangerous chemical reaction that can kill people. The people at highest risk for CJD are those with brain biopsies, dura mater transplants, and those who have received human growth hormones.

“God Bless You” Came During Plagues

It’s nursery rhyme time! “Ring around the rosie” refers to the red ring surrounding a lymph node. “Pocket full of posies” refers to flowers people kept in their pockets to hold to their noses to suppress the smell of death surrounding them. “Ashes, ashes, we all fall down” refers to cremation. What a lovely childhood rhyme! This is all related to the Bubonic and Pneumonic Plagues when huge numbers of people died in Europe. The saying, “God bless you,” when someone sneezes refers to the spread of the plague by respiratory means. I guess if you were sneezing, your days were numbered!

Hot Topic! Home Laundering of Scrubs

Home laundering of scrubs is an economic issue - not an infection control issue. Jurkovich, 2001, said there was no statistical difference in bacterial growth with home laundering. The Centers for Disease Control (CDC) said home laundering was an “unresolved issue.” OR Manager has a good article about home laundered scrubs in PDF format at www.ormanager.com/favarticles/index.htm. PDF is “Portable Document Format.” “PDF was developed by Adobe Corporation to allow efficient electronic distribution of large documents. A PDF file will look the same on the screen and in print regardless of what kind of computer you are using or which software package it was created from. A large document can be compressed small enough to download quickly, and displays text and pictures as if you were looking at the original book or brochure.” http://cnug.clackesd.k12.or.us/cnug/definepdf.html

The Centers for Disease Control (CDC)

The CDC has new guidelines for hand hygiene. Health care workers may use alcohol-based hand rubs or antimicrobial soap during regular patient care - not a pre-op hand scrub. Alcohol preparations reduce bacteria counts better than antimicrobial soap. In the “Hand Hygiene in Healthcare Settings” (draft), the CDC says don’t use a brush for surgical hand antisepsis! The CDC says to use alcohol-based hand rubs or antimicrobial soap without a brush. Rubbing hard or using a brush simply brings up more bacteria. Follow the directions on the soap container. Pre-op showers for patients may be beneficial. (“May be beneficial?” It seems to me they definitely would be beneficial infection control-wise and aroma-wise!) Here’s the clincher - the CDC says “No artificial nails for health care workers.” I’m proud to say my hospital (Kaiser Harbor City in Southern CA) is going to institute that mandate very soon. If you deliver patient care anywhere in the hospital, you will not wear artificial nails (due to the studies showing documented bacterial growth).

Central Lines Require Ultrasound

The Agency for Healthcare Research and Quality (AHQR) says ultrasound should be used for the insertion of central lines. Maximum sterile barriers should be used when placing central lines and antibiotic prophylaxis should be used on all patients receiving central lines. I have an easier solution - teach and enforce the use of superb sterile technique.

By Mary Ritchie

Tidbits from the April 2002 Anaheim AORN Congress

Surgically Acquired Infections

“The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) are working together to develop a new national health care quality improvement project to prevent postoperative infection.

Postoperative infection is a major cause of patient injury, mortality and health care cost. An estimated 2.6 percent of nearly 30 million operations are complicated by surgical site infections each year. Infection rates, up to 11%, are reported for certain types of operations. Each infection is estimated to increase a hospital stay by an average of 7 days and add over $3,000 in charges (1992 data). Appropriate preoperative administration of antibiotics is effective in preventing infection.

The project’s goal is to improve the selection and timing of administration of prophylactic antibiotics, both important factors in effective prophylaxis. Surgical procedures to be studied for this project include Coronary Artery Bypass Graft (CABG), cardiac, colon, hip and knee arthroplasty, abdominal and vaginal hysterectomy, and selected vascular surgery procedures.

California is scheduled to be in round two which begins November 1, 2002.
For more information, see www.surgicalinfectionprevention.org or contact: CMRI, 1 Sansome Street, Suite 600, San Francisco, CA 94104, Phone Number: (415) 677-2000, Fax Number: (415) 677-2195”

Roll Call

One of my favorite parts of Congress is the roll call of the states with the number of delegates present just like in the U.S. Congress. Many people have funny or boastful introductions which may include mention of winning sports teams. This year, Kansas said they were the home of the world’s largest hair ball.

California had the most delegates with 124. Texas was next with 92 delegates. Montana and Wyoming had two delegates each. Vermont, Delaware, and Puerto Rico had three each. My favorite this year was Florida’s introduction by Thomas J. Macheski,. It was a triple limerick and very cute. I couldn’t get reprint permission for the web site.

Leah Curtin - Keynote Address “Shared Values for a Troubled World” April 21, 2002

1. spontaneous willingness to reach out (love)
2. truthfulness - speak one’s own truth and listen to others
3. fairness
4. freedom - define for yourself who you’ll be
5. responsibility
6. tolerance
7. the role of women
8. respect for life
9. respect for the rule of law
10. honor

DRGs started in 1982. DRG really stands for “Da Revenues are Gone” not “Diagnoses Related Groups.” (That’s a joke.) DRGs resulted in decreased lengths of stay, marketing, ambulatory surgery centers, consultants, and the determination that 100 beds/100,000 population is all that’s needed.

Home health care requires two hours of documentation for each one hour of care. Long term care requires one and one half hours of documentation for each one hour of care. Acute care requires one hour of documentation for each one hour of care.

Serious errors in hospitals happened 3.7% in 1990 and 17.7% in 1997. The night shift wasn’t covered in these statistics.

“Implementing New Technology in the OR” April 25, 2002

AEM (active electrode monitoring) instruments are shielded and monitored. The protective shield on the instrument ensures capacitive coupling doesn’t happen (which means no stray burns). The electrosurgical generator ( bovie) won’t work if the coating (instrument insulation) is broken. One suggested way to test this is SEM - surgeon electrode monitoring. Have the surgeon place the insulated part of the instrument against his/her bare hand, activate the bovie, and see if there’s a burn! It took a few seconds for us to realize this was a joke and then there was hysterical laughter.

Kay Ball was one of three speakers for this presentation (the others were Kathleen Catalano and Janet Lewis). Kay Ball was very entertaining at 0800! She started her presentation with a slide of a Taco Bell sign in Columbus, OH stating “Hiring All Shits.” Now some of us know where we can find jobs! The end of her presentation was a showing of a computer-animated green alien with one large eye and one antenna (very cute guy!) singing “I Will Survive.” Just as the audience is caught up with the rhythm and theme, a silver disco ball suddenly falls on the alien and squashes him just as he’s singing the refrain “I will survive.” The audience went crazy with laughter. I was in tears from laughing so hard - and I was barely recovered from the SEM episode (a photo accompanied that too).

Scanlon

Scanlon hosted a party Wednesday night (April 24) in the Hilton Hotel. They had food, drinks, and a live band with dancing. Tim Scanlon greeted everyone personally at the door and then he made rounds of the large ballroom throughout the evening and greeted people again at tables and in groups. I’m old enough to remember the elaborate parties that used to be held at Congress before cutbacks and the decision to host speakers and scholarships instead of parties. The speakers and scholarships are great and a much better use of money than parties - but it was nice to have a small taste of the old days! Thank you to Scanlon and the Scanlon family!

www.debracrumpton.com

Check this web site above. Debra Crumpton spoke to us on April 23 right after Amanda Gore (whose presentation was fun and energizing). I was disappointed to see so many people left the arena after Gore's speech because Debra Crumpton's speech was "Meeting the New World Leadership Challenge" which people told me sounded boring. It wasn't. It was wonderful! Debra didn't bounce around the stage and act goofy like Gore - but her topic was different. And it wasn't her personality to act goofy. She was a very good and engaging speaker. I was captivated by her and what she had to say.

By Mary Ritchie

Donna Watson’s Presidential Address
Thursday, April 25, 2002

Donna Watson, RN, MSN, CNOR, ARNP, FNP-C, said we, as nurses, focus on the mind, body, and spirit of the patient. She related a story about someone who asked a male nurse why he was a nurse and not a physician. His reply was, “I dared to care.”

Donna’s goals for her year as our National AORN president:

* Safety of our patients with optimal outcomes. Every patient deserves safe, high-quality care. A five member AORN presidential commission on patient safety has been appointed. The initiative is “Patient Safety First.” The web site is www.patientsafetyfirst.org. (The web site is easy to navigate, clear, detailed, and has excellent content.) Detailed explanations of this initiative are here along with resources for patient safety. Questions about patient safety can be directed to patientsafetyfirst@aorn.org. A toll-free hotline number is 1-866-285-5209 as an alternative to e-mail. There will be a patient safety column in the AORN Journal. A brochure and resource kit are also available. Educational programs and videos are being developed.

Patient safety is AORN’s number one priority. Patient safety is an ongoing issue. Dan Sandel, president of Sandel Medical Industries (An AORN of Alameda County April 2002 newsletter advertiser) is the exclusive sponsor of Patient Safety First. When we left the closing session of Congress, we were all given bright yellow plastic bags filled with Patient Safety First information. I saw very few people with just one bag! Everyone wanted to share this information!

AORN will also have a task force to investigate workplace safety and disaster preparedness.

Donna ended her presidential address with the story of a little boy who was throwing starfish back into the ocean. The waves were huge and were tossing large numbers of starfish onto the beach. An adult came by and told the little boy he was wasting his time throwing a few starfish back into the water when there were huge numbers on the beach. What possible difference could he make by doing that? As the little boy picked up one more starfish to save, he said, “It makes a difference to this one.”

By Mary Ritchie, delegate

The Perioperative Nursing Data Set (PNDS)

The second edition of the PNDS debuted at Congress this year. On Monday of Congress week, Dr. Susie Kleinbeck presented a program outlining improvements that have been made.

For those of you who are unfamiliar with the PNDS, it is a collection of words that represents the concepts of the perioperative nursing process. It is the standard language of perioperative nursing that describes pre, intra, and postoperative interventions carried out by the perioperative nurse to achieve positive patient outcomes. The language allows us to describe and quantify the contributions we, as perioperative nurses, make to patient care and answers the question of why we need a registered nurse in the OR.

The Perioperative Patient Model is the visual conception of the PNDS. It is divided into four sections or domains – Safety, Physiological Responses, Behavioral Responses: Family & Individual and Health System. Each nursing domain contains patient outcomes, nursing diagnoses and interventions specific to that domain.

One change in the PNDS has to do with outcomes. An example of an outcome from the first edition of the PNDS is The patient is free from signs and symptoms of infection (O10). Although this is an appropriate perioperative patient outcome, it is one that realistically cannot be measured in the average patient who is discharged the same day they are admitted because patients do not manifest signs and symptoms of surgical infection in that short time period. In the second edition of the PNDS, interim outcomes are described that can be measured at the time of discharge from the OR and discharge from the facility. Examples of interim outcome statements for The patient is free from signs and symptoms of infection are:
* The patient has a clean, primarily closed surgical wound covered with dry, sterile dressing at discharge from the OR.
* The patient’s wound is free from signs or symptoms of infection and pain, redness, swelling, drainage, or delayed healing at time of discharge.

Is the PNDS simply an organized vocabulary to be discussed by nursing scholars or is it something every nurse can use? The answer is found in the second edition of the PNDS where several applications are described including – policies and procedures, job descriptions, staff education, care plans, competencies, clinical pathways, quality indicators, and documentation.

I believe the PNDS is the most significant contribution to perioperative nursing to come along in the 32 years I have practiced in our specialty. I am honored to be a contributing author to the PNDS second edition and a member of AORN’s PNDS work group.

Submitted by Kathie Shea, delegate

Traditionally the House of Delegates meets twice at Congress to conduct business of the Association. Given the controversial nature of issues brought before the House, meeting twice this year was not enough. In an unprecedented move, President Sheila Allen convened a third session. The issues were complex enough that she wisely adjourned the House to a Committee of the Whole. This allowed for more informal discussion and time for debate without being encumbered by parliamentary procedure. I have never seen this done and was very impressed with how effective it was.

As a result of discussion and straw polls conducted during the Committee of the Whole, the Board of Directors withdrew the bylaws changes regarding extraordinary voters, delegates representing the Golden Gavel, and providing for each national past president to serve as a delegate.

A motion was made to double the size of the House to 3000 delegates using a proxy system; however, when it was pointed out the current House only seated a little over 1200 of its possible 1500 delegates, the folly of the motion was brought to light and promptly defeated.

This left two issues to be decided – amendments that would dissolve standing committees in favor of annually appointed committees to serve a special purpose as determined by the Board of Directors and the addition of two delegates from each Specialty Assembly to the House. The House voted in favor of deleting the standing committees and defeated adding delegates from Specialty Assemblies.

In other new business, the proposed AORN Revised Statement of Patients and Health Care Workers with Bloodborne Diseases was adopted as well as the postponement of a $15 dues increase until next year. The proposed bylaws amendment related to special meetings was also passed. This will allow a mechanism for The House of Delegates to act via proxy at a special meeting if called at the written request of five members of the Board of Directors. Passage of this amendment allows for the possibility of timelier decision-making and implementation.

Submitted by Kathie Shea, delegate

Random Comments and Thoughts

It was announced in closing session the 49th AORN Congress had 6,464 attendees and 5,902 exhibitors for a total of 12,366. There were 119 students (Jackie Cummings from AORN of Alameda County was one of them) and 98 nurses joined or renewed at Congress.

Closing session ended with The Blues Brothers (the next Congress is in Chicago) coming onto the stage and escorting the officers and Board of Directors off stage and in procession out of the arena. The music was lively and almost everyone on the Board and the officers were wearing sunglasses to keep the Blues Brothers theme!

There was a reception on Thursday for the newly elected officers and Board members. This was the best reception of all! It was in the ballroom at the Marriott (a nicer setting than the convention center). There was champagne punch (adding champagne to that typical red punch really adds a whole new dimension!), vegetable and fruit platters, and servers mingling with trays of meatballs and egg rolls. It was really very nice! We spoke to two women from Illinois who were selling Chicago pins (very elegant in black and gold with the Chicago skyline and “50th AORN Congress” engraved on the back). They were staying at a small motel that had a safe in the lobby for guests to store their valuables. They wondered what the desk clerks thought of them and their activities due to their deposits of several hundred dollars every few days - from pin sales! We were laughing about the perceptions that they’d only started depositing large sums of money after they’d been there a few days. They thought the desk clerks might think they’d built up a clientele after a few days and were doing well on the streets by now!

One aspect of Congress that made me thrilled was seeing iMacs for the e-mail stations. Hooray for Macintosh! Unfortunately, I never utilized the iMacs due to long lines and short patience!

A disappointment about Congress was the lack of my favorite National Anthem singer. His name is Robbie Britt and he made me cry every time he sang the National Anthem. He sang it with such feeling and force and most importantly - with no variations in words or cadence. I even bought a tape of his patriotic songs! I still remember the prolonged and resounding applause that occurred after his singing. And I was surrounded by many others with wet eyes! I equate Anaheim Congresses with this man singing the National Anthem. And he was absent.

By Mary Ritchie, delegate

2002-2003 Officers and Board of Directors

* = newly elected

President - Donna S. Watson, RN, MSN, CNOR, ARNP, FNP-C
*President-Elect - Betty J. Shultz, RN, CNOR
*Vice President - Michelle Burke, RN, MSA, CNOR
Treasurer - William J. Duffy, RN, BSN, MJ, CNOR
*Secretary - Sharon A. McNamara, RN, MSN, CNOR

Board of Directors
*Lorraine J. Butler, RN, MSA, CNOR
Debra L. Fawcett, RN, BSN, MS
Paula R. Graling, RN, MSN, CNOR
*Charlotte L. Guglielmi, RN, BSN, CNOR
Anita Jo Shoup, RN, MSN, CNOR
Debora S. Tanner, RN, BSN, MSM, CNOR
*Nathalie F. Walker, RN, BS, CNOR

2002-2003 Nominating Committee:
*Michelle M. Byrne, RN, MS, PhD, CNOR
Sylvia Durrance, RN, BSN, CNOR
*Jane H. Flowers, RN, MSN, CNOR
Antonia (Toni) B. Hughes, RN, BSN, MA, CNOR
*Armando Riera, RN, BSN, CNOR
Advisor - Sheila L. Allen, RN, BSN, CNOR, CRNFA

Summary Information on House of Delegates

AORN has 40,126 members. On Thursday, April 25 at 1330, there were 1,296 delegates registered. (The House can have 1500 delegates.)

* The $15 dues increase has been delayed until July 1, 2003.

* Motions before the House that were defeated:
Each specialty assembly being granted two delegates and two alternates to Congress.

* Motions before the House that were withdrawn:
Voting privileges being granted to past presidents, Board of Directors, Golden Gavel (composed of past Board of Directors members), and the Extraordinary Voter proposal (400 volunteers to be granted voting privileges).

* Motions before the House that were passed:
Bloodborne Pathogen Recommendation.
President-elect can form committees and task forces as she/he sees fit.
Congress delegates will serve one year terms so business can be conducted and voted on all year.

A clarification was noted that AORN is NOT opposed to certification or registration of surgical technologists as long as it’s done under nursing. AORN is opposed to the licensure of surgical technologists.

There are only 23 states that mandate there be an RN circulator in the OR. The CMC regulation is 482.51. If your state is not one of these 23, what are you doing to ensure patient safety by mandating an RN be the circulator in each OR?

By Mary Ritchie, delegate

Look for additional member reports and more photos coming to this site soon!

California Poppy Pin
The Official 2002 Congress Pin

The State Flower of California is the Poppy. It's also the mascot for the Operating Room Nursing Council of California (ORNCC). The poppy is seen predominately in the winter months. When there is plenty of rain, they fill the state with the most beautiful orange color.

California Indians cherished the poppy as both a source of food and for oil extracted from the plant. Its botanical name, Eschsholtzia californica, was given by Adelbert Von Chamisso, a naturalist and member of the Prussian Academy of Sciences, who dropped anchor in San Francisco in 1816 in a bay surrounded by hills of the golden flowers. Also sometimes known as the flame flower, la amapola, and copa de oro (cup of gold), the poppy grows wild throughout California. It became the state flower in 1903. Every year April 6 is California Poppy Day, and Governor Wilson proclaimed May 13-18, 1996, Poppy Week.

The ORNCC would like to make this beautiful flower available to you. The pin was designed to capture the essence of the poppy - fun, elegant, warm, and generous! It can be worn on a business suit or a casual outfit. It is a cool gift for kids; yet your mother or grandmother will love it. It's also a great gift for that special someone.

The pin is about 2.3 inches long and 1.5 inches wide and is ceramic.

Order form:

Please send_____pin(s) @ $15.00/each plus shipping and handling of $1.50/each order to:

Name:
Address:
City, State, Zip

Please make checks payable to ORNCC and mail to:
Pat Spongberg
27048 Santa Susana
Mission Viejo, CA 92691

For questions, contact Pat at psponb@aol.com
Please allow two weeks for delivery after the order is received