eCommunication from the American Society of Ophthalmic Registered Nurses
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ASORN
EYE kNOW - eNewsletter from the American Society of Ophthalmic Registered Nurses

May 2015


May is a month of celebrations, one of which is International Nurses Day on May 12th. It's no coincidence that this day is also Florence Nightingale's birthday. Most of us are at least somewhat familiar with the story of her work during the Crimean war, establishing the first professional training school for nurses and her tireless campaigns to improve health care standards. We continue to honor her because her positive influence is still felt far and wide.

As I was researching her life, I was fascinated with not only the better known facts about her life and achievements, but with some of the more obscure items I came across:
  • Florence was named for the city in which she was born.

  • She returned to London from Crimea (she had become famous for her pioneering work there) under an assumed name. She walked from the train station to her parent's home alone, to avoid publicity.

  • While she did not actually invent the "pie chart," as many claim, she was amongst the first to show its usefulness. She used it to identify the root causes of soldier's deaths in the Crimean war.

  • Her likeness was on the British 10 pound note for many years.

  • She owned over sixty cats in her lifetime.

  • Her tombstone has only her initials and dates of birth and death on it.

  • Famously known as the "Lady with the Lamp," she also wrote about the importance of light for patient's health.

  • A quote: "Were there none who were discontented with what they have, the world would never reach anything better."

While many of the items above are simply entertaining, some illustrate just how influential Florence remains. While I was visiting the website of the Florence Nightingale museum in London, I noticed that they chose to celebrate this month with an exhibit on light therapy. As ophthalmic nurses, many of us have followed the research on light therapy used for seasonal affective disorder and the role of the retina. One never knows how far the ripples will travel when a stone of inquiry is tossed into the sea of knowledge!

As you celebrate this Nurses Day, I hope you'll take inspiration from the spirit of Florence Nightingale, who also said "Happiness is the gradual realization of a worthy ideal or goal." Whether your goals are simple as obtaining CEs or as complex as identifying future standards of practice, ASORN is here to help you realize your professional goals. One of the many benefits of membership is access to the wisdom of your peers in the ophthalmic community. With this in mind, I invite you to share your tips for ophthalmic nursing practice through this e-newsletter. Not a writer, you say? No worries, just send your idea to me via email and let me help. Your colleagues will benefit from your experience!

Happy International Nurses Day!

Kari L. Magill, RN, BSN, CNOR
kmagill@med.umich.edu

Advice from Edna

Advice from Edna: Tips for Ophthalmic Nursing Practice


It can be a real challenge to remember all of the surgeon's preferences in a busy ophthalmic nursing practice. Part of being prepared in the operating room is identifying the particular needs of the surgeons and having the room and the patient prepared so that procedures can be done efficiently. The less time spent on matters such as positioning the patient after the surgeon enters the room, the more time he or she can spend engaged in the procedure. One tip for positioning is this: Have a stick marked with colored tape to indicate the bed height preferred by surgeons using the room. Each tape marker can also have the corresponding physician's name. When the patient is brought into the OR, use the stick to adjust the bed height for the surgeon. This will eliminate one more task for the doctor prior to starting the procedure.

Submitted by Nancy Haskell, RN, CNOR

Have a question?
Ask ASORN with our Ask an Expert tool.

Have a tip?
Submit to kmagill@med.umich.edu.

QA Question of the Month

"Informed consent is permission obtained from a patient to perform a specific test or procedure. It is the process of communication between a patient and a medical provider."


Although these statements appear to be simple, they engender many nursing considerations. What are some behaviors which are the nurse's responsibility in the informed consent process?

Answer:
  1. Ensure that the informed consent process follows federal, state, and accrediting regulations as well as institutional policies.
  2. Ensure that the informed consent is signed by a competent person of adult age or a legal representative.
  3. Assess the patient's comprehension of treatment. The nurse may do this by asking, "What are you having done today? With which doctor?"
  4. Ensure that the patient is in agreement with the treatment, the physician(s) providing the services, and the operative site referred to on the consent.
  5. Ensure that the consent is obtained prior to sedation or administration of drugs. Some institutions require that an informed consent be signed prior to the day of service while others have it signed when the patient arrives for the procedure. Follow your institution's policies and procedures.
  6. Ensure that the consent is in the patient's primary language.
  7. Report any discrepancies to the physician, e.g., an incorrect operative site or if the consent does not match what the patient states he or she is having done.
Source: Essentials of Ophthalmic Nursing, Book 1, First Edition (American Society of Ophthalmic Registered Nurses) 2014, pp169-170
ASORN Summer Symposium - June 20, 2015 - Boston, MA

Certification – the "Aha" Moment

At a recent doctor’s appointment I was introduced to a dermatology resident. After the formal introductions and diving into work and life history I asked, Dermatology? Really? He came back with Ophthalmology? Really? Touché! Then came the most common question, Why ophthalmology? For many, there is an “aha” moment. But for me, those moments didn’t stop. It was multiple “aha” moments that brought me to love ophthalmology.

The fall edition of INSIGHT, The Journal of ASORN, will contain an article titled His Name is Alex. The article describes a heartwarming, personal experience I had which I greatly enjoy sharing. It gives an account of one of my “aha” moments and was the beginning of my ophthalmic journey. That journey has led me to a network of friends and colleagues from various places around the world who share the same love and passion for vision. But best of all, that journey led me to seal the deal and become a certified registered nurse in ophthalmology (CRNO). This is where I want to be. I can’t imagine doing anything else. This is what makes me happy. “Do it Lori,” I kept telling myself, “you love this stuff!”

When I made the decision to certify, a friend and co-worker decided to certify as well. Excellent! We could do this together. Months of studying, bugging the doctors to explain this or that, and researching those areas of ophthalmology we did not have much exposure to, we decided it was time. It has been six years now since I have been certified and I proudly display those initials explaining what CRNO means to all who ask. And when they ask, “why ophthalmology? Why certify?” I say “His name is Alex. He was my “aha” moment.”

Look for the article in the fall. Then ask yourself, “what is my “aha” moment?” When that smile comes across your face and you can answer by saying that ophthalmology is where you want to be, that it’s what makes you happy, then it’s time. Seal the deal. Visit www.asorn.org/certification, and learn how to become certified.

Lori Pacheco, RN, CRNO
Boston, MA
ASORN 2015 Annual Meeting - Las Vegas - November 13-14

It is a Good Idea

It is commonly known that “it is a good idea” to change your home smoke detector batteries when the clocks change each Spring. If you are like me, it is something that is typically put off until the batteries let me know that they need replacement and I should have changed them. Undoubtedly, this happens at the most inopportune time. It is never good to hear that distinctive, irregular beep somewhere in the house when you are trying to sleep. After you search through the house impatiently listening for the illusive detector to identify itself, invariably it is discovered to be the one in the most difficult location to reach. Standing on a chair won’t work, so the situation is made even worse knowing that getting a ladder will be necessary. Hopefully a replacement battery is available. While it does not seem to be a priority on the day you change the clocks, it is a good idea to take the time to do it.

What else may be a good idea? It is a good idea to make the time to check the status of your nursing license and certification. Your license is your permission to work in the field. Like the beeping smoke detector in the middle of the night, it is not pleasant to find out you need continuing education credits immediately before your license expiration date. It too will probably come at the most inopportune time, such as before a desperately needed and scheduled vacation. It is a good idea each year to review your continuing education progress. It is a good idea to have additional certification, such as the Certification for Registered Nurses in Ophthalmology (CRNO). This certification not only recognizes professional qualifications and knowledge but also demonstrates a personal commitment not found in everyone.

Periodically review your personal and career ambitions. Although you may love your current job and position, it is a good idea to look back at where you have been, where you are now and where you want to be in two, five and ten years. Do you think you might want to be a nurse manager, nursing director, surgical center director? If so, it is a good idea to start looking at the job requirements and start working toward achieving them now. If you think ahead, you will already be qualified for your desired position before you miss out on a great opportunity. In preparation for advancement, it is a good idea to learn additional knowledge and skills. It is a good idea to expand your role in an organization by learning other jobs and volunteering to be on local, regional and national committees. Working with different people and being seen by other professionals in the field is helpful in networking and having others see your strengths, skills, knowledge and ambition.

It is a good idea to be an active member in professional organizations, such as ASORN. Volunteering at regional and national meetings is a great networking tool for whatever the future holds for you. It is a good idea to attend the meetings because it provides an opportunity to talk to other professionals in the field. Many employers will pay for some or all of the expenses associated with attending the meetings if it is presented as something that will not only benefit you professionally but something that will benefit their organization.

Don’t wait for the surprise beep because you failed to act. It is a good idea to know where you want to go and take the necessary steps in advance to achieve them. It’s just a good idea!

Barbara Ann Harmer, RN, BSN, MHA
EyeQ Webinar Series - United in Vision - FREE for paid members!

Corporate Spotlight - Avella Specialty Pharmacy

Avella

Why Current Good Manufacturing Practices (CGMPs) are great news for your practice.


New processes and requirements around clean room facilities benefit patients in terms of safety and quality.

In 2012, an outbreak of serious infections in patients receiving spinal injections was traced to contaminated vials from an unaccredited compounding facility. While issues like these are extremely uncommon, the FDA responded to this issue with the passage of the DSQA, which includes more stringent requirements for facilities that compound drugs. As part of these regulations, large pharmacies that distribute a high volume of compounded drugs can now register as designated Outsourcing Facilities.

In fact, this designation is now required for pharmacies that need the ability to manufacture large batches of compound sterile preparations (CSPs) without prescriptions for individual patients and/or to ship these products across state lines. And while many leading pharmacies already maintain strict quality controls, this designation provides an opportunity for these organizations to reinforce to providers that quality and patient safety are key priorities.

Current Good Manufacturing Practices and clean room requirements

Outsourcing Facilities are subject to increased government oversight and must comply with current Good Manufacturing Processes (CGMPs) as defined by the FDA. CGMPs are strict, detailed guidelines that must be observed during the preparation of compounded medications in order to eliminate contamination of medications, deviations from protocols or the use of incorrect ingredients.

Among other requirements, the DQSA outlines that Outsourcing Facilities must develop and maintain CGMP-compliant clean rooms. For example, in April 2015 Avella Specialty Pharmacy completed construction on a state-of-the-art clean room to satisfy CGMP requirements. This separate facility has equipment that continuously monitors the sterile compounding environment. Two microbiologists also sample and monitor the facility and personnel on a daily basis.

Clean rooms like the one developed by Avella allow pharmacies to implement quality and safety measures such as:
  • Continuous environmental monitoring of air, service and personnel
  • Stability and sterility testing of each formulation
  • Strict controls over the source and quality of drug components
  • Rigid disinfection and sterilization protocols, including full sterile garb
This new designation will give providers the peace of mind that the highest standards for purity, sterility and safety are being upheld. As such, ophthalmology practices that are looking for the highest quality preparations will want to identify a designated Outsourcing Facility as their pharmacy partner.

More information about Avella’s Outsourcing Facility can be found on their website.
2015 COS ASORN Nurse and Technician Program - Austin, TX - August 21-11
Copyright © 2015 American Society of Ophthalmic Registered Nurses, All rights reserved.


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