2016 DELEGATE NARRATIVE

Pearls for the AORN Seminar and Expo

• bring snacks/ plan to snack most days (Breakfast before you leave 0530 or 0630 or 0730; snacks accordingly; break around 12/1300; snacks; break after 1700 (dinner w friends, even before parties just in case); parties generally have some food, maybe not your food; snack before bed)

• there will be no time to work out, join the 5K and zumba a lot of fun!

• plan to buy and ship, for loc`ker space at least

• plan out schedule when you get book(Sat night as delegate, come early to get registered, come earlier if Sun or Mon morning/long lines)

• bring spiral to take notes, no wifi/ computer is heavy

• don't assume food is what you will eat

• don't miss the Scanlan party jeans are okay

• plan out nights when you're free for dinner w the group, plan lunches as well (Wed 1 hour break we could've eaten)

• don't always sit w TX unless you're in congress by state

• write something down to remember the person on their business card; write whatever you need from them on yours (you won’t remember when you get home unless you do!!)

• plan a little vacation time, but plan to be there 7/5 unless there's something in the morning

• posters in AM (don't forget eval)

• exhibit hall is crazy crazy

• breakout sessions aren't that great unless you're in that field

• talk to people. Everywhere.

• credit card for most things, bring cash just in case

• get closest hotel you can afford

• find local places, talk to locals

• get all the stickers

• take pics of people

• bookstore is discounted and interesting, still have to ship home somehow/ same for exhibit floor items/ souvenirs

• follow the crowd

• vote first night

• bring comfy/business casusal/dressy/work out

Attending the AORN Surgical Conference & Expo as a delegate was a rewarding experience. This was my fourth Congress since becoming a member of AORN in 2006 and first as a delegate. I found the General Sessions to be the highlight of each day. However, my first pearl as a delegate was the electoral process. The candidates' forum was an interesting phenomenon and where as I would have chosen to vote for a candidate based on their biography, the forum afforded me the opportunity to hear them speak, answer questions relevant to issues, and their ability to think on their "feet" so to speak. Coupled with the candidates forum were the first and second houses of delegates with recognition of local chapters, motions to be discussed and voted on, and new motions to be considered for next year gave me the sense of belonging. The Second pearl I took away from the Expo was the initiative AORN is taking to involve younger members in the day to day operation of the organization which will mold the young leaders for the future. The revised structure for volunteering will make it easier for young leaders to get involved in the organization at various levels.

The Third pearl that resonates with me was the importance of safety for the population we serve. Although we all went into healthcare and more specifically nursing to take care of our patients/ clients, the 1999 IOM report "To Err is Human" shed light on the many mistakes made that were detrimental to patients and their families. Since then The Joint Commission (TJC) put out the universal protocol (time out, correct patient, site marking etc) in an effort to minimize if not eliminate harm to our patients. However, wrong site surgery was the number one sentinel event reported by TJC in 2015. Colonel Mike Mullane's timely message in his general session presentation the "Normalization of Deviance" made a tremendous impact on me. As he made reference after reference the role deviance from norm played in the demise of the space shuttle challenger, the same can be applied to the OR where deviance lead to errors such as wrong site surgery. As he so rightly stated once one get away with deviance once, then twice, or even three times, it becomes a habit and deviant practices becomes the norm until catastrophe strives.

Serving as a delegate was a rewarding experience for me and I would recommend that any member who has not served the chapter in this capacity should at least consider doing so in the future. These are just three pearls I wish to share but Surgical Conference & Expo had so much more to offer including networking, and education.

The ICD 10: Meeting PeriOperative Challenges was very well prepared. Having spent more than 2 years in OR Scheduling, I was stunned by the enormity of the changes. Often, the PeriOperative nurses notes were the only way for the IT people to figure out what actually happens in the OR. For example, appendectomydoes not work, but the system will accept removal of appendix. Arthrotomy isn’t accepted but opening of knee joint/space for diagnosis or confirmation of arthritis in joint is.

Normalization of Deviance by astronaut, Colonel Mike Mullaney ,was incredibly powerful. Colonel Mullaney used the Challenger explosion to demonstrate that once you cut a little bitty corner, 'fudge just a bit', it becomes much easier the second, third, fourth time. A near miss unaddressed is a disaster waiting to happen.

Two nurse researchers presented a study on retention in the OR. Orientation of a perioperative nurse can cost a facility between $40,000 and $60,000, and yet in many facilities, administration doesn’t address very fixable situations that cause nurses to leave, including feeling like the odd man out, being bully-ed, not being supported when bringing a potential problem to management’s attention, even tables in the lounge where only certain nurses are welcome.

One of the Exhibit Hall study books, Opioid Issues in Health Care presented some differences between opioid use in the United States and Europe. Patients in Europe with ankle fractures are given NSAIDS instead of opioids and are released shortly after surgery. Lumbar laminectomy patients not given opioids are often released the day of surgery. Government agencies such as the FDA, DEA, CDC, as well as the Joint Commission are calling for a change in medication protocols focused on avoiding opioid overuse and misuse. The trend is to treat patients with a multimodal regimen using blocks, pain pumps, and NSAIDS.

This was the first AORN Conference I have attended in several years and much has changed. The internet is successfully integrating itself in our organization. From registration to the conference “app” to the on-line evaluations of sessions you really must be connected to reap all that EXPO has to offer.

As several delegates mentioned at our May 3rd chapter meeting where we shared some of our take-aways, Colonel Mike Mullane's presentation the "Normalization of Deviance" was especially meaningful. This former astronaut went on to define normalization of deviance as that variance which occurs so often that it becomes the new normal. His example was well documented with specific details of the Space Shuttle Challenger disaster. Translate this to our perioperative environments and I immediately reflect on recent activities at work. I was recently involved in the revision of our electronic Surgical Safety Check Lists. We convened a task force with representation from all 14 of our North Texas Baylor Scott and White Health ORs. We reviewed what was working well and our opportunities for improvement. We also reviewed our compliance reporting numbers from the last year. We listened as the task force discussed pain points. We then updated our comprehensive checklist and re-educated staff on the fire risk assessment, anesthesia timeout, the procedural timeout and the signout/debrief sections. This latest version was implemented April 5th. Our goal of course is patient safety and the intent is to make these checklists meaningful.

Other sessions that were valuable included “Business Case for Quality: Why Investing in Quality Ultimately Results in Better Financial Performance”, “ICD-10 Meeting the Perioperative Challenges” and “Disaster/Emergency Preparedness Planning”.

I would be remiss if I did not mention all the education that was available on the Exhibit Floor. I hope all our chapter delegates were able to review the poster our own Margaret Hubbard presented: “Baseline Competency Documentation in the Operating Room”. The business of our association as discussed in the Forums as well as the House of Delegates and the Candidates’ Forum are important aspects of a comprehensive EXPO experience. Meeting new people, sharing common concerns and discovering innovative solutions are just some of the “pearls” for the taking. I came away with a pearl bracelet!