A Jane McCluskey, RN
The OR nurse as purchaser In the early years of nursing, physicians and nurses depended a great deal on their o w n ingenuity in curing the ill. Although their methods could be considered unorthodox by today’s standards, the treatment proved fairly effective much of the time. Practitioners experimented with materials and resources they had at hand. It was not uncommon for the physician to order brews, teas, and concoctions derived from plants and herbs as effective medication. These natural resources were also used as poultices, stupes, fomentations, and counterirritants in “curing.” Whether these treatments and procedures were psychological or physiological in their efficacy, the treatment did often “cure” or at least satisfy the patient. This inventiveness of the early practitioner has been usurped by industry, which, through its expertness, has offered replacements for the crude
A Jane McCluskey, R N , is supervisor of operating rooms, recovery room, and
GU clinic, Genesee Hospital, Rochester, N Y . She is a graduate of Bugalo Children’s Hospital. A member of the AORN Board of Directors, Mrs McCluskey is chairman of the AORN Industry Collaboration Committee.
products, equipment, and devices of yesteryear. Many years of research and study have produced reliable, safe products for the public. By the time a product reaches the industrial market, the consumer can be relatively certain sufficient research has rendered it safe for use. The Federal Drug Administration (FDA) established committees to set up standards for quality control in medicalhurgical equipment and devices. At its request, many subcommittees have evolved where specialty products and devices can be discussed by experts in any particular field. The American National Standards Institute (ANSI), Association for Advancement of Medical Instrumentation (AAMI), and Health Industry Manufacturers Association (HIMA) all work through their committees in offering FDA and institute review boards recommendations for standards. Presently, the American Society for Testing and Materials (ASTM) offers services for the “development of standards on characteristics and performance of materials, products and systems. This includes terminology, test methods, specifications, classifications, and recommended practice.”’
AORN Journal, November 1975, Vol22, No 5
719
Since each nurse and physician is considered a private practitioner, it is their responsibility to accept accountability not only for the care of their patients, but for the safety and dependability of all products and equipment used in their care. How does this affect the operating room nurse? She probably has more exposure to the industry’s commodities than any other personnel. Modern surgery depends on sophisticated instrumentation; safe, operable equipment; and reliable materials as adjuncts to acceptable procedures performed during surgery. It is apparent, then, that the operating room nurse not only has the opportunity, but the duty to select those products and devices that meet the principles of quality care. That she is meeting this obligation is shown in the study done by the firm of Wilson, Wechsler & Associates of Los Angeles at the request of the Board of Directors of AORN.2 This survey shows that the OR nurse controls the buying in the operating room suite. With the number of products on the industrial market, many of which meet the same or similar needs, it is essential to take a critical look at the product to be selected for patient use. Sound exercise of this responsibility does not come without experience and judgment. It takes good nursing assessment to know what the patient’s need is and how it is t o be met. The OR nurse must set criteria for selecting the product that will meet these requirements. Her first priority is to be certain the patient needs the item. Secondly, does the use justify the cost? Thirdly, can it be obtained, and lastly, is the product compatible with hospital standards? To make these determinations, she must have the delegated authority and
720
budget control to initiate purchasing influence. At this stage of evaluation, industry can be most helpful in providing information about a product. This should be substantiated by statistical data and all resources possible should be investigated to be sure that all clinical information regarding the product is known. The Emergency Care Research Institute of Philadelphia issues monthly information that “provides independent, objective judgment for selecting, purchasing, inspecting, maintaining and using medical equipment and s y s t e m ~ . Many ” ~ hospitals subscribe to the Health Devices program of the institute. When making a decision on which product to purchase, the most important consideration is quality. Any product, equipment, or device used by a physician or nurse in treating a patient must be reliable and of the quality to do everything it is supposed to do. There are many similar products on the market, but in most cases, there are usually one or two brands that perform better than the others. Such quality products should be selected especially when they are directly involved in treating the patient. Research and warranty papers should be available on major equipment. When the item has been selected, it is important to know it can be obtained on a regular basis. If it periodically becomes unavailable, a substitute has to be purchased. This may have to be done quickly and without proper evaluation; a less desirable product may be accepted. If the department budget is tight, it is more costly to purchase from another vendor who cannot offer discount rates for minimal buying. We all know through experience that it is the nurse who takes the blame for an item not being available.
AORN Journal, November 1975, Vol.22, N o 5
t is important that
Iwith the product is backed dependable service.
It is important that the product is backed with dependable service. No matter how good and reputable an item is, it usually has to be serviced or repaired at some time. This is particularly true of major equipment that gets heavy use. When this occurs, you must be assured of positive answers to the following questions. Will a service man arrive promptly to repair the equipment? Most companies offer service within 24 to 36 hours. Few hospitals can afford to be without major equipment for more than a day. Many institutions prefer to have such equipment serviced through a scheduled maintenance program with the company to prevent breakdowns and interruption of use. 0 Does the company offer a “loaner” for use if the item cannot be repaired at once? This is a convenient arrangement and usually the sign of a reliable company. 0 Will the service representative follow through to see that the problem was solved to your satisfaction? Manufacturers who have respect for their products and their customers will offer this kind of service. Having answers to these questions beforehand makes the OR nurse secure in her job as purchaser and assures the patient continuity of care.
Most OR administrators have a strict budget to follow so it is essential to know if a product is fairly priced. If the exact same product can be purchased from another vendor at a much lower price, then consideration should be given to the one with the more attractive price. However, all other representation must be equalavailability, dependability, and service. Deviation from volume buying tends to raise the price of the product since most companies allow some discount if the hospital buys in significant quantities. Further discounts through volume buying are often offered to hospitals belonging to regional hospital councils. It is wise to know all affiliations available to your particular hospital. Standardization of equipment or products in an institution and community can be advantageous for volume discount buying. However, there are some impediments. Standardization usually represents committee approval and often delays selection and delivery. It can also limit choice and may cause you to compromise your criteria. A product is only as good as the company and sales representative who back it. The representative must be available, knowledgeable, and alert to the particular needs of the user and consumer. Most companies offer sufficient training programs so their rep-
AQRN Journal, November 1975,Vol22, N o 5
721
resentatives know what their product is, what it does, how it performs, and what steps must be taken if the item does not perform. Because of this training and orientation of company staff, the OR personnel can expect appropriate inservice on any purchased product or equipment. It is important that each nurse, physician, and staff member be instructed in how to use a new product and basically how it works. Although at times the instruction may seem too fundamental and a waste of effort, inservice on all equipment is a safety precaution and financial saving. How many times have we seen equipment put through a steam autoclave when gas sterilization was stipulated? When a staff member understands equipment, it is handled safely, used properly and to its best potential. Inservice on equipment is wise insurance and should be part of the investment in purchase. A competent sales representative will be anxious t o follow up on the inservice to be the direct link between the customer and the product. The user under these conditions can put trust and confidence in him wherever his product is concerned. Equally essential in selection of a product is the security of knowing it is sterile if the package so states. Simplicity of packaging, along with a convenient method of opening the package while still maintaining sterility, is a must for all products. The fabrication of the item, the method of sterilization, and if it can be resterilized are facts that assist the OR nurse in proper care and storage of the item. The OR nurse wears many hats during her day. As a purchaser of safe, reliable, high quality products, equipment, and devices, the OR nurse has a profound obligation to her patient in
722
selecting merchandise that meets high caliber criteria and is, therefore, compatible with the operating room’s standard of excellence. 0 Notes 1. American Society for Testing and Materials (ASTM), Consensus Standards for Materials, Products, Systems and Services, Brochure 1174-20M, 6.
2. Wilson, Wechsler & Associates, Purchasing Power of the OR Nurse (Denver: Association of Operating Room Nurses Inc, November 1974). 3. Health Devices, Special Abstract Issue (Philadelphia: Emergency Care Research Institute, October 1974).
ANA division supports speciaw group certification The American Nurses’ Association (ANA) Division on Community Health Nursing Practice has joined two other specialty nursing organizations in supporting the use of certification programs for occupational health nursing specialties. The ANA Division on Community Health Nursing Practice, the American Board for Occupational Health Nurses (ABOHN), and the American Association of Industrial Nurses have endorsed and supported the ANA certification program and that of the American Board for Occupational Health Nurses. The ANA certification program in community health nursing incorporates all areas of community health, including occupational health. The nurse successfully completing the program is certified as a generalist in community health nursing. The ABOHN certification program is designed specifically for nurses in occupational health. In announcing the endorsement, Raymond Cink, RN, chairman, ANA Division on Community Health Nursing Practice, stated, “The three organizations believe that mutual support of both certification programs will avoid duplication of efforts, unite nursing, and improve health care. Both programs are designed to promote high quality nursing practice.”
AORN Journal, November 1975, Vol22, No 5
The OR nurse as purchaser In the early years of nursing, physicians and nurses depended a great deal on their o w n ingenuity in curing the ill. Although their methods could be considered unorthodox by today’s standards, the treatment proved fairly effective much of the time. Practitioners experimented with materials and resources they had at hand. It was not uncommon for the physician to order brews, teas, and concoctions derived from plants and herbs as effective medication. These natural resources were also used as poultices, stupes, fomentations, and counterirritants in “curing.” Whether these treatments and procedures were psychological or physiological in their efficacy, the treatment did often “cure” or at least satisfy the patient. This inventiveness of the early practitioner has been usurped by industry, which, through its expertness, has offered replacements for the crude
A Jane McCluskey, R N , is supervisor of operating rooms, recovery room, and
GU clinic, Genesee Hospital, Rochester, N Y . She is a graduate of Bugalo Children’s Hospital. A member of the AORN Board of Directors, Mrs McCluskey is chairman of the AORN Industry Collaboration Committee.
products, equipment, and devices of yesteryear. Many years of research and study have produced reliable, safe products for the public. By the time a product reaches the industrial market, the consumer can be relatively certain sufficient research has rendered it safe for use. The Federal Drug Administration (FDA) established committees to set up standards for quality control in medicalhurgical equipment and devices. At its request, many subcommittees have evolved where specialty products and devices can be discussed by experts in any particular field. The American National Standards Institute (ANSI), Association for Advancement of Medical Instrumentation (AAMI), and Health Industry Manufacturers Association (HIMA) all work through their committees in offering FDA and institute review boards recommendations for standards. Presently, the American Society for Testing and Materials (ASTM) offers services for the “development of standards on characteristics and performance of materials, products and systems. This includes terminology, test methods, specifications, classifications, and recommended practice.”’
AORN Journal, November 1975, Vol22, No 5
719
Since each nurse and physician is considered a private practitioner, it is their responsibility to accept accountability not only for the care of their patients, but for the safety and dependability of all products and equipment used in their care. How does this affect the operating room nurse? She probably has more exposure to the industry’s commodities than any other personnel. Modern surgery depends on sophisticated instrumentation; safe, operable equipment; and reliable materials as adjuncts to acceptable procedures performed during surgery. It is apparent, then, that the operating room nurse not only has the opportunity, but the duty to select those products and devices that meet the principles of quality care. That she is meeting this obligation is shown in the study done by the firm of Wilson, Wechsler & Associates of Los Angeles at the request of the Board of Directors of AORN.2 This survey shows that the OR nurse controls the buying in the operating room suite. With the number of products on the industrial market, many of which meet the same or similar needs, it is essential to take a critical look at the product to be selected for patient use. Sound exercise of this responsibility does not come without experience and judgment. It takes good nursing assessment to know what the patient’s need is and how it is t o be met. The OR nurse must set criteria for selecting the product that will meet these requirements. Her first priority is to be certain the patient needs the item. Secondly, does the use justify the cost? Thirdly, can it be obtained, and lastly, is the product compatible with hospital standards? To make these determinations, she must have the delegated authority and
720
budget control to initiate purchasing influence. At this stage of evaluation, industry can be most helpful in providing information about a product. This should be substantiated by statistical data and all resources possible should be investigated to be sure that all clinical information regarding the product is known. The Emergency Care Research Institute of Philadelphia issues monthly information that “provides independent, objective judgment for selecting, purchasing, inspecting, maintaining and using medical equipment and s y s t e m ~ . Many ” ~ hospitals subscribe to the Health Devices program of the institute. When making a decision on which product to purchase, the most important consideration is quality. Any product, equipment, or device used by a physician or nurse in treating a patient must be reliable and of the quality to do everything it is supposed to do. There are many similar products on the market, but in most cases, there are usually one or two brands that perform better than the others. Such quality products should be selected especially when they are directly involved in treating the patient. Research and warranty papers should be available on major equipment. When the item has been selected, it is important to know it can be obtained on a regular basis. If it periodically becomes unavailable, a substitute has to be purchased. This may have to be done quickly and without proper evaluation; a less desirable product may be accepted. If the department budget is tight, it is more costly to purchase from another vendor who cannot offer discount rates for minimal buying. We all know through experience that it is the nurse who takes the blame for an item not being available.
AORN Journal, November 1975, Vol.22, N o 5
t is important that
Iwith the product is backed dependable service.
It is important that the product is backed with dependable service. No matter how good and reputable an item is, it usually has to be serviced or repaired at some time. This is particularly true of major equipment that gets heavy use. When this occurs, you must be assured of positive answers to the following questions. Will a service man arrive promptly to repair the equipment? Most companies offer service within 24 to 36 hours. Few hospitals can afford to be without major equipment for more than a day. Many institutions prefer to have such equipment serviced through a scheduled maintenance program with the company to prevent breakdowns and interruption of use. 0 Does the company offer a “loaner” for use if the item cannot be repaired at once? This is a convenient arrangement and usually the sign of a reliable company. 0 Will the service representative follow through to see that the problem was solved to your satisfaction? Manufacturers who have respect for their products and their customers will offer this kind of service. Having answers to these questions beforehand makes the OR nurse secure in her job as purchaser and assures the patient continuity of care.
Most OR administrators have a strict budget to follow so it is essential to know if a product is fairly priced. If the exact same product can be purchased from another vendor at a much lower price, then consideration should be given to the one with the more attractive price. However, all other representation must be equalavailability, dependability, and service. Deviation from volume buying tends to raise the price of the product since most companies allow some discount if the hospital buys in significant quantities. Further discounts through volume buying are often offered to hospitals belonging to regional hospital councils. It is wise to know all affiliations available to your particular hospital. Standardization of equipment or products in an institution and community can be advantageous for volume discount buying. However, there are some impediments. Standardization usually represents committee approval and often delays selection and delivery. It can also limit choice and may cause you to compromise your criteria. A product is only as good as the company and sales representative who back it. The representative must be available, knowledgeable, and alert to the particular needs of the user and consumer. Most companies offer sufficient training programs so their rep-
AQRN Journal, November 1975,Vol22, N o 5
721
resentatives know what their product is, what it does, how it performs, and what steps must be taken if the item does not perform. Because of this training and orientation of company staff, the OR personnel can expect appropriate inservice on any purchased product or equipment. It is important that each nurse, physician, and staff member be instructed in how to use a new product and basically how it works. Although at times the instruction may seem too fundamental and a waste of effort, inservice on all equipment is a safety precaution and financial saving. How many times have we seen equipment put through a steam autoclave when gas sterilization was stipulated? When a staff member understands equipment, it is handled safely, used properly and to its best potential. Inservice on equipment is wise insurance and should be part of the investment in purchase. A competent sales representative will be anxious t o follow up on the inservice to be the direct link between the customer and the product. The user under these conditions can put trust and confidence in him wherever his product is concerned. Equally essential in selection of a product is the security of knowing it is sterile if the package so states. Simplicity of packaging, along with a convenient method of opening the package while still maintaining sterility, is a must for all products. The fabrication of the item, the method of sterilization, and if it can be resterilized are facts that assist the OR nurse in proper care and storage of the item. The OR nurse wears many hats during her day. As a purchaser of safe, reliable, high quality products, equipment, and devices, the OR nurse has a profound obligation to her patient in
722
selecting merchandise that meets high caliber criteria and is, therefore, compatible with the operating room’s standard of excellence. 0 Notes 1. American Society for Testing and Materials (ASTM), Consensus Standards for Materials, Products, Systems and Services, Brochure 1174-20M, 6.
2. Wilson, Wechsler & Associates, Purchasing Power of the OR Nurse (Denver: Association of Operating Room Nurses Inc, November 1974). 3. Health Devices, Special Abstract Issue (Philadelphia: Emergency Care Research Institute, October 1974).
ANA division supports speciaw group certification The American Nurses’ Association (ANA) Division on Community Health Nursing Practice has joined two other specialty nursing organizations in supporting the use of certification programs for occupational health nursing specialties. The ANA Division on Community Health Nursing Practice, the American Board for Occupational Health Nurses (ABOHN), and the American Association of Industrial Nurses have endorsed and supported the ANA certification program and that of the American Board for Occupational Health Nurses. The ANA certification program in community health nursing incorporates all areas of community health, including occupational health. The nurse successfully completing the program is certified as a generalist in community health nursing. The ABOHN certification program is designed specifically for nurses in occupational health. In announcing the endorsement, Raymond Cink, RN, chairman, ANA Division on Community Health Nursing Practice, stated, “The three organizations believe that mutual support of both certification programs will avoid duplication of efforts, unite nursing, and improve health care. Both programs are designed to promote high quality nursing practice.”
AORN Journal, November 1975, Vol22, No 5
