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Inside the Monitor:

President’s Address

Our Vision, Mission, Values &

Goals

Board of Directors for 2017

Regional Reports

Upcoming Courses

Update: CNA

PeriAnesthesia Nurses

Certification

Featured: Scholarly Work

ASPAN’s 36th National

Conference

NAPAN conference

ICPAN conference

Continuing Education

Health and Wellness

OPANA membership

Thank you!

President’s Address

Contact

OPANA today: www.opana.org

Dear OPANA members,

After a long winter, spring is in the air! I just noticed

today that my tulips are starting to poke through the

ground and I will be looking forward to the red and

white Canada 150 years celebration bulbs I planted last

November. Speaking of celebrations, the National

Association of PeriAnesthesia Nurses of Canada is busy

planning their 15th Annual national conference. The

conference will be held in beautiful Vancouver, British

Columbia on the weekend of June 10th and 11th. Head

on over to www.napanc.org to catch the early-bird

rate! Speaker topic includes information from the local

police force related to the fentanyl crisis in Vancouver,

transgender patients in the PACU, advance care

planning in PeriAnesthesia, as well as many other

interesting topics. We would love to see you there and I

will take this time to remind you that there are

competitive bursaries available through OPANA and

NAPANc to help you out with finances.

The OPANA Board of Directors has discussed how we

can best support PeriAnesthesia nurses in their

professional development. This year we are cognizant

of the number of nurses who are challenging themselves

by writing the Canadian Nurses Association national

PeriAnesthesia Nursing certification exam

https://nurseone.ca/certification; especially since CNA is

now offering the examination twice a year with flexible

writing times. OPANA offers bursaries in all 7 regions to

help successful candidates pay for the cost of the exam.

In terms of helping prepare candidates , OPANA

supports the University of Toronto, Laurence S.

Bloomberg Faculty of Nursing one-day PeriAnesthesia

Review Course being held on April 22, 2017

https://bloomberg.nursing.utoronto.ca/pd/professional-

development/perianaesthesia.

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For those candidates writing the exam in the fall, OPANA is planning a one-day

workshop to review key education points in PeriAnesthesia nursing…Stay tuned!

OPANA has recently learned that members who register their OPANA membership via

RNAO NO LONGER have their personal information shared with us. This has led to some

confusion in that OPANA has not received our membership list and must now send all

email communications to our RNAO-OPANA members via the RNAO. If you are an

OPANA member who has registered via the RNAO, and would like OPANA to have your

information, please advise us via info@opana.org . We apologize for any delays in

communication from OPANA, and we are working on this.

In an effort to reach out to more PeriAnesthesia nurses in Ontario, our board of directors

is also planning to hold quarterly board of director meetings at different hospital venues

around the province. We hope to be able to attend a site visit and connect with

PeriAnesthesia nurses to help promote the work OPANA does!

OPANA has also recently approved having nursing student liaison positions within our

board in an effort to bridge the gap between students and nurses interested in

PeriAnesthesia nursing. We recognize that there are knowledge translation

opportunities between the generations of nurses working in PeriAnesthesia and we are

striving to have all voices heard and foster the professional development of future

PeriAnesthesia nurses.

I wish you all a wonderful spring and I hope to see you at some of the PeriAnesthesia

educational events being held this year!

Yours in PeriAnesthesia Nursing,

Ramona Hackett OPANA President

President’s Address

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OPANA Executive Board of Directors

Vision:

A respected nursing practice that leads high quality patient care throughout the PeriAnesthesia

road to recovery

Mission:

To recruit and retain high caliber nurse leaders who influence excellence in PeriAnesthesia

patient care

Promote respect, positive communication and

collaboration among all members of the patient/family/healthcare team

Value excellence and integrity in all interactions

Be accountable and ethical in our nursing practice through our actions and

decisions

Commit to excellence in nursing by promoting a culture of lifelong learning that

integrates evidence-based practice, research, professional development and

competence

Demonstrate genuine respect for uniqueness and diversity

Face our challenges through innovation, creativity, shared knowledge and

experiences

Collaborate with inter-professional colleagues to deliver the best quality of care

GOALS

To promote and subsidize research that leads to evidence-based best practices

To provide venues to share education and learned experiences

To build a data base of topics that influences PeriAnesthesia nursing practice

To promote interconnectedness (universal oneness) with PeriAnesthesia nursing

associations and related interest groups around the world (e.g. NAPANc, ICPAN,

ORNAC, Ambulatory Clinics, Surgical Specialty Groups)

VALUES

Opana’s Vision, Mission & Values

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President: Ramona Hackett

Immediate Past President: Carol Deriet

Treasurer: Marianne Kampf

Treasurer-elect: Nancy Poole

Secretary: Nicci Chow

Regional Directors:

General Toronto Area: Linda Marshal-Masson and Sherry France

Southern Ontario: Marianne Kampf and Caroline Fellows-Smith

Central Ontario (Georgian Bay Area): Karen Wessel

Western Ontario (London Area): Nancy Rudyk

Eastern Ontario (Ottawa Area): Morag Mercer, Stephanie Currie

Northwest Ontario (Greater Sudbury, Sault Ste. Marie Area):

Farah Khan Choudhry

Northeast Ontario (Thunder Bay Area): Vacant

Directors at Large:

Dentistry & Free Standing Clinics (at large): Vacant

Director of Educational Resources: Nancy Rudyk

Director of Communications & Newsletter: Nelisha Bhaloo & Nicci

Chow

Director of Membership: Nancy Poole, Jurist Rosales-Tran & Arlene

Bernardino

Director of Website: Carol Deriet & Dhivya Eapen

Medical Advisor: Dr. Beverly Morningstar

Board of Directors

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Southern Ontario: Hamilton Niagara Regional Report Spring 2017

As we begin to write our updates for this edition it has come to mind that we really

would like to connect more with our links in our region and even though it gives us joy to

provide updates in our practice and projects within our own community it would be

even more exciting to hear from you too.

Caroline and I will personally reach out and make a connection as we are only as

good if we hear what is happening within our region as a whole. Now that spring is fast

approaching and it will be welcomed by so many of us let’s make this an effort for and

from of all us.

Email: kampf@hhsc.ca we would love to hear from you and connect.

With the upcoming NAPANc 2017 conference in June Caroline and I are working on an

abstract submission regarding patients undergoing DI interventional procedures and

the care they need pre and post in the Post Anesthesia Care Environment. Within our

own hospital we have developed a preprinted order (PPO) set for patients undergoing

breast surgery and are cared for in SDO. That means they are a same day overnight

patient in the PACU and are discharged home prior to 7am the next day. Very few PPO

sets exists in the SDO setting and it is a start for continuity of care both from the nurse

and physician. In our SDS unit we have also introduced Bay assignments for the RNs and

RPNs with daily huddles. This was openly discussed with the staff to ensure better

continuity of care and accountability for the patient. This practice change has been

well received to date and we continue to monitor to ensure we are achieving the

desired outcome and to hear of any concerns from staff in order to course correct.

One question that was brought up is can an RPN give IV push meds in a phase 2

setting? The answer is no. Even bench marking with colleagues there is no area I have

heard where the RPN is giving an IV push medication in a phase 2 PA setting. The

method of administration is to be a mini bag infusion for medications. We do not have

a cardiac monitor on the patient in this setting and we are putting the patient in a

situation of undue risk. For example, if you were to consider IV 2mg Ondansetron, this

medication with respect to absorption and desired effect is no different in time whether

it is given IV push or via mini bag and the risk of placing the patient in a position of

possibly experiencing Torsades is simply not safe. Remember we are talking about

patients in Phase 2 not Phase 1. We continue to work at our Charge nurse resource

package and have succeeded to be at the half or nearly past the half-way point in

draft. I know of no such resource that exists anywhere from those I have contacted

across the country. Yes there are job descriptions but we are looking at this as a

mentoring tool to be provided for a nurse to be able to refer to as a resource in the

Regional Reports

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many roles they provide within the PeriAnesthesia Environment. Another project that I

have been asked to participate in will be to provide a gap analysis of the Labor and

Delivery area reviewing how patients are recovered, identify the gaps and provide

suggestions in order to facilitate any learning needs within the team. Lastly, I am

attending the conference in June in Vancouver which looks to have an excellent

program and I encourage you to consider going as well. There are funding channels to

seek out. At this conference, I will formally announce my expression of interest for the

NAPANc Treasurer Elect role. I have already sent this in writing to the current NAPANc

President. Having been a part of the OPANA organization for the 10 years at least, I

have lost count; I am ready to look forward to providing support at the National Level.

This again is a volunteer position and I have to say I have a passion for PeriAnesthesia

nursing. Please consider thinking and writing the CNA certification exam. We are happy

to provide study groups and our next workshop will focus on this topic of support. On a

personal note I am highly anticipating attending the Canada Blooms Garden Show in

Toronto this week. It is a yearly ritual for me to soak in the colors and smell the scents

reigniting energy within that carries over into my personal, professional and volunteer

work. One of the quality educational initiatives we have been promoting for RN’s and

RPN’s at the McMaster Children’s is to have everyone in the Diagnostic Imaging

Department PEARS Certified ( As well as BLS and ACLS since it is a combined

department caring for Pediatrics and Adults) . PEARS (Pediatric Advanced Emergency

Assessment, Recognition and Stabilization) teaches providers how to recognize

respiratory distress, shock, cardiac arrest and provide appropriate lifesaving

interventions within the initial minutes of response. The goal of PEARS is to improve the

quality of care provided to seriously ill or injured infants or children that are in our case

post procedure: General Anesthetic and require practitioners to have comprehensive

knowledge for airway management resulting in improved outcomes. This skill set is used

in our DI recovery area, and even though the responsibility of Stage 1 recovery is for

RN’s, but our RPN’s are involved in Stage 2 recovery. Skill sets that we focused on in the

DI Recovery area for our RPN’s involved:

VAT ( Vascular Access) skills

CVAD ( Central Venous Access skills

Analgesia/Anesthesia patient care monitoring

PCA-IV Blood Administration

Care of MH Susceptible Patients

Care of OSA patients

We are growing our team and standardizing our skill sets.

Yours in PeriAnesthesia Nursing, Marianne Kampf & Caroline-Fellows Smith

kampf@hhsc.ca & Fellows-Smith@hhsc.ca

Regional Reports

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General Toronto Area: Sherry France & Linda Marshall-Masson

Trillium health Partners has been busy harmonizing our pre-operative assessment

clinic process so that there is consistency at all three sites: Credit Valley Hospital,

Mississauga Hospital and Queensway hospital. Our goal is to provide all patients

with one experience, improve operational efficiency through standardization

and also to ensure right care, in the right place, at the right time. All the staff

have been working diligently over the past year to harmonize and update all

Pre-operative assessment forms, orders and patient information booklets. Our

challenge was to identify differences in practice and process at all three sites

and then to determine which process is not only the most efficient, but the best

practice for the patient’s.

Successful engagement and collaboration of anesthesia, surgery,

administration, leadership teams and front line staff is what ensured our success.

Go-live date is schedule for April 4th, 2017.

Code Grey in the Operating Room

The PeriAnesthesia/Peri-operative staff at Trillium Health Partners is not

certain whether the recent Code Grey's or System Failure can be attributed to

the ongoing construction or the warmer temperatures. We are certain however,

that the organization has been challenged on more than one occasion in the

past several months with Code Grey. Fluctuating temperature and varying

humidity levels in the operating room have been quite a concern for staff.

According to the Operating Room Nurses Association of Canada

(ORNAC, 2012) the recommended relative humidity range in an operating room

is required to be at 30% to 60%. Temperature range within an operating room is

recommended to be maintained between 20-23 degrees (ORNAC, 2012).

Temperature and humidity must be kept within such strict parameters to reduce

microbial growth and static electricity. If there is a potential breach of

temperature or humidity controls, hospital staff must promptly collaborate with

infection prevention and control, facility engineers, and medical device

reprocessing departments to ensure safety is maintained.

The teamwork, collaboration and dedication displayed by the

PeriAnesthesia and peri-operative staff at Trillium Health partners were

exemplary. On a moment's notice, dedicated staff came together to ensure the

operating room environment and all associated equipment remained sterile

and safe. The work continued for many hours, and extended to several days.

Unfortunately, it was necessary to reschedule some surgeries to ensure

safety for the patients. Staff willingly came together and worked overtime,

Regional Reports

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weekends and evenings for several weeks to ensure delivery of the best care

possible to our community. Great teamwork!

References

Operating Room Nurses of Canada: Standards, Guidelines, and Position

Statements for Perioperative Registered Nursing Practice (2013) Section 4:

Environmental Safety and Responsibilities.

We will keep you updated on our progress.

Thank-you,

Sherry France and Linda Marshall-Masson

Board of Directors, OPANA

Regional Co-directors - GTA

Sunnybrook Health Sciences Centre

At Sunnybrook Health Sciences Centre, there has been a lot of interest in focus

ultrasound treatment with patients who have debilitating essential tremors.

Have a look at this YouTube video for a glimpse into this amazing new work that

is life changing for patients! Focused Ultrasound treats Essential Tremors

Other exciting work includes the work being done by another neurosurgeon, Dr.

Todd Mainprize who has helped discover how to break through the blood-brain

barrier, potentially helping patients with brain tumours receive directed

chemotherapy Breaking through the Blood-Brain Barrier

Regional Reports

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Central Ontario (Georgian Bay Area):

This quarter has been a very busy time. Southlake Regional Health Centre team

welcomed a new Clinical Educator to the Perioperative area, Candace

Epworth. Candace has been a Post Anesthesia Care Nurse for over 10 years

and is excited to start in her new role. In January, the endoscopy unit

implemented CO2 monitoring for designated procedural sedation patients. The

Pre-op clinic has made changes to their patient passport to gather patient

reported data at their visit and give them something concrete to keep track of

what service they are receiving on the day of their visit. Upcoming work includes

working on the new Hospital Information System which is planned for

implementation in 2018.

Karen Wessel, RN, MHA/ED

Board of Director, OPANA

Regional Director – Central Ontario

Eastern Region (Ottawa area): Morag Mercer & Stephanie Currie

Poem Procedure

Peroral Endoscopic Myotomy is used to treat Achalasia and spastic esophageal

disorders not responding to medical therapies, e.g. diffuse esophageal spasm. It

is done by cutting the inner layer of the muscle near the lower esophageal

sphincter the incision is closed with endoscopic clips. The procedure is done

under anesthesia as it takes approximately 3 hours to perform. The poem

procedure is done at Kingston General Hospital by Dr. Bechara and he is the first

to bring this new and innovative procedure to Canada.

NT-proBNP test

This is a blood test done preoperatively to identify patients that are at increased

risk of a cardiovascular event postoperatively. If patients’ blood levels are

increased pre-op, an ECG is done pre-op on the day of surgery and

immediately post-op in PACU and post-op day 1. Troponin levels are also sent

postop day 1 & 2.

Morag Mercer & Stephanie Currie

Regional Co-directors – Eastern Region (Ottawa area)

Regional Reports

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Canadian Nurses Association PeriAnesthesia Certification Exam

On April 5, 2014 PeriAnesthesia Nursing was recognized as the 20th specialty designated

by the CNA for certification. Being a certified PeriAnesthesia nurse nationally

recognizes you as being committed to excellence in your practice and committed to

lifelong learning. It identifies you to your employer, your colleagues, and to your

patients, as someone who demonstrates specialized knowledge and enhanced

professional credibility because you took the initiative to challenge yourself to achieve

your goal of being a certified PeriAnesthesia nurse!

This year, for the first time, CNA is offering the examination in the Spring AND in the fall!

Application to write the exam will be open from January 3 – March 1, 2017. A reminder

that the exam is now conducted completely on-line.

Eligibility:

You must be a registered nurse with current registration or licence in Canada.

You need to meet the experience and/or education requirements (see below).

Your supervisor and/or consultant in your specialty has to fill out the Endorsement

of Experience form.

You must pay exam fees at application time:

o for CNA members $570 + $105 test center fee (+applicable taxes)

o for non-CNA members $756 + $105 test center fee (+applicable taxes)

Experience requirements

Option A — experience only:

A minimum of 3,900 hours’ experience as a registered nurse in your specialty area over

the past five years in full-time, part-time or casual employment.

Option B — experience plus education:

A minimum of 2,925 hours’ experience as a registered nurse in your specialty area over

the past five years in full-time, part-time or casual employment

A formal post-basic course in your specialty area at least 300 hours in length and taken

over the last 10 years.

- See more at: https://nurseone.ca/en/certification/get-

certified/eligibility#sthash.IjegvOD3.dpuf

https://nurseone.ca/certification

Update: CNA Certification

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Spring:

January 3 to March 1, 2017 — Applications to write or renew by exam

May 1 to 15, 2017 — CNA certification exam window

Fall:

June 1 to September 1, 2017 — Applications to write or renew by exam

November 1 to 15, 2017 — CNA certification exam window

Update: CNA Certification

Benefits of Certification

Becoming CNA certified is one of the most positive and powerful achievements for a

nursing professional. As a certified RN, you will have:

the only nationally recognized RN credential for nursing specialties

an advanced level of knowledge, expertise and commitment to show patients,

colleagues and employers

a stronger sense of accomplishment and personal confidence in your practice

greater opportunities for career advancement

a broader network of nursing peers and more ways to showcase your knowledge,

skills and experience

a more focused continuous learning and continuing competence plan

What makes certified nurse’s stand out?

CNA-certified nurses have:

an advanced clinical expertise, knowledge and commitment

specialty knowledge, authenticated by exacting national standards

a clear dedication to quality, evidence-based care

a resolve to pursue life-long learning, patient advocacy and professional practice

a demonstrated commitment to continuing competence and specialized

education

maintained recognized standards of proficiency and professionalism

When you add the official certification credential after your name, patients, employers,

licensing bodies and the public will be able to recognize your experience and

competence in your nursing specialty or area of nursing practice. Once you’re CNA

certified, you’ll stand out as an RN who cares to be the best!

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To access the full article, please click on the link below:

http://www.jopan.org/article/S1089-9472(16)30441-5/abstract

To access the full article, please click on the link below: http://www.jopan.org/article/S1089-9472 (16)30418-X/fulltext?rss=yes

Scholarly Work

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For more information click on link: http://www.aspan.org/Events/2017-National-Conference

ASPAN’s 36th National Conference

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Please click on the link for registration: http://napanc.ca/assets/Forms/2017%20Napanc%20conference%20Registration%20form%20(1).pdf

NAPANc National Conference

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Please click on the link for registration:

http://www.icpan.org/

ICPAN National Conference

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For additional information: Please visit our website: bloomberg.nursing.utoronto.ca

Or contact us at: pd.nursing@utoronto.ca

PeriAnaesthesia Review Course | April 22, 2017

Course Description This one day course will review essential competencies in the care of the adult and pediatric PeriAnesthesia patient. The course will also cover best practices and current evidence related to the care of this unique patient population at each phase of their journey through the perianaesthetic experience. Interactive materials will showcase visually-based aids related to PeriAnesthesia education. Participants will be exposed to content described in the Canadian Nurses Association’s (CNA) Blueprint for PeriAnesthesia Nursing Practice.

Program Learning Objectives Participants will be able to identify common issues in the care of the perianaesthetic patient at

each phase of their journey through the anaesthetic process (i.e. pre-operatively, intra- operatively, post-operatively and upon discharge)

Participants will be able to describe common effects of anesthetic agents on patients

Participants will be able to identify signs of hemodynamic instability

Participants will be able to articulate essential components of a high quality, comprehensive approach to PeriAnesthesia care for both paediatric and adult patients

Participants will be able to describe available resources for PeriAnesthesia education

Audience This one-day workshop is aimed at all health care professionals who are working in or have an interest in PeriAnesthesia Care. This includes nurses working in or interested in working in the recovery room in hospitals service pediatric and adult populations. Nursing students with an interest in care of the PeriAnesthesia patient are welcome to attend this educational event.

The Centre for Professional Development at Bloomberg Faculty of Nursing at the University of Toronto is pleased to present this event.

Continuing Education

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SPRING VEGETABLE GOAT CHEESE FRITTATA

This savory organic Spring Vegetable Goat Cheese Frittata is a simple and quick

mealtime solution that your family will love for breakfast or dinner!

Author: Krissy Allori

Recipe type: breakfast

Yields: 4-6 servings

INGREDIENTS

8 eggs

1 cup cottage cheese (I used Horizon)

1/4 cup flour

1 teaspoon baking powder

1/2 cup fresh snow peas, removed from shell

1 1/2 cup fresh asparagus, chopped into bite

sized pieces

2 cups fresh spinach

2 tablespoons butter (I used Horizon)

4 green onions, sliced thin

4 ounces goat cheese (I used chive flavor)

salt and pepper, as desired

INSTRUCTIONS

1. Using stand mixer with whisk attached, beat

eggs and cottage cheese on medium speed

for five minutes. Then add flour and baking

powder and mix until combined.

2. While eggs and cottage cheese are mixing,

blanch the snow peas, asparagus, and

spinach in boiling salted water for one

minute, then immediately transfer to ice water to stop the cooking process.

Once cooled, strain and squeeze out water from veggies.

3. Preheat oven to 450 degrees F.

4. Heat a 10 inch cast iron skillet over high heat. When hot, melt butter in pan.

Once butter is melted, reduce heat to medium and add egg mixture. Allow

to cook for 1-2 minutes, and then add your blanched vegetables. Then top

with sliced green onions, and finally with crumbled goat cheese. Once egg

mixture has cooked on stove for 5-6 minutes, transfer to preheated oven and

cook until golden brown and mixture no longer jiggles, about 8-12 minutes.

Remove from oven and serve hot.

Health & Wellness

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THE CHOCOLATE SMOOTHIE

Ingredients:

-2 to 4 teaspoons cacao powder (raw cocoa)

-1 medium banana

-1/3 medium avocado

-pinch cinnamon & vanilla

-1/2 cup water (or as needed)

-ice to taste

-1 teaspoon maple syrup or agave (optional, if needed)

Method:

-Blend all ingredients together until smooth

-Serve chilled & enjoy!

Health & Wellness

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Being a member promotes: ✓ Opportunity to network with peers

✓ Pride in having a professional organization

✓ Affiliation with NAPAN©, our national association

✓ Nursing excellence

✓ Advocacy with other qualified PeriAnesthesia nurses

Membership Benefits include: ✓ Quarterly newsletters

✓ Reduced registration fee at OPANA-sponsored educational events

including our bi-annual conference and Annual General Meeting

✓ Reduced registration for workshops

✓ Opportunities for members to apply for financial support for

continuing educational activities (conference bursaries)

✓ Discounts on NAPANc Standards of Practice

✓ Membership in the National Association of PeriAnesthesia Nurses –

Canada (NAPANc)

✓ Opportunity to vote on important OPANA issues

✓ Networking opportunities

✓ Access to our on-line forum

Ways to register to become an OPANA member: Use our website: www.opana.org and join online. Cost per membership is $50.

Member of RNAO? Add OPANA to your membership.

Even better, if you are already a member of RNAO and paying your fees with

an employer payee deduction, consider adding OPANA to your membership.

It would calculate out to less than $13.00/pay for RNAO & OPANA. No hassle,

renewal or fuss!

Membership runs from November 1-October 31. Membership is aligned with

the RNAO membership dates, as well as the annual OPANA conference.

Renew your membership when you register for our conferences. A great

reminder!

Join OPANA today!

For more information on OPANA membership Visit www.opana.org

OPANA is an Affiliated Interest

Group of the RNAO