Implementing a sharps safety program is a three-step process
Publish Date: 3/29/2012
Despite calls to action and regulatory standards, there is still an issue with implementing sharps safety initiatives in the OR. The keys to implementing an effective sharps safety program are three-fold: availability, policy and leadership.
Step one is to have the appropriate tools available and to have a good selection of these tools to encourage surgeons to use sharps safety devices, said Ramon Berguer, MD, FACS, during “Sharps Safety: It’s a Team Effort” on Thursday. The good news is that the tools are out there now, he said. If nurses make ordering easy and provide a good selection of devices, it will be less difficult to get surgeons to adopt them.
Dr. Berguer adopted the use of safety needles (a term he prefers to blunt tip needles, which just sounds bad, he said) because of his belief that the risk of using sharps wasn’t worth it. Estimates of suture needle injuries are as high as 80,000 per year at a cost of $40 million. Needlesticks are the most common cause of accepted worker’s compensation claims in the United States, and fines and liabilities could reach into the millions.
Step two is to establish an OR sharps policy. With a policy in place, nurses can promote safe sharps practices with the clout of their institutions behind them. Having a policy in place makes the “loop of accountability” smaller, Dr. Burgeur said, noting that although surgeons probably don’t know anyone from OSHA, and therefore may not feel the pressure of an audit, they are accountable to the institutions where they practice.
To promote compliance with sharps safety policies and long-lasting change, it is important to foster a culture of safety, said Deborah Spratt, MPA, BSN, RN, CNOR, NEA. To do that, Spratt said, tell the perioperative team members what the benefits are for making a change, and discuss any proposed changes before they are put into practice so people have a chance to acclimate to the idea before they have to implement it. Having a champion available to promote the change is integral to success. For maintaining the change, particularly in terms of supply changes like blunt tip needles, remove the old supplies from circulation. “People slip back very easily,” Spratt said. “You need to take the old product out and bring the new product in to make a true change.”
The third step is to ensure leadership support for the program. Dr. Burgeur emphasized the importance of having support from the administrators and the chief of surgery. Start with identifying a physician champion, he said, and then gain administrator and leadership support through education. “But you have to keep going back and be an example,” he added. “They may not like you and they may not like it, but they have to support [the sharps safety effort] or no one will follow it.”
In implementing a sharps safety program, AORN has created the Sharps Safety Tool Kit. Donna A. Ford, MSN, RN-BC, CNOR, described the resources in the multidisciplinary tool kit, which include webinars, FAQs answered from the surgeon and surgical technologist perspectives, education sessions, evidence-based posters, a sharps safety checklist, sample evaluation tools for sharps safety devices, a video demonstrating use of a neutral zone, a letter to surgeons to help with buy-in, and a collection of resources for further reading.
A 2010 study changed Dr. Berguer’s view from encouraging the use of safety needles to mandating policy changes. The authors analyzed percutaneous injury surveillance data from 87 US hospitals during a 13-year period. Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the passage of the Needlestick Safety and Prevention Act of 2000, injury rates in nonsurgical settings went down by 31.6%, but went up in surgical settings by 6.5%. This shows the importance of mandating sharps safety policies in the surgical setting, Dr. Berguer said.
The four primary evidence-based techniques for sharps safety are using double gloving, blunt tip suture needles, safety engineered devices, and a no passing zone. Additional resources that can be helpful for supporting data are on the CDC and University of Virginia Health System websites. There are also position statements and other supporting documents for sharps safety on several association websites, including American Nurses Association, American College of Surgeons, Association of Surgical Technologists, and Council on Surgical and Perioperative Safety.