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4 steps to shape fire risk assessment

Publish Date: 10/3/2012

Know your fire risk. That's the message perioperative fire safety experts stress as health care facilities across the country take time to recognize National Fire Prevention Month.

"While many surgical teams have incorporated fire risk assessment into their safety checks prior to the procedure, many others still do not - they should," advises AORN Perioperative Nursing Specialist Byron Burlingame, MS, RN, CNOR.

Last year AORN released a detailed fire risk assessment checklist as part of its updated Fire Safety Tool Kit (free to AORN members). The FDA Preventing Surgical Fires initiative, a project Burlingame and AORN partners such as the Council on Surgical and Perioperative Safety have worked closely with, also includes information on fire risk assessments.

Burlingame suggests 4 steps for creating and implementing fire risk assessment:

Step 1: Form a multidisciplinary team and decide together what type of assessment should be used 

"Protecting patients from fire MUST be a team approach," Burlingame stresses. He suggests a representative from each role on the surgical team have a say in shaping the assessment process.

A fire risk assessment tool is used to assign a rating to key risk factors, such as if an alcohol-based skin prep agent is used, if the procedure is above the xiphoid process, or if supplemental oxygen and lasers are used. Some examples of risk level designation include:

  • A, B, C, D, E, with results being any one letter or any combination of the letters
  • 1, 2, 3, 4, with results being a total number indicating level of risk
  • High, medium, or low risk designation

The result of the assessment is associated with specific interventions to be performed by each team member.

Step 2: Tailor the assessment to fit the team's workflow and needs 

The RN circulator often leads the fire risk assessment and many facilities incorporate this assessment into the "Time Out" script and documentation prior to the case, Burlingame notes.

"Make sure the assessment takes place when all team members are engaged and can participate - this allows them to mentally and physically prepare for their role in fire safety."

Step 3: Educate all surgical team members on the specific roles, risks and interventions for fire risk assessment 

"Timing is everything when it comes to fire safety. It's critical to understand your individual role and the role of your team members in conducting the assessment," Burlingame explains.

Comprehensive fire safety education should be included in training to conduct the assessment. Burlingame points to resources in AORN's Fire Safety Tool Kit, and the FDA Preventing Surgical Fires website.

Step 4: Measure consistent use of fire risk assessment and each team members competency with fire safety interventions 

Observation and documentation audits are valuable ways to make sure the fire risk assessment is being practiced, Burlingame advises. He also stresses the importance of measuring competency in fire safety interventions. This competency tool for nurses is also included in AORN's Fire Safety Tool Kit.

"Communication is key," he stresses. "Talk to the staff, and ask about ways to adjust and refine the assessment so it works."

Additional Resources 

Access AORN's Fire Safety Tool Kit
[AORN members have open access, anyone can join AORN to gain access]

Explore the FDA Preventing Surgical Fires website for education and recommendations addressing fire prevention.


Guidelines for Perioperative Practice


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