Dangerous
savingsPerioperative professionals can play an important
role is speaking up to ensure cost-cutting measures are safe
By Carina
Stanton
Senior News Editor/Writer
What is the cost of safety in your OR? This is a question one perioperative professional was recently forced to consider when her manager told staff they were no longer allowed to double-glove unless working on an orthopedic case or working with a patient known to be infected with Methicillin-resistant Staphylococcus aureus, hepatitis or HIV/AIDS. Citing the use of double gloves in other cases as a waste of money, the manager also told staff members to begin to wear exam gloves for decontamination work, so as not to waste surgical gloves.
"I have been double-gloving for five years and know for a fact that this has saved me many times from having blood or other body fluids come in contact with my skin," said the perioperative professional asked to make these changes, who preferred to keep her name anonymous. "I feel there is a total loss of concern for how we protect ourselves," she added.
Is one glove enough to keep you safe? Single-gloving
and other cost-cutting measures some healthcare facilities
may be implementing in this down economy could impact safety
and cost more in the long run.
Standing up for safety
"AORN firmly believes in double-gloving to protect yourself, because double-gloving minimizes the risk of healthcare workers being exposed to blood during invasive procedures," explained Mary Ogg, RN, MSN, CNOR, a perioperative nursing specialist in AORN's Center for Nursing Practice.
She pointed to several resources that cite data supporting double-gloving for invasive procedures, including AORN's Recommended Practices for Prevention of Transmissible Infections in the Perioperative Practice Setting (Perioperative Standards and Recommended Practices, 2009 Edition, pages 475-485), the American College of Surgeons' Statement on Sharps Safety and a February 2009 article in AORN Journal, "Do surgical personnel really need to double-glove?"
Ogg encouraged any perioperative professional facing similar safety risks in the healthcare setting to share these resources with colleagues and to stay informed about ongoing research in sharps safety through sources such as the AORN Journal.
Finding surgeon champions is also a good way to encourage safety practices such as double-gloving, according to Ramon Burguer, MD, chief of surgery at Contra Costa Regional Medical Center in Martinez, Calif.
He suggested that perioperative nurses trying to encourage safety practices in their facilities "become conversant and aware of the current available data on safety measures, because data are usually the most powerful drivers of change in professionals such as nurses and physicians."
Listen to an interview with Burguer and Trish Seifert, RN, MSN, CNOR, CRNFA, FAAN, editor-in-chief of AORN Journal about ways to implement sharps safety in your facility.
Penny-wise, pound-foolish
"Reducing supply use is one method facilities may be using to cut costs in this down economy, but when you get down to cutting basics like gloves, that is not an area worth compromising," said Peggy Camp, RN, BSN, MSN, clinical resource director for the continental division of Hospital Corporation of America who works regularly with perioperative staff to find safe, sustainable ways to reduce supply costs.
Another dangerous cost-cutting measure facilities may make that impacts safety is asking staff members to wear a less expensive, non-enforced gown, even when this level of protection is not sufficient. Quality can also be impacted when facilities move to using lower quality materials. For example, low quality sponges may drop fibers.
Then there are cost-cutting measures that just don't make sense, such as purchasing less expensive surgical hats that may be smaller, so a staff member needs to wear three caps to cover their head, Camp explained. "Being penny-wise but pound-foolish doesn't save money; in fact, it often ends up hurting facilities by impacting safety, quality and costing more in the long run."
Smart cost-control
In the last three to four years, healthcare facilities have taken a closer look at supply costs in the perioperative setting, because OR supplies represent 60% of hospital costs overall, according to Camp.
"I like to look at controlling cost versus reducing cost. It's close to impossible to reduce costs, but all healthcare professionals, from administrative leadership to staff working directly with patients, need to be mindful of costs and be good stewards of resources," Camp said.
| Top 5 ways to control supply costs in the OR 1. Find ways to use less customized and more standardized supplies, when appropriate 2. Consolidate different products used for the same purpose, when possible 3. Consider using remanufactured, reusable and reposable supplies 4. Work with vendors on existing contracts for better pricing 5. Find ways to reduce waste in the OR, such as not opening supplies that may not be used Source: Peggy Camp, RN, BSN, MSN |
She outlined several key areas where cost-controlling in the perioperative setting can make a difference.
The first step is to evaluate current inventory, starting with commodity products, such as gowns, gloves, masks, dressings and packs. Consolidating some of these products can help to control costs.
However, Camp cautioned that any changes to supplies must include input from staff. "A change in product has to be a good fit and be championed by users," she said. "Simply making a change and telling staff to conform to it, without gathering their input, will make it more difficult for change to be accepted."
Reducing waste and moving from customization to standardization where it makes sense is another way facilities can find ways to control costs. For example, Camp said, on average, 13% of supplies and products pulled for a case are thrown away. By opening only what is needed for a case, this waste can be reduced.
Standardizing physician preferences, when appropriate, can also help in controlling costs, but again, she stressed the need for communication to ensure standardization be done appropriately.
"It is also important to keep in mind that many physicians may not be thinking about supply costs, because they haven't been asked to, but this economic challenge we are all facing is a good time to educate staff about costs," Camp explained. "Just raising awareness about supply costs with all members of the surgical team can really make a difference."
Beyond supplies
Facilities also need to think twice before making other cost-cutting measures, such as cutting education and overworking staff, which also can impact safety and quality and can impair cost-savings, according to Byron Burlingame, RN, MS, CNOR, a perioperative nursing specialist in AORN's Center for Nursing Practice.
For example, a staff member who is not properly educated to reduce surgical site infection may cost a facility more money than it would have cost to provide that staff member with needed education.
He said online education is one way to stay current with practice, while controlling costs, but facilities need to make sure they are providing access and awareness of alternative education if funding for traditional education methods is reduced. Find AORN's online continuing education offerings.
Appropriate staffing also can become a challenge in a tight economy, particularly if staff numbers are reduced or open positions are not filled.
"Perioperative leaders need to be conscious to schedule staff in ways that prevent fatigue," Burlingame said. He pointed to resources that provide guidance on preventing fatigue for perioperative nursing staff, including the Nursing Organization Alliances' Principles of Fatigue and AORN's Guidance Statement: Safe On-Call Practices in Perioperative Practice Settings.
Talk back
What are safe ways your facility is controlling costs? Tell us by sending an e-mail to aornnews@aorn.org with "Savings" in the subject line.
Read more news in AORN Connections.