For the second straight year, Outpatient Surgery is proud to recognize a few of the country's extraordinary leaders and finest surgical facilities with our OR Excellence Awards. Statuettes are not included, only the shine of the spotlight on those who too often toil in anonymity. A few months ago, we invited surgical facilities of all types to nominate themselves for achieving excellence in one of 6 critical areas: financial management, pain control, patient satisfaction, infection prevention, patient safety and staff safety. We were wowed by the quality and the quantity of the nominations. Winners were chosen for the outstanding contributions they've made to the ambulatory surgery industry and for the wonderful examples that they've set. The profiles you'll read over the next 23 pages are a testament to the remarkable work surgical facility managers and outpatient surgical facilities are doing every day. Please join us in congratulating this year's winners.

— Editors of Outpatient Surgery Magazine

FINANCIAL MANAGEMENT

When last we wrote about The Surgery Center at Brinton Lake, the news wasn't good. "Embezzling Business Manager Gets Jail Term," screamed the headline last December. Part obituary and part crime report, the story underneath detailed how the ASC in suburban Philadelphia discovered that a trusted employee had stolen $245,000 over a 15-month period, slowly draining the center dry so as not to arouse anyone's suspicion.

Joseph Grostas rang up $59,545.37 in unauthorized charges on the center's credit card, transferred $71,000 to his personal bank account, diverted $21,706.78 to pay his mortgage and made more than $26,000 in cash withdrawals from the center's account. The damage went beyond stolen money. A grim paper trail showed that Mr. Grostas was also derelict in his duties. The ASC owed $650,000 to vendors — bills the now-jailed business manager duped others into believing he had paid.

How does a small business recover from such a disaster? It took some selling, but Gina Espenschied, RN, BSN, CNOR, the ASC's plucky administrator, convinced her 24 physician-owners that she could restore the center to good financial health in 6 months.

"I told them, 'Give me 6 months. If we work with our vendors and keep cases coming in, we can do this.' Ms. Espenschied resisted her surgeons' offer of a cash call to pay off their debt to vendors even though, she says, "early on it was a struggle every month to meet payroll and to pay our bills."

And now, less than a year after a scandal that nearly sunk it, The Surgery Center at Brinton Lake is back on its feet again, hosting between 550 and 600 cases a month and aggressively paying down its debt. The LLC's physician-investors even received dividend checks in April, but only enough to cover each partner's tax burden. So dramatic has the 5-year-old center's turnaround been that we've named it winner of Outpatient Surgery Magazine's 2010 OR Excellence Award in Financial Management.

Reversal of fortune
Once the finger-pointing stopped and the shock wore off in the wake of the embezzlement, Ms. Espenschied and her team got to work.

• Paying their vendors. She and Materials Manager Jeffrey Graham explained their plight to vendors and worked out a 6-month payment plan with each. The ASC didn't ask for its debts to be forgiven, only for some time and some leniency. "They were all understanding. A few of them were really down about the whole thing," says Ms. Espenschied. "They got us all the back invoices we needed."
• Lightening their inventory. When Ms. Espenschied started at the ASC in September 2007, $273,000 worth of inventory sat on the shelves. "It looked like a distribution warehouse instead of a surgery center," she says. She's since trimmed the on-hand inventory to about $113,000 — including implants she inherited — that the center turns over every 90 days. Part of the paring meant returning unused and unneeded items to vendors. She remembers the OR crammed with rows of tables filled with items to return to vendors, including 15 boxes of size 8 of the most expensive surgical glove. The ASC also steadfastly purchases products off GPO contracts and runs product trials. "We farmed out everything for pricing," says Ms. Espenschied. "If it was acceptable clinically, we went with it."
• Renegotiating their contracts. The fastest way to the unemployment line is to host lots of money-losing cases. Ms. Espenschied identified 10 such cases, including Medicare shoulders with lots of hardware and fractures that were costing nearly $3,000 in supplies while paying only $700.
• Tightly managing their cash. The ASC is tending to the many small and not-so-small practices that promote financial health. Like paying bills on time (fewer than 42 days), collecting appropriate co-pays and deductibles on the date of service, and hitting monthly financial goals. "Our accounts payable department is very aggressive in ensuring that payment to vendors goes out promptly," says Ms. Espenschied.

Ms. Espenschied credits Lisa Payne, the ASC's scheduler, with helping the center run lean and mean. Ms. Payne is a whiz at condensing the daily schedule to allow for maximum utilization of staff so "we don't have staff not doing patient care." Not long ago, 5 surgeons were running 5 ORs every morning until 10 a.m. and then the cases dried up and "we'd have a lot of people here for the beginning of the day but not doing anything afterward," says Ms. Espenschied. "We owe them hours. Nobody wants to work someplace where you're supposed to be working full-time, but you get sent home every day at 11 a.m." One quick fix: The ASC gave the center's heavy users 3 full block days a month so they can do a full day's cases in the OR.

Brighter days ahead
The Surgery Center at Brinton Lake might forever be associated with the 2008-09 embezzlement scandal that nearly toppled it. But rather than dwelling on its past, the staff and surgeons are busy creating a new legacy. Maybe that's why Ms. Espenschied also nominated her facility for an OR Excellence Award in Patient Satisfaction.

— Dan O'Connor

PAIN MANAGEMENT

Regional blocks and pain pumps are at the core of anesthesia care and pain control at the famed Andrews Institute Ambulatory Surgery Center in Gulf Breeze, Fla., whose 8 ORs see lots of orthopedic and ophthalmology cases. Of the 426 procedures that the ASC performed this June, more than half (241) employed blocks. Only 77 of June's 426 patients (18.07%) were administered narcotics in PACU, and that was comparatively high, says QA Coordinator Barbara Holder, RN, LHRM, who has tracked the data since the center's first cases in April 2007. In the 2,885 cases performed between January and June 2010, only 353 (12.24%) required post-op narcotics. "Without narcotics, they can interact with family, eat and drink, and maintain control of their pain, because they're out ahead of it," says Terri Gatton, RN, CNOR, CASC, administrator of the center we're pleased to name winner of Outpatient Surgery Magazine's 2010 OR Excellence Award for Pain Control.

"Monthly, our pharmacy consultant is amazed regarding the low number of narcotics that we use throughout our facility," says Ms. Holder. "Our secret is the administration of regional blocks. Our anesthesiologists are experts."

Dispensing fewer post-op narcotics and discharging patients on time keep the center's surgical schedule efficient. Plus, the anesthesia providers' blocks make the facility and its care look extremely effective, says Gregory Hickman, MD, director of anesthesiology and medical director, a lasting impression on patients that administrators and surgeons certainly appreciate.

"Our patient satisfaction numbers have always been 95% or 96%," says Ms. Gatton. "Word of mouth is the cheapest form of marketing."

Dr. Hickman estimates that 90% to 95% of hospital patients and well over 50% of surgery center patients are administered opioids in post-op. But he's well aware of the number he and his staff are aiming for: as few as possible. "We're setting a benchmark," he says. "It's hard to beat what we're doing."

Making it work
Dr. Hickman began placing interscalene blocks in shoulders 20 years ago and has been working with Andrews Institute founder James Andrews, MD, since 1992. Hand-picked by Dr. Andrews to oversee regional anesthesia at the ASC, he's been applying block techniques — supported by local anesthesia infusion pumps that provide continuous care for 3 to 4 days post-op — to such aggressive orthopedic cases as unicondylar knee replacements, high tibial osteotomies, major humerus fractures, open and total shoulder repairs and surface reconstructions of shoulders and knees. In 3 ? years, the center has sent more than 2,000 patients home with infusion pumps for post-op pain relief.

One key was getting the ASC's board to agree to a $50,000 ultrasound machine. "Ultrasound guidance is successful and consistent," says Dr. Hickman. "I would not consider doing blocks without an ultrasound machine anymore."

Ms. Gatton sold the board on the goodwill ultrasound would engender among surgeons whose patients wouldn't call them in pain after hours.

The block nurse
Specially trained nurses dedicated to block administration are assigned to assist the center's 2 full-time anesthesiologists throughout the day, every day. As with surgeon and scrub tech, the procedure goes more smoothly if the assistant knows the way.

Ms. Gatton has news for you if you think you don't have enough staff or payroll to form a block team. Regional anesthesia reduces the need for post-op patient nursing, letting you move a full-time equivalent from her PACU role to a block nurse job in pre-op.

The Andrews Institute ASC has trained 33 nurses on how to take the block nurse concept —"an incredibly efficient model," says Ms. Gatton — back to their facilities. The center hosts regional anesthesia fellowships and ultrasound cadaver lab sessions. "People come to watch how we do what we do," says Ms. Gatton. "It's going to make them more efficient."

Every pre- and post-op nurse can assist in educating regional anesthesia patients on what to expect following surgery and how to operate the local anesthesia infusion pumps once they get home. Dr. Hickman says that every patient is discharged with a sheet of instructions that includes his cell phone number in bold print, but even considering the aggressive cases for which blocks are used, he gets very few calls from patients.

— David Bernard

PATIENT SATISFACTION

Back in the 1990s, Ruth Baltes, RN, MSN, attended a 6-week seminar at UCLA Medical Center that forever changed her perspective on patient care. The hospital had hired an international firm to come in and teach caregivers how to apply customer service principles from the corporate world to health care. "At the time I thought it was ridiculous to call patients 'customers,'" recalls Ms. Baltes. But the concept stuck with her, and she says a commitment to customer satisfaction is what sets Monterey Peninsula Surgery Center, where she's worked as a PACU nurse and educator on and off for the past decade, apart from other facilities. It's also what makes Monterey the winner of Outpatient Surgery Magazine's 2010 OR Excellence Award in Patient Satisfaction. "While our philosophy is patient-centered care, we realize that we are running a successful business," she explains. "The patient is our customer, and we want that customer for life."

Ms. Baltes knows that the concept of patient-as-customer makes some caregivers squeamish. But times have changed. Patients now have much more control over where and how they'll receive care, and competition among providers has become more heated in today's difficult economic climate. Particularly in the outpatient surgery arena, where patients are usually electing to have procedures done, "we can't assume, as we did 20 years ago, that everyone's just going to come to us," says Ms. Baltes. While it seems strange to hope that patients will return to your facility — after all, no one wants to have surgery — disappointing just 1 customer in a relatively small community can have devastating ripple effects for any business. That's why when Ms. Baltes looks at satisfaction ratings of 99% for her facility, all she can see is the 1% who weren't satisfied and what that might mean for future volume. "We know that we can't just be 'good.' We need to be 'excellent' to get [patients] to return or recommend us," says Ms. Baltes.

So what separates a good patient experience from an excellent one? After nearly a decade of poring over patient satisfaction surveys, Ms. Baltes found it's quite simple: People want to be heard and appreciated. "You don't need to give out expensive cookies or lattes or hire a designer to come in and fix up the place," she says. "A lot of what people write is about their feelings, the intangible things of what is happening" during their stay. For example, they're likely to mention whether the surgeon listened and answered their questions, whether cases were running on time or whether the facility looked clean. "We don't have latte machines or fancy hotel rooms," she says. "We've found we don't need those things. It's the intangible things that result in great service and satisfaction."

Sympathetic ear
When Ms. Baltes first started working at Monterey Peninsula Surgery Center about 10 years ago, it was one small, wholly physician-owned facility. Back then analyzing patient surveys, running reports and handing them over to the board was a simple process that "didn't seem that important," she recalls. But after taking a hiatus for several years to start a family, Ms. Baltes returned to the center (now with 3 locations and a total of 8 multispecialty ORs) in a very different economic and healthcare climate. She soon recognized that the old way of doing things wasn't going to cut it anymore.

Focusing on that 1% of patients who weren't satisfied, Ms. Baltes began organizing surveys according to categories of complaints — pre-op, post-op, facility, staff — and compiling the data in graphs and tables for facility leaders to analyze. Then she picked up the telephone and began calling patients directly to address their concerns. Rather than getting defensive, Ms. Baltes lets dissatisfied patients know that she agrees with and understands their frustration, and that she intends to do something about it, thereby turning a negative into a positive. "If you really listen to them and respond to them, you'll find they aren't angry anymore. After their complaint is heard, I can often regain their loyalty." In fact, Ms. Baltes says most patients are excited to hear from her; they don't expect that their surveys will be read, let alone taken to heart.

Teachable moments
A patient's complaint is "really a gift," says Ms. Baltes. "Otherwise, how would you know you were doing something wrong?" Treating each complaint as a teachable moment for the staff, Ms. Baltes uses role-playing exercises to reinforce customer service skills. For example, in a workshop for nursing assistants, she had staff members pose as patients and had the nursing assistants "admit them" to the center, teaching them how to personalize each patient's visit by introducing themselves in a familiar way, gently touching patients on the shoulder and saying "thank you" before they leave. "That human element makes it much more personal for the patient," says Ms. Baltes, who noticed that after the workshop, patients started mentioning more staff members by name in their surveys. "That's when you really know you're doing a good job, when they say they felt like family and remember the names of people."

Positive reinforcement with staff helps boost customer service, too. Every month, Ms. Baltes compiles a list of surgeons and staff members whose names appeared in positive comments on patient surveys and publishes it on a bulletin board in the break room. At the annual Christmas party, the staff member who was mentioned the most throughout the year receives special recognition and a prize. "I try to carry that same mantra about being heard and recognized to the staff and surgeons — our internal customers," says Ms. Baltes. "If we respect each other and have a happy staff, then we have happy patients."

Always room to improve
The Monterey Peninsula Surgery Center is not resting on its laurels. The facility hopes to solve a recurring problem identified in patient satisfaction surveys: how to keep friends and family members apprised of their loved ones' status during the perioperative process. "The nurse doesn't always have time to run out there and say how things are going," says Ms. Baltes, so the center's looking into hiring more staff or recruiting volunteers to serve as liaisons who can answer questions that family members in the waiting room may have. "It is really quite simple: We are not perfect. We want to improve. People have the need to be heard, understood and appreciated."

— Irene Tsikitas

INFECTION CONTROL

Whenever Executive Director Emily Duncan, RN, BS, CASC, and OR Director Bobbie Kendrick, RN, CNOR, see staff or surgeons at the Lakeland Surgical & Diagnostic Center practicing proper hand hygiene, they pass out gold-plated dollar coins. The positive reinforcement has worked. "We had heard of a center that gave out pink slips, but that didn't seem like an employee-friendly approach," says Ms. Duncan. Instead, thanks to a suggestion from the center's CEO, the facility, winner of Outpatient Surgery Magazine's 2010 OR Excellence Award in Infection Prevention, launched a hand hygiene surveillance program based on rewards, not punishment.

Staff and surgeons at this Lakeland, Fla., facility take infection prevention seriously. They study it. They meet about it. They constantly strive to make improvements to their hand hygiene protocols, environmental cleaning and product purchasing. Ms. Duncan and Ms. Kendrick lead the charge. They manage a program that focuses on providing continuous education for staff and physicians, who in turn have bought into the importance of curbing surgical site infections.

Setting the tone
Ms. Kendrick is known to walk unannounced into ORs to look for infection prevention breaches. It's during those impromptu visits that she notices the little things that can lead to big problems: staff wearing outside clothes under scrubs or personal jewelry that's left uncovered. More often than not, however, Ms. Kendrick is happy about what she sees: a group of caring professionals who want to get it right. "People get nervous when I walk in the room," she admits, "but the visits let them know that we're serious about infection prevention."

The beauty of the center's infection prevention program is that, while it's headed by Ms. Kendrick and Ms. Duncan, it's driven by insights gathered during quarterly meetings of the infection prevention committee, which is composed of representatives from each department in the facility. Ms Kendrick says it's that facility-wide participation that delivers the message of the infection prevention program more broadly than if mandates were delivered to the front line without soliciting feedback. Staff take more of an ownership in policies they help create, and take more interest in implementing them in everyday practice.

In addition to the in-house department representatives, an epidemiologist and pathologist from outside practices sit on the committee. "They bring a higher level of expertise," says Ms. Duncan, adding that the docs raise the committee's effectiveness to another level and ensure the facility is following the latest national and evidence-based standards. When infections strike, says Ms. Duncan, the physicians provide insights into why or how they occurred, which validates the findings of internal investigations and lets her focus her efforts on solutions that work.

The facility also boasts a product standardization committee that regularly assesses the latest options in cleaning and chemical disinfectants, as well as hand hygiene and environmental cleaning products. Its goal, says Ms. Duncan, is to standardize the products used throughout the facility based on staff suggestions, clinical research and product trials.

Hands-down winners
The key to improving hand hygiene compliance is to conduct ongoing surveillance at irregular intervals, says Ms. Kendrick. Occasionally stand near scrub sinks or hand sanitizer dispensers — without a clipboard in hand, so you don't draw attention to yourself — and observe your staff's hand hygiene routines. Nurses and docs shouldn't know when you're watching, but they should that you could be watching.

Empower your staff to patrol the hallways, looking for colleagues who forget to scrub or wash their hands properly, the 2 managers advise. Give each worker a stack of small business-sized cards that contain the message, "Save lives, clean your hands." When staff members forget to wash their hands after caring for a patient, an observant co-worker should slip them one of these friendly reminders.

Ms. Duncan even found an instructional video (of sorts) on the CDC's website. The video shows a French modern dance troupe's interpretation of proper hand hygiene protocols in the healthcare setting (see for yourself here: www.vigigerme.org/videos). The video is a little zany, but the way it delivers its message is unforgettable, say Ms. Duncan and Ms. Kendrick, who showed the performance during a mandatory quarterly staff meeting. They had their staff stand up, mimic the hand hygiene movements and, perhaps most importantly, laugh. They made infection prevention fun. They made it memorable. "Our staff will never look at hand hygiene the same way again," says Ms. Kendrick. "On occasion, we still see them performing the dance in the hall."

Visiting vendors aren't exempt from following the facility's hard-and-fast hand hygiene rules. Each must pass a web-based infection prevention education program before he can enter the facility; vendors must also scrub in before they enter the OR, and are held to the same rigorous standards as surgical professionals. The facility's surgical manager educates each vendor individually about scrubbing's do's and don'ts, and isn't afraid to boot noncompliant reps out of the OR.

Hand sanitizer dispensers and signs hang next to each of the facility's entrances. Volunteer guides greet visitors with a smile and a reminder about the facility's hand hygiene protocols. Ms. Duncan says accreditation surveyors were truly impressed by the greeters' knowledge of the facility's hand hygiene protocols and friendly insistence that all visitors comply with it.

Whatever it takes
"We've learned more and more" as the years have passed, says Ms. Duncan. "We went from covering the typical things to working with a 10-module educational program that's mandatory learning for everyone at our facility, including the physicians." She believes excellence in infection prevention lies in a refusal to settle for anything less than the very best practices. "We want to do whatever it takes to ensure our patients and staff are in the best hands when it comes to infection prevention," she says.

— Daniel Cook

PATIENT SAFETY

At Blanchard Valley Hospital in Findlay, Ohio, improving patient safety is ingrained in the facility's fiber. It's not a sometimes-thing; it's an everyday approach to how things are done. Constant attention to safety measures, infection control practices, professionalism and staff education contribute to high-quality care that patients receive.

"This attention to patient safety and quality delivers peace of mind at an anxious time," says Marlene Brunswick, RN, MSN, CNOR, RNFA, director of perioperative services at the 150-bed hospital with 8 ORs. The effort has also paid off in the hospital's ratings. HealthGrades rated Blanchard Valley among the top 5% of 5,000 hospitals across the country for patient safety, based on 12 measures including surgical outcomes, post-op care and the number of complications.

Perioperative educator
About 4 years ago, the surgery department created a full-time perioperative educator position in order to have a single point-person in charge of new employee orientation and staff education. Educator Kristina Jolliff, RN, BSN, CNOR, RNFA, has a surgical background, so she understands the challenges and the culture of a busy surgical department that does about 4,000 cases a year.

Every Friday morning at 7 a.m., Ms. Jolliff heads an education meeting for the perioperative staff where the team discusses such safety issues as changes in guidelines from the Joint Commission or the Association of periOperative Registered Nurses. Having an educator lets Ms. Brunswick funnel information and changes in policy she's learned in hospital committee meetings to an educator who can adapt the changes into training sessions. Ms. Jolliff also manages yearly updates of staff competencies and organizes demonstrations or training sessions with sales reps so that staff is well-trained on the devices used in the department.

Beating benchmarks
One of the goals of the perioperative services department is to create an environment that exceeds minimum expected benchmarks for surgical site infections for class 1 and class 2 wounds established by the Centers for Disease Control and Prevention. "We strive to be under the benchmark," says Ms. Brunswick.

In the last few years, the perioperative department has begun using antimicrobial sutures, improved its teaching methods for pre-op skin cleansing and strictly enforced proper surgical attire. "No jewelry is to be worn in our surgical suites, for example, to stress the importance of recommended standards," says Ms. Brunswick.

The department also gets patients involved in infection prevention. Surgery patients are required to take a chlorhexidine shower the night before and the day of surgery. Each patient receives a bottle of the soap during the pre-op visit. Handing the patient a bottle of chlorhexidine gets patients thinking about their role in preventing infections. "It helps increase awareness," says Ms. Brunswick. When patients arrive on the day of surgery, a staff member asks if they've taken their shower.

Year-round compliance
To make sure that the perioperative staff is complying with Joint Commission requirements, staff from other departments are assigned, or volunteer, to conduct "mini-tracers" to audit compliance with requirements such as using 2 patient identifiers to make sure that the right patient is receiving the right treatment, or avoiding the use of possibly confusing medical abbreviations. These reports tell the department how well the staff follows guidelines during periods between visits from surveyors, who usually visit every 3 years. "We want to always be in compliance," says Ms. Brunswick.

Another way of improving the quality of care that patients receive is to encourage staff to continue their educations. Many staff members in the perioperative services department have certification in their specialties. Surgery Charge Nurse Stacy Graymire, RN, BSN, and Surgery Department Manager Trevor Schmiedebusch, RN, BSN, CNOR, RNFA, help staff members advance professionally and earn an RN, BSN or MSN. Ms. Brunswick also accommodates the time constraints that come with going back to school and working at the same time. "We adjust staffing to fit their class schedules," she says.

Unlike many hospitals, Blanchard Valley hasn't cut its tuition reimbursement, and the perioperative services department has a budget for purchasing educational materials. Investing in your employees pays off in better delivery of care and professionalism, says Ms. Brunswick. "They take more ownership for their behavior."

Continuous improvement
At Blanchard Valley, Ms. Bruns-wick and her colleagues are always improving the processes that protect patients. Currently, the surgical department is expanding the electronic documentation system, which will help with medical reconciliation to prevent medication errors and allergic reactions.

Keeping patients safe is a full-time job for everyone. It means ensuring that every staff member pays attention to detail during every case. "That's our commitment," says Ms. Brunswick. "Quality in medical care takes a true team effort."

— Kent Steinriede

STAFF SAFETY

Several years ago, the data on sharps injuries at Blessing Hospital were all over the place. There'd be 2 to 3 injuries per month, then a period of no injuries for a couple months before the injuries would start again. "It looked like the spikes on an alligator's back," recalls Lori Fecht, RNFA, director of perioperative services, who in January 2007 was one of the leaders of a Six Sigma team analyzing 3 years' worth of sharps injury data at the 9-OR facility in Quincy, Ill. While the occasional periods without injury were encouraging, the spikes indicated that process improvements were needed to protect surgical staff from this recurring occupational hazard. That's when Six Sigma "Master Black Belt" Al Miller stepped in and issued this challenge to the staff: "We can eliminate sharps injuries in the OR!" Three years later, Ms. Fecht says the annual rate of injuries has fallen from more than 10 in 2007 to a single injury so far in 2010.

Redefining sharps safety
No other department in the 450-bed hospital had more sharps injuries than surgery. A performance improvement team assembled to tackle the problem. The team consisted of a surgical tech, RNFA, OR supervisor, hospital safety officer and physician champion (a general/vascular surgeon), with Mr. Miller and Ms. Fecht leading the charge. A review of previous years' data on sharps injuries revealed that problems with the handling of sharps were a recurring trend, so the team began by establishing a new sharps safety policy. The key elements of the policy include:

• Mission statement. Designed to inform the staff of the overarching goals of the sharps safety policy, this brief overview says that "if we standardize our functions and behaviors, we can eliminate sharps injuries in the OR," explains Ms. Fecht.
• Operational definitions. The policy defines in clear terms every aspect of sharps handling that could be described. For example, it explicitly spells out what it means to hand a sharp "up" or "down."
• Sharps zone. The new policy creates a uniform, standardized process for passing sharps on the field. No one is to pass a sharp directly. Instead, each case must establish a sharps zone (usually a standard white towel) and all staff must use trays to pass needles, knives and other sharp devices. The only exceptions to this rule are certain gynecological and microsurgical procedures, where other equipment and the positioning of the patient and surgical team would inhibit the use of sharps trays.
• New sharps containers. The hospital purchased large bins and placed one in each OR. The bins, operated by foot pedals, let staff remove sharps from the field, open the lids and immediately discard them without having to transport them over long distances or potentially contaminate their hands by coming into contact with the bins.

Policy into practice
After several months of constructing and refining the new policy, the performance improvement team educated the surgical staff — including physicians — on it and implemented the new sharps zone method of passing. While this initial education was important, Ms. Fecht says "monthly audits were key to ensuring staff were well-educated and compliant" with the new policy. "You can know the policy, but unless you can demonstrate competency related to the policy, you're not going to be effective."

In the beginning, members of the performance improvement team conducted the audits, since they were most familiar with the new definitions and procedures. Eventually they handed auditing duties to members of the surgical team so they could keep tabs on each other. Using statistical process control charts, team leaders took the data from the audits and charted it alongside sharps injury data to see how compliance with the new policy corresponded to injury rates. "As long as we were in compliance, we saw we didn't have any sharps injuries," says Ms. Fecht. But that doesn't mean the hospital immediately went to a 0% rate of sharps injuries. Instead, the new policy sparked a steady decline, with 6 injuries reported in 2008 (when compliance with the brand-new policy was 87%), 3 reported in 2009 and 1 reported in 2010, when compliance reached 99.8%.

When injuries do occur, the staff members involved are asked to come before the sharps safety leadership team and explain what happened. In most cases, says Ms. Fecht, staff admit to taking shortcuts or ignoring the policy because they're in a hurry. Ms. Fecht says open communication among staff is key to the success of the sharps safety policy. She checks in with staff from time to time to ask if physicians and other team members who were at first resistant to the new policy are continuing to comply, and she encourages staff to speak up and remind their colleagues that they need to use the sharps trays. "You have to emphasize that it's a safety risk," says Ms. Fecht. "I don't think anyone would deliberately hurt someone, but if you're not compliant, someone's going to get hurt."

Ongoing education
Over the past 3 years, Blessing Hospital has "not only dramatically reduced injuries, but has sustained this very important safety initiative in the operating room," says Ms. Fecht. Sharps safety education is a mandatory part of orientation for new staff and also part of annual competencies. "We're in sustain mode," she says.

— Irene Tsikitas