THIS WEEK'S ARTICLES
Ergonomic Patient Handling Made Easy
Transfer devices stave off strain-related staff injuries while keeping patients safe.
There's no reason for any of your hardworking nurses to suffer a strain injury from transferring a patient from pre-op to the OR table or from the OR to PACU — especially with all the proven transfer devices out there.
Case in point: Small mattresses that inflate and enable healthcare providers to simply and safely slide patients from surface to surface without lifting or straining themselves in the process. Brandy Ginzinger, RN, director of surgical services at UCF Lake Nona Medical Center in Orlando, Fla., swears by these devices to achieve safe and ergonomic patient transfers every time. With this type of transfer device, the uninflated mattress lies flat under the patient in pre-op, and they travel to the OR with the undeployed device flat on the stretcher.
Upon the patient's arrival in the OR, a provider simply plugs in the device. A hose connects to the mattress, with the inflation button at waist level so staff never lose sight of the patient or place themselves in potentially dangerous positions to inflate the mattress, which can lead to strain-related injury. The device even has a feature that essentially makes it foolproof. "It has an outline of a human body to guide patient placement, and an area where staff can write in the patient's identification," says Ms. Ginzinger.
All too often, providers reserve this type of device for heavier patients. However, as Ms. Ginzinger points out, "You can't rely entirely on weight to determine who is best suited for its use." Almost any patient and all providers can benefit from these ergonomic aids, but patients who benefit most from them are overweight, those with physical limitations that make transfers between lateral surfaces difficult, and those who are already ventilated or unconscious.
If you've never used such a transfer device, Ms. Ginzinger has some crucial advice about what to do prior to adding it to your workflow. "Don't just talk through how transfers should work," she says. "See it, feel it and walk through the entire process. Have a staff member lay on the mattress, blow it up and practice transfers. It's much less intimidating to learn the process when you demonstrate it with staff before trying it out on a patient."
The Power of Visual Counts
This facility standardized a counting board for its ORs to better prevent incidences of retained foreign objects.
Retained foreign object (RFO) events continue to occur in ORs, typically due to skill-based errors, communication breakdowns or trouble with tools and technologies. These factors, however, are ultimately preventable through process improvement and standardization.
For example, Jillian Bowers, BSN, RN, CNOR, educational nurse coordinator at University of Michigan Health in Ann Arbor, says incorporating customized count boards into her team's sponge tracking protocol resulted in a "huge improvement" in count accuracy. Previously, staff had used a variety of tools and methods to aid their counts, such as worksheets that were not visible to the entire team and generic whiteboards that were set up differently depending on which team was using them. Ms. Bowers set about eliminating that variability and standardizing a counting method across the entire facility.
Keeping in mind the AORN recommendation to keep the count visual, she assembled a multidisciplinary team to design the perfect count board template for every OR team. "We asked staff members to huddle in small groups and describe their ideal board," says Ms. Bowers. "From those sessions, we took pieces we liked from each group, shared them with the entire surgical staff and incorporated feedback from the larger group in the final design."
The resulting board uses individual, easily identifiable magnets that note the full names of surgical items, as opposed to the various whiteboards and count sheets used previously that included abbreviations and names that varied depending on the team using them, which increased the potential for error.
Common surgical items such as sponges, sharps and miscellaneous supplies are listed down the left side of the board, while the number and types of sutures are listed down the right side so staff can more easily add the numbers vertically. By using removable magnets, staff can customize the board to show only the items that will be in the surgical field for each procedure. This on-the-fly customization helps to reduce the overall clutter of the board, allowing staff to focus on tracking only the items that are used during that particular surgery.
The board is hung in each OR adjacent to the sterile field so it's clearly visible to all members of the surgical team. Ms. Bowers says that staff's involvement in the development of the board was a source of pride that resulted in smooth and wide adoption. "Allowing the staff to participate in the design of the board gave them ownership of what it looks like, how it works and where it's placed," says Ms. Bowers. "We had the staff involved throughout the entire process, and it made a big difference in how well they've incorporated it in their routines." It's proven so popular that Ms. Bowers says three surgery centers within the Michigan Health system also added the board at their facilities.
Ms. Bowers says the new count board bolsters Michigan Health's culture of accountability and transparency, which aims to prevent never events from happening. "Communication and teamwork are huge across the board," says Ms. Bowers. "Without that, you'll run into issues."
Bringing Holistic Safety Solutions to Patients and Healthcare Professionals in the Outpatient Surgery Setting
Focus on safer care, better outcomes is a priority for OR teams and this industry partner.
Top of mind for those who serve in the outpatient community — for the past two years and running — has been the safety of the patients who place their trust in their healthcare professionals. These OR teams offer their surgical services across many specialties in today's pandemic environment, and they have been vigilant about their patient's safety and outcomes. Of course, patient safety has always been a priority in ambulatory surgery centers, but today this renewed focus has spurred much discussion and innovation for the field.
When patients enter a hospital outpatient department or ASC, they should not have to worry about safety concerns, including surgical site infections, pressure injuries, complications resulting from retained surgical sponges and fall-related injuries. These conditions can be costly to treat and can disrupt the recovery process for patients.
Safety has always been part of the history at Stryker, starting with the founder Dr. Homer Stryker's first products. Over the years, the company has continued to look for ways to innovate new products or acquire businesses that promote patient as well as caregiver safety. Safety is more than just the products offered – it is the education, ongoing support, processes and partnership with customers that help deliver better patient outcomes across the continuum of care.
Stryker Chair & CEO Kevin Lobo shared on LinkedIn "Patient safety and outcomes have always been at the core of our evidence-based design process in all of our products. With this in mind, we continue to push for advances in visualization, stroke therapies, orthopaedics, robotics, emergency care, arthroscopy and interventional spine. We also have increasingly personalized approaches to musculoskeletal procedures and have made advancements in digital and enabling technologies to help surgeons safely perform procedures."
The company demonstrates a strong commitment to protecting patient safety through technology initiatives and customer feedback. Through this feedback, Stryker has developed and acquired solutions to meet the unique needs of customers. Examples include evacuating surgical smoke from ORs, providing filtration systems, securing controlled substance waste, and combating infection with cleaners and disinfectants. Company-wide collaboration brings holistic safety solutions to both patients and caregivers across the continuum and sites of care, continuing to drive toward greater impact through new technologies.
Solutions to further enhance patient safety include Neptune SafeAir Smoke Evacuation. A day in the operating room (OR) for an HCP can have the same impact as smoking 27 unfiltered cigarettes.1 Stryker's suite of smoke evacuation products helps reduce caregiver exposure to these biohazards.
Another safety solution is the SurgiCount and SurgiCount+ Safety-Sponge Systems, a digital process that assists doctors and nurses in tracking surgical sponges during surgery. The system has been used in over 16 million procedures, potentially saving the healthcare industry more than $825 million.2
With this keen focus on safety across the continuum of care, both patients and staff are offered the practical solutions to make the surgical journey in both outpatient departments and ASCs a safe and successful one.
Note: For more information please go to https://www.stryker.com/us/en/about/annual-review/2021.html
1. Hill DS, O'Neill JK, Powell RJ, Oliver DW. Surgical smoke - a health hazard in the operating theatre: a study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units. J Plast Reconstr Aesthet Surg. 2012;65(7):911-916.doi:10.1016/j.bjps.2012.02.012.
2. Jones A. Stryker builds surgical safety business with no-mistakes sponge system. M Live. https://www.mlive.com/news/kalamazoo/2017/09/stryker_builds_surgical_safety.html Accessed February 8, 2022.
How to Use C-Arms Safely
Best practices and new safety features limit radiation exposure.
Training staff to take the right precautions in conjunction with C-arms that have the latest safety features can protect them and their patients from exposure to dangerous levels of radiation associated with fluoroscopy. Here's how to achieve adequate time, distance and shielding levels to make intraoperative imaging safe and successful.
Reduce time and dosages. Relying more on pre-op images can equate to less intraoperative C-arm usage while helping you abide by the "as low as reasonably possible" principle, says Bart J. Friedman, MD, a radiologist at Allegheny Valley Hospital in Natrona Heights, Pa. "Analyzing original radiographs before performing the fluoroscopic examination can reduce the repeat rate for the time required for the procedure," adds Andriy Kekosh, RT, a radiology technician and radiation safety officer at Boston Out-Patient Surgical Suites in Waltham, Mass.
Newer C-arm features such as image-holding capacity, pulsed fluoro, single pulse, manual mode and time-warning settings can further help to limit radiation exposure times. Some models also include laser-aimers and flat-panel image detectors. Good technique on the part of your radiologists, such as tapping the activation pedal rather than keeping their foot down on it, also helps reduce exposure.
Maintain safe distancing. Be mindful of the source-image distance when using the C-arm. Keeping patients 12 to 15 inches from the X-ray tube and as close as possible to the image intensifier can drastically reduce the amount of exposure to scatter radiation.
Promote PPE use. Staff should always don leaded eyewear with side shields, leaded gloves and a wraparound apron when working on imaging cases, says Mr. Kekosh. Lead acrylic shields placed under the OR table or mounted on the ceiling also help to limit staff exposure to radiation scatter. Dr. Friedman says radiation badges or dosimeters are important for radiology technologists who frequently work surgical cases so they can monitor their own exposure levels.
By combining best practices, a trained staff and newer equipment designed with safety in mind, your staff can generate the images they need while minimizing radiation exposure to staff and the patient in the process.
Protect Your Team From the Dangers of Surgical Smoke
Perioperative staff at this hospital are breathing a little easier, thanks to the efforts of two nurses.
Why don't all healthcare facilities employ surgical smoke evacuation systems? The problem is that many providers are not aware of the devastating effects surgical smoke can have on their bodies. "I had been in the OR for a year before I heard about the risks of surgical smoke," recalls Carolyn Maxam, RN, MSN, CNOR, a surgical nurse at Glen Falls (N.Y.) Hospital. "I knew it smelled awful, but I didn't know the dangers associated with it."
Surgical smoke has been shown to contain toxic gases, viruses and bacteria, causing eye, nose and throat irritation, headaches, congestion and asthma-like symptoms in more than a half-million healthcare workers who are exposed, often for hours at a time. That is why Ms. Maxam and surgical nurse Britny McFadden, MSN, RN, OCN, teamed up to tackle the issue head on.
The two nurses performed ample research and then trialed smoke evacuation products. "We called all the vendors ourselves and asked them to send us information and flyers," says Ms. Maxam. "We then went to our leadership team with the information we gathered, and together we chose three different evacuation systems to trial."
Surgeons trialed each system in the OR for three to four weeks each. "Some surgeons only operate one day a week, so we wanted to make sure they all had an opportunity to evaluate them," says Ms. Maxam. Although some surgeons pushed back on the idea of using the devices during surgery, many stated that as long as the system did not interfere with their procedures and wasn't excessively noisy, they would have no problem adding it to their surgical routine.
Now the air is much cleaner in the hospital's ORs. "Proper surgical smoke evacuation is important for the health of everyone in the room," says Ms. McFadden. "If you can smell it, you're breathing it in."