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Make the Switch to Safety Scalpels
Practical advice for getting your (protected) points across.
David Bernard
Publish Date: July 9, 2015   |  Tags:   Staff Safety
safety scalpels CONVERSION Counter users' skepticism with data and education.

You know why your surgeons need to use safety scalpels: Because government regulations and professional organizations demand them, and because you want to protect your employees from on-the-job injuries. How to get the devices into surgeons' hands, though, is a more challenging question. For 3 facilities that made a switch and made it stick, the conversion depended on information and involvement. Here's how.

1. Support your case
Before you propose a change to your facility's clinical practices — and by most accounts, adopting safety scalpels is a sizable change — back up your case with compelling evidence and moral support.

The OR staff at Sumner Regional Medical Center in Gallatin, Tenn., hadn't experienced much in the way of scalpel jabs, but the potential for harm remained a chief concern for the center's safety committee. When the state's occupational safety and health department issued standards on preventing healthcare workplace risks, it put the committee's concerns into sharp focus.

"The OSHA ruling helped us to go to surgeons and tell them, 'We don't have a choice. To protect our staff, to meet state requirements, we have to at least try this,'" says David Wilkerson, BBA, BSN, RN, Sumner's director of surgical services.

A scientific, data-driven appeal coached surgeons to do, or at least begin to consider, the right thing. "Doctors are very 'show it to me, prove it,'" says Mr. Wilkerson. "We showed them data on all the sharps sticks throughout the facility, national data, and percentages — if you're in this many cases, here's the likelihood you'll be injured."

Seeking out allies among your facility's leadership can also boost the cause. "Doing the right thing means getting the right people involved," says Gail Law, BSN, director of standards and quality at Essex Specialized Surgical Institute (ESSI) in West Orange, N.J., which has predominantly used safety scalpels since its opening in 2009. Your medical director and chief of business operations, for instance, are not only obligated to provide a safe place to work, but have a vested interest in avoiding the health, staffing and legal costs of sharps injuries, she says.

safety scalpel HANDS ON A role in the choice can help surgeons to accept safety scalpels.

2. Involve your physicians
Swapping out all of your center's scalpels for safety-engineered blades is by no means an easy assignment, but it will be much easier to sell to your surgeons if they have a say in the process.

"Don't force a change on anyone," says Karen Maloney, RN, BSN, CASC, directory of ambulatory surgery centers for Allegheny Health Network in Wexford, Pa. "Let them know that this isn't optional, but make sure they feel like they're part of it. A decision is being made, and they get to choose which one they'll be using."

Physicians at her health system's 3 ASCs are currently in the process of hands-on trialing 3 types of safety scalpels. One unique benefit of this particular trial, she notes, is that it hasn't been weighted by cost considerations since the scalpel's prices aren't that much different from each other.

Instead, the instruments' weights and the ease of activating their safety features were front and center. "The handles were a big deal," says Ms. Maloney. "Were they close to what they're used to handling? Did they change how they do things?"

The participatory roles you extend to your surgeons should be genuine and not perfunctory. When you're reviewing their survey responses on what they liked and disliked about a product, or discussing their experiences with each one, take their input seriously, even if this means considering an option outside of the original purchasing plans.

"Ultimately, we explained that we were switching to safety blades," says Ms. Law, "and if they did not like these, then we would find an alternative. One surgeon did not like [a manufacturer's blade]. The rep tried to work with her, but eventually we switched to another manufacturer's safety blade."

3. Reps are a resource
A safety scalpel vendor's rep may be able to do much more than just supply you with products for your trials. Find out if you can enlist them to help in education and evaluation efforts, even beyond a promotional introduction to their blade's highlights. "An attentive rep will work with you as a team," says Ms. Law, who points out that it's in their interest to do so if they want your business.

ESSI's preferred safety scalpel rep logged plenty of time on site during the trial. "She observed surgeries first before we changed over," says Administrator Joyce Kozacik, RN, CASC, who coordinated the switch with Ms. Law. "Then she made suggestions on how the surgeons could use the safety scalpels better, like going in at a slightly different angle, and offered them all the different product options available."

"The rep spent every day, for weeks on end, with them until they'd identified which blade the doctor wanted," says Ms. Law. "The size, the width, the bevel. So much goes into the selection of an appropriate blade. This seemed well-received by the physicians."

A resourceful rep might even be able to parlay a sharps conversion into a net gain for your supply budget. ESSI's rep put together procedure packs containing ophthalmic safety scalpels and disposable cannulas for less than what the center's non-safety blades cost. "Economics was a great selling point to win surgeons over," says Ms. Kozacik. "The rep created customized packs for each physician, which made pulling cases a lot easier."

4. Respect surgical realities
When you're planning hands-on trials for safety scalpels, keep in mind that (as with any new product) initial uses may present users with a learning curve. "Pick a lighter-volume day, or run the trial only for a portion of their cases," says Ms. Maloney. "If a new scalpel slows down their day, you don't want to ruin their schedule."

Also, be aware that following safety guidelines will not eliminate all unintended consequences. To be specific, there are some things that a shielded scalpel can't do. "You retract the cover, and you only have so much blade for an incision," says Mr. Wilkerson. "Some orthopedic cases, some larger patients have more tissue to get through. Without a safety cover, the blade can go where it needs to."

While nearly all of Sumner's cases employ safety blades, the center still holds some traditional scalpels in order to avoid adversely impacting the process or compromising outcomes. "They're packaged separately, they're not in any tray," says Mr. Wilkerson. "A scrub is responsible for pulling them when they're needed, and the reason must be more than just, the surgeon doesn't want to use a safety knife."

Last but not least, if your initial efforts to implement safety scalpels fail, don't give up. Keep looking and keep trialing. "Continue to search for something that satisfies your surgeons," says Mr. Wilkerson. "Until you reach that product, continue to trial. All that you can do is what you have to do to keep staff free from injuries."