LOOKING SHARP Ms. Plett ordered custom-made lead aprons for staff who work a lot of X-ray cases.

From the filters in their facemasks to the soles of their non-slip shoes, the surgical staff at Honorhealth Scottsdale Thompson Peak Medical Center in Scottsdale, Ariz., might be the best-protected group in all the land. And they have Pat Plett, BNRN, MS-HSA, CNOR, the winner of this year's OR Excellence Award for Staff Safety, to thank for making employee safety a top priority.

"My motto is, if I get told no the first time I ask for a staff safety purchase, I just have to do a better job the next time," says the pleasantly persistent Ms. Plett, 56, the clinical director of perioperative services. "No does not mean I'm not going to ask again. It just means I have to do my homework a little better and have a little more research to show."

When it comes to protecting her staff from harm on the job, Ms. Plett will spare no expense and let nothing stand in her way. Take the wheels on every piece of rolling equipment, for example. When pressure-washing stripped away the natural lubrication from the wheels on the case carts and back tables, making maneuvering them "like trying to push the wheels through mud," Ms. Plett battled and bargained until she won approval to replace all the wheels. The cost: $30,000.

Staff notice such above-and-beyond efforts. "People feel like she listens to them and actually gets things done for them when they bring concerns forward," says OR Supervisor Pat Sega, MSN, RN, CNOR. "She's good at pursuing important issues and not letting them drop. She sticks with it and makes sure that it gets done."

There's more. Much more. Ms. Plett bought 8 (one for each OR and a spare just in case) closed fluid waste management systems so staff didn't have to handle canisters and put themselves at risk of exposure to bloodborne pathogens. She bought personalized and fitted lead aprons for staff that work ortho and spine cases, and ordered customized ergonomic chairs for her pre-operative assessment nurses who spend most of their workdays seated, either talking on the phone or staring into a computer. Then there were those underperforming facemasks and a few other threats to staff safety for Ms. Plett to slay.

PERFECT POSTURE Ms. Plett ordered customized ergonomic chairs for staff who sit most of the day.

• Facemasks. It turns out the facility's most popular facemask fit and felt better than it filtered biohazards. It said so right there on the box that the mask, the one everyone liked so much, didn't meet AORN's standards for laser safety for cautery smoke plume filtration, so Ms. Plett got rid of them. "All of our masks should reach a certain level of filtration that indicates that they're safe," says Ms. Plett, adding that surgeons and staff were upset when she removed the mask from the supply room. They backed down once Ms. Plett explained her reasoning. "I wasn't going to be convinced to bring it back," she says. "If there's really a safety issue or concern, it's going to take a lot for me to change my mind."
• Wheels. Back to those wheels. As Ms. Plett found out the hard way, there's a potential downside to pressure-cleaning your OR equipment. The power of the water can literally rinse away the natural lubrication from wheels. "Staff were having a terrible time trying to move all of the wheeled pieces of equipment," says Ms. Plett, who called the situation a "back injury waiting to happen." But they weren't just harder to maneuver than a rusted shopping cart. The pressure-washing also apparently loosened some of the wheels from their legs. When staff lifted a table loaded with orthopedic implants over a cord, a wheel fell off, sending the table's contents flying down the hall. That's when Ms. Plett ordered new wheels for every back table and case cart, including pins that go through the table leg where the wheel attaches. No more grunting and groaning when wheeling equipment, and no more tables tipping over.
SLIPS, TRIPS AND FALLS Staff at Honorhealth Scottsdale (Ariz.) Thompson Peak Medical Center get a $40 credit each year to purchase slip-proof shoes.
• Shoes. Every Thompson Peak employee receives a $40 annual stipend toward a pair of slip-proof, skid-proof shoes: housekeeping, nursing, everybody. The shoes cost around $60, so staff only have to pay $20 out of their own pockets. "We've shown that [these shoes] dramatically reduce the number of slips, trips and falls, and injury to staff — as well as injury claims," says Ms. Plett, who adds that staff who decline the stipend must still wear slip-resistant shoes in and around the OR.


PREVENT SHARP INJURIES Ms. Plett instituted a no-passing zone policy to cut down on sharps injuries and needlesticks.
• No-pass zone. To prevent needlestick injuries in the OR, Ms. Plett established a "no-pass zone" policy. "Being the advocate for the staff, I know that needlesticks are the biggest hazard in the OR," she says. "Physicians can be so focused on what they're doing that they don't want to look up when passing scalpels and needles." It took a lot of educating, but the surgeons now know to place all sharps in a neutral zone rather than handing sharps. Ms. Plett also added labels on sterile packs that indicate a no-pass zone. "It's a bright yellow visual that reminds everyone that this is a no-pass zone," she says. "This is where you place sharps. Don't just throw them on the Mayo stand."
• Video cameras. It's not uncommon to have video cameras in your ORs, but what about security throughout the rest of your facility? Ms. Plett had cameras installed in the storeroom, the sterile processing department, pre-op, the sterile core, the lounge, vendor staging areas and hallways. This has helped in a couple ways, says Ms. Plett. First, it makes visualization easy, especially during off-hours. Second, it cuts down on the amount of walking for the staff member at the control desk looking for a team member. "But the biggest thing is [security] off-hours," says Ms. Plett. "Who's where, what do I need. If I'm here by myself, I can see if anybody is in here that shouldn't be — especially in such areas as the central storage room and vendor staging, where we house the most expensive things."
• Safety coaches. Each perioperative department has safety coaches, volunteer nurses or techs, who assist in encouraging safe practices in their areas. The safety coaches are Ms. Plett's safety deputies. They have the authority and autonomy to remind staff, "Oh, by the way, you shouldn't be bending that way to transfer a patient." They place warning signs on wet floors and correct surgeons who don't use a no-pass zone.
• Fluid waste disposal. Safe fluid waste disposal was a big box for Ms. Plett to check off, not only to prevent possible contamination by bodily fluids but also to reduce hazardous disposal. She converted each of her 7 ORs to closed fluid systems, wheeled machines that, once filled, staff roll into a water closet and connect to a docking station, a specially plumbed port through which the machine empties and cleans itself. "There's always an opportunity for contact with infectious waste when disconnecting a canister from a suction line and capping it," says Ms. Plett, who says staffers have more than once accidentally spilled a canister on the floor.
GOOD FOR THE SOLE An anti-fatigue mat for the nurse who stands at the OR control desk workstation.
• Ergonomic workstations. Ms. Plett was familiar with the ergonomic studies that show the hazards of sitting in front of a computer for hours at a time, which is precisely what her pre-operative assessment clinic staff did each day. To protect her staff's posture and vision, Ms. Plett ordered an ergonomic chair for each clinic staff member and hired a consultant to set up their workstations, keyboards and monitors just so. She did the same for her billing and scheduling person. She also reconfigured the OR control desk workstation so that the nurse working there can stand while she charts. "Standing can be more productive than sitting," says Ms. Plett. Of course, she placed an anti-fatigue mat at the OR control desk.
• Individualized lead aprons. Thompson Peak does a lot of ortho and spine cases, procedures that of course require X-rays. For proper fit and cleanliness, Ms. Plett ordered individualized lead aprons for certain staff members. "If they're too big and too heavy, they can be tough on the back," says Ms. Plett.

SAFE TRANSFER It takes little effort to transfer patients on a cushion of air.

ST. JOSEPH/CANDLER HEALTH SYSTEM
Transfer Patients With Ease

Back injuries to surgical staff members can be debilitating. Unfortunately, they're a common occurrence when staff transfer patients to and from a stretcher or a bed, especially total joint and neuro patients who can't help lift and move themselves. At St. Joseph/Candler Health System in Savannah, Ga., Arthur B. Shumate, RN, BSN, MSN, CNOR, the system director of surgical services, says that HoverMatts have solved the problem. "Every surgical patient gets a HoverMatt," says Mr. Shumate. "It literally hovers them up on a cushion of air. It barely takes any strength at all to move them to a stretcher or bed." You'll find a HoverMatt in each of the 17 ORs at St. Joseph's, plus a few in pre-op as well.

— Dan O'Connor

Worth it?
Thompson Peak's staff retention and satisfaction scores are all the proof Ms. Plett needs to know that her safety efforts are well worth the effort and expense. "Having been a staff person, it's nice to know that somebody is listening and cares about what you think," she says. "That is huge. Staff's opinions count. I like to listen. Usually when concerns start bubbling up, they're related to safety. I take them seriously and like to be proactive. I don't like to wait until something happens." On Ms. Plett's watch, chances are they won't.

— Dan O'Connor