Staff Safety

CLEARING THE AIR Terri Foster, BSN, RN, CNOR (right), shows a scrub tech how to use the smoke evacuator.

The hazards of surgical plume are well known, and have been for a while. So are the benefits of using smoke evacuation devices and safety experts’ recommendations to do so. But at one Michigan hospital, the issue just wasn’t among many staff members’ top priorities.

A little more than a year ago, smoke evacuators were being used in less than one-third of cases. Terri Foster, BSN, RN, CNOR, the surgical services educator at Allegiance Health in Jackson, Mich., knew it was going to take more than just orders from above to encourage the use of smoke evacuation technology. Ms. Foster and her colleagues used troubleshooting and trialing, facts and humor, documentation and monitoring to clear the air. For their efforts to protect their staff from harmful surgical plume, we proudly award the team at Allegiance Health the OR Excellence Award for Staff Safety.

Finding out what works
The facility already owned smoke evacuation equipment, and staff had been encouraged to use it. It was time to figure out why they didn’t. “The initial barriers included the bulkiness of the tool and the loudness of the machine in operation,” says Ms. Foster. “The biggest thing surgeons wanted was something that wasn’t going to be in the way. Noise was the other consistent objection.”

On the plus side, they had a wider range of options to trial this time around. As it turned out, the trials didn’t just eliminate the factors that didn’t work for the OR teams. They also illuminated what did work. “We found an accessory that connects between the electrocautery machine and the smoke evacuator device, which triggers the evacuation to turn on when the cautery pencil is in use and to shut off when it’s not in use,” she says.

This automatic activation makes the smoke evacuator abundantly more usable, and safety equipment that is easily and conveniently usable is more likely to motivate staff to comply with safety practices.

HEAVY LIFTING
Solutions That Spare Staff’s Backs

UP AND AT ‘EM A sit-to-stand lift and walker is one of many tools for safer patient transport.

Even your most gung-ho, can-do nurses and techs aren’t immune to the hazards of trying to lift or transfer patients without assistance, and a momentary lapse in judgment can leave them — and you — dealing with the resulting musculoskeletal injuries, reduced abilities and absences. Help them to protect themselves by equipping your facility with a range of lift-assist equipment to maintain proper body mechanics in various situations, and by training your staff to use the devices, says Maria Sliwinski, RN, MHHS, CNOR, the clinical educator for surgical services at St. Elizabeth Boardman Health Center in Boardman, Ohio.

The pre-op and PACU departments at her facility, part of the Humility of Mary Health Partners (HMHP) system, have ready access to inflatable cushions for patient positioning and transfer, wheeled walkers with attached seats and portable battery-powered sling lifts. OR team members use slider sheets to move patients between stretchers and the table.

Orientation for new hires, routine “boot camp” reviews for lift champions and annual competencies for staff help to encourage the equipment’s use and spare employees’ backs and extremities. “It was a big initiative throughout HMHP,” says Ms. Sliwinski, “and it’s pretty much hard-wired with us. It’s easier on patients, and there’s less risk of us hurting ourselves.”

— David Bernard

It’s a truism, incidentally, that Ms. Foster’s facility has also put to service in other efforts. Where there’s smoke, there’s a fire hazard, particularly when you’re using alcohol-based skin preps around electrosurgical devices and oxygen. To make sure staff observe the manufacturer-mandated 3-minute dry time in the hustle of a surgical schedule and prevent the risk of flash fires, each OR got an easy-to-set-and-reset kitchen timer that counted down to safety. “This left no room for discrepancy between the nurse and surgeon in terms of dry time,” says Ms. Foster.

A slide show with a smile
If you want your educational in-services to be effective, you have to hold your audience’s attention. Ms. Foster knows a couple of tricks for varying her presentations and keeping staff meetings lively.

“I may use a ‘Jeopardy’ game to train on a less-than-interesting subject,” she says. “Or, throughout the presentation, I’ll add a humorous slide to try and keep staff engaged. Our surgery manager has said that she knows there will be at least one cute dog picture in any presentation I am giving.”

So, along with explanations of what generates plume (in addition to cautery and laser use, be wary of orthopedic power tools), an admonition that a room’s airflow exchange isn’t nearly as effective in evacuating smoke as a targeted suction device is, and warnings of respiratory risk, there’s a sprinkling of wit. The presentation’s title, “The Dangers of Smoking in the OR,” is accompanied by a stock photo of an old-style gentleman with a cigar. Signs depicting a seabird behind a red circle-slash (“No puffin”) were posted around the ORs. “If the hospital is smoke-free, why should our OR staff have to put up with secondhand smoke?” asks Ms. Foster.

The education also includes hands-on training, since knowing how to properly use the equipment is key to routinely putting it to use. An employer has a vested interest in protecting its workers’ health, she notes. “We don’t want their lungs to be the thing that filters the smoke out.”

There are even a couple of administrative steps you can add to the daily surgical routine to make sure smoke evacuation is a consistent caution, not an occasional afterthought.

“After we find out what each physician likes or doesn’t like working with, we add the smoke evacuation equipment to their preference cards,” says Ms. Foster. “That helps a lot with use.”

The facility’s also added smoke evacuation use to its pre-op safety checklist, documentation that it uses to monitor compliance. Electronic medical records make it easy to check the box reporting that the equipment was in use during a case, as well as to quickly review the number of cases per month in which it was used.

“Our service-line managers also spot-check random cases when electrosurgery is in use, to see if smoke evacuation is also in use,” she says.

The results have been encouraging. By October of 2013, compliance had jumped to 91%, and “since January 2014, our compliance has consistently been 95% or higher,” says Ms. Foster. “Now it’s a team effort. Everyone encouraging everyone else to do the right thing.”

— David Bernard