Top Perioperative Concerns For 2016
In the most recent OR Today Reader Survey, readers were asked to identify the most pertinent issues that will affect OR nurses and surgical techs this year. Here, are the things that are top of mind for OR professionals as we enter the new year with insights from industry experts.
“The perioperative arena has always presented a challenge for the staff and for their leaders in trying to find the work/life balance that is critical to their mental and physical well-being,” says Virginia Chard, Director of Surgical Services for Pen Bay Medical Center in Rockport, Maine.
“As a surgical director in a community hospital, this becomes even more of a challenge due to a smaller number of staff sharing in the call burden,” Chard adds.
Along with the challenges associated with call – the uncertainty, sleeplessness and stress – another factor that Chard believes is impacting work/life balance in the OR is the generational differences in today’s workforce.
“The OR workforce today is statistically older than the general nursing population,” she says. “Senior team members have a different expectation and understanding of the perioperative role, including the responsibility of call, while younger staff are seeking more of a balance.”
Younger OR staff have a different expectation of their role and the on-call responsibilities that go with it, Chard adds.
“As OR managers, we are being challenged to find mechanisms to make the on-call burden workable across the workforce,” she explains.
Pen Bay Medical Center has created a system referred to as “Sleep Time” that is designed to help OR staff achieve a more healthy work/life balance. Employees who work the day following a night of call are only scheduled to work a four-hour shift that day, but they’re paid for an entire eight-hour shift.
“The younger members of the team appreciate the additional time this gives them in their busy lives,” says Chard. “And Sleep Time has provided a safety net for all staff for those busy nights of call.”
Staff Recruiting, Retention and Training
“My top two concerns are retention of existing employees and recruitment of new employees,” says Ren Scott-Feagle, MSN/Ed, RN, CNOR, Clinical Educator for Surgical Services at the University Medical Center of Southern Nevada in Las Vegas.
“In my opinion, the most crucial aspect of retention is tracking and addressing ‘why’ employees are leaving,” Scott-Feagle adds. “Failure to measure and analyze separation statistics and address the ‘why’ question results in a revolving door that negatively affects patient care and staff engagement.”
Susan Phillips, Vice President of Surgical Services at UNC Hospitals in Chapel Hill, North Carolina, says that staff recruiting and retention are what keeps here up at night.
“It seems like we are all recruiting for the same small group of perioperative staff,” she says.
“Even more than in the past, we are searching for candidates who are knowledgeable, adaptable, flexible and professional,” Phillips adds. “I still think compensation may move a candidate, but fit will keep the candidate on your team.”
According to Phillips, UNC Hospitals does Workforce Engagement Surveys every year to determine what staff members want from their jobs.
“Our staff wants to have the resources to do their job well – instruments, supplies, equipment and training,” she says.
“And they want engagement and involvement in their daily work environment,” Phillips adds. “They want to see that fairness is used and for everyone to do their job well, completely and consistently.”
Sharon Morris, Surgical Services Staff Nurse at North Valley Hospital in Kalispell, Montana, says that they are getting a large number of new “green” nurses in the operating room.
“They are not really receiving much training in the area of surgery at their schools of nursing,” she says.
“I would like to see nursing schools include the specialty of surgical nursing in their curriculum,” Morris adds. “There is such a wealth of information in regard to sterile technique, instrumentation, positioning and the ability to operate medical equipment in the surgical arena that is so foreign to nurses just getting out of school.”
Fortunately, there is some good news on the infection prevention front. According to the most recently released statistics from the Agency for Healthcare Research and Quality (AHRQ), hospital acquired conditions (HACs), which include health care associated infections (HAIs), fell by 17 percent in 2014.
Due to this decrease in HACs, 87,000 fewer hospital patients died and $19.8 billion in health care costs were saved between 2011 and 2014, the AHRQ estimates.
“Although HACs persist despite incentives and strategies to eliminate them, these reductions indicate that hospitals have made substantial progress in improving safety,” the AHRQ noted when releasing the statistics.
Amber Wood, MSN, RN, CNOR, CIC, Senior Perioperative Practice Specialist with the Association of periOperative Registered Nurses (AORN), says that the best way to reduce HAIs is to follow the manufacturer’s instructions for application of the skin antiseptic.
“Also, practice excellent hand hygiene and provide a clean environment for the patient,” says Wood.
Wood notes that since the White House issued the National Action Plan for Combating Antibiotic-Resistant bacteria early last year, there has been an increased focus on antimicrobial stewardship in infection prevention.
“Perioperative nurses should learn about their role in antibiotic stewardship, as this is a very real threat to our patients experiencing successful surgical outcomes,” Wood says.
Sterilization and Cleaning of Endoscopes and Utensils
Education and experience are of the utmost importance when it comes to sterilizing and cleaning scopes and utensils, says Nancy Chobin, President and CEO of Chobin & Associates Consulting in Lebanon, New Jersey.
“OR personnel should never process an endoscope unless they have been trained and their competencies verified,” says Chobin. “And competencies should be performed annually.”
Chobin has observed that scope processing often gets put aside until “there is time” since the patient must come first.
“However, delays in processing a scope can lead to cleaning issues which can ultimately impact successful high-level disinfection,” she says.
“I usually recommend that the facility limit the number of nurses assigned to scope processing so they do not have lapses in the processing,” Chobin adds. “The nurses should be assigned the responsibility for processing the scopes as their major responsibility that day.”
While regular instruments and utensils are usually processed by sterile processing staff or trained endo technicians, Chobin says most facilities today are using endoscope technicians to reprocess scopes.
“These devices are highly sophisticated and should only be cleaned by staff who continually perform these functions and who have demonstrated competencies for processing each type of endoscope used at the facility,” says Chobin.
AORN Changes to Scrubs Dress Code
According to Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, Director, Evidence-Based Perioperative Practice for AORN, the changes made to the AORN surgical attire recommendations are minimal.
“For example, ‘no fleece’ was removed from the guideline,” she says.
“Any fabric worn in the OR should be tightly woven, low linting, stain resistant and durable, no matter the type of fabric,” Spruce adds. “There are some fleece fabrics that meet this requirement and may be worn as long as they are laundered by a health-accredited laundry facility.”
The other major change, says Spruce, is that when non-scrubbed personnel are in the restricted areas, they should completely cover their arms with a long-sleeved scrub top or jacket.
“So arms should be covered while in the restricted area, while prepping the patient’s skin, and while preparing and packaging items in the clean assembly section of the sterile processing area,” says Spruce. “Previously, the guidelines said that arms had to also be covered in the semi-restricted area.”
Also, AORN reinforced the recommendation to not home launder scrubs, Spruce adds.
Overcoming OR Challenges
Keep these tips and ideas in mind as you and your staff strive to overcome the greatest OR challenges of 2016.