By Elizabeth Even, MSN, RN, CEN
There are few areas where precision and accuracy matter more than within an operating room (OR). It is difficult to identify another location that is under such intense time pressure and scrutiny. In ambulatory surgical centers (ASC), surgical procedures must be correct, and they must be time efficient. When patients enter an ASC, they are likely amid hundreds of thousands of dollars of life-saving equipment, medications and instrumentation. However, even the best equipment and technology available is useless without a highly trained health care team standing around the OR table. Competently trained and experienced staff is invaluable for any organization, and many would argue that staff members are the most precious resource in health care. Afterall, without staff, an ASC loses its ability to care for patients. In surgical environments where patient conditions may change rapidly and care decisions must be made quickly, proficient staff are an even more critical component.
Because of the incredibly important role staff play in health care, ensuring a safe work environment is vital. In addition to suffering from scheduling crunches, health care organizations also must endure the cost of lost staff due to both turnover and time off following a workplace injury. The price tag can be staggering. According to Becker’s Hospital Review health care injuries cost health care organizations billions of dollars every year in addition to millions of days of lost work. The article continues stating that the health care industry reports a significantly higher number of injuries compared to other areas, with OR injuries landing high on the list. Lengthy cases, awkward postures, sharp instruments and heavy instrument trays are just a few common culprits lurking in an ASC that can cause staff injury.
As discussed, the OR can be like a pressure cooker at times. When individuals are pressed for time, they naturally resort to finding quick ways to “get it done.” In the OR, “getting it done” may mean holding a patient for positioning during surgery instead of seeking an alternative that may be more time consuming. Fact is that in many situations, it is quicker to move a patient from a stretcher to an operating table with the help of a few staff members or to position them by holding them yourself than to utilize alternative options. However, taking these short cuts is precisely what leads to injured staff and ultimately costs health care organizations big dollars down the road. Needlestick and sharps injuries are also very common and occur at a higher rate in an OR than other areas of the hospital. According to the Centers for Disease Control and Prevention (CDC), hospital employees are victims of about 385,000 sharps injuries each year. According to the Association of periOperative Registered Nurses (AORN), 30 percent of the estimated needlestick and other sharps-related injuries occur in an OR, specifically while health care staff pass suture needles and scalpels. The Joint Commission standards and elements of performance, located in the Infection Control chapter of The Ambulatory Care Manual, can assist health care organizations assess their own risks for injury and determine how to best mitigate those risks.
One area that is frequently assessed for risk is the physical environment of the surgery center. The Environment of Care Chapter of The Joint Commission’s Ambulatory Care Manual, guides organizations as they establish and maintain a safe, sanitary and functional environment. The standards address a broad range of environmental issues from handling hazardous materials and equipment maintenance to fire drills and ensuring suitable lighting. According to The National Institute for Occupational Safety and Health (NIOSH) hierarchy of controls elimination and substitution of a hazard is the most effective way to ensure workplace safety. Engineering controls are third on the hierarchy and can be highly effective at protecting employees and patients in a way that does not affect workflow or take any extra effort on the part of the employee by ensuring that the environment is appropriately designed and maintained. Examples such as negative airflow in rooms and HVAC filtration units keep staff safe by minimizing their respiratory exposure while caring for patients with respiratory infections.
In addition to the obvious and measurable physical and environmental risks, mental health can be at risk in an ASC as well. The COVID-19 pandemic has highlighted the incredible importance of mental wellness of all staff. Much research has been published about culture of safety in health care and never has that been more important than while working on the frontlines during a pandemic. “We are all in this together,” has been the sentiment communicated in many articles written about health care staff in various facility departments throughout this past year. But what is meant by “culture of safety?” To some, the phrase may conjure up an image of an irate surgeon throwing instruments during a tirade. However, it is much larger and much smaller than that at the same time. Ignoring or belittling co-workers, grueling scheduling and intimidation are all less obvious ways that staff may create a toxic work environment. The Joint Commission’s standards and elements of performance address the importance of maintaining a culture of safety in the Leadership chapter in the Ambulatory Care Manual. Additionally, establishing a culture of safety is communicated in number of Quick Safety articles, Sentinel Event Alerts, blog posts and updates on The Joint Commission website. Patient safety is at the very heart of The Joint’s Commission mission. The foundation for safe patient care is ensuring staff are reporting to a safe work environment. Health care leadership can accomplish this with a well-developed and maintained physical environment and safe equipment, clear policies and procedures to guide care as well as a strong culture of safety in which all employees feel empowered to speak up when they have concerns. Joint Commission standards and elements of performance in the Ambulatory Care Manual can aid organizations on their journey to excellence and zero harm. True leaders know that every single member of the care team from the front desk receptionist to the surgeon performing the case all play an imperative part in the overall care delivery every day. We truly are all in this together.
Elizabeth Even, MSN, RN, CEN, is the associate director, clinical standards interpretation, division of healthcare improvement, The Joint Commission.