156 - Going Clear: Implementing a Surgical Smoke Free Program
Clinical Issue: Surgical Smoke EvacuationDescription of Team: The PVHMC Go Clear team consists of multiple RNs and certified scrub technicians from the main surgical department (Main OR). Initial efforts were focused in the Main OR with plans to implement a surgical smoke free environment in the Women's Center and Outpatient Pavilion. The Go Clear team is being led by Pam Tisuthiwongse, MSN, RN, PHN with support from Perioperative Services Director Martha Soto, MSN, RN, CNOR, and Perioperative Services Manager Cyrene Del Rosario, BSN, RN. Preparation and Planning: Research was done through AORN.org for information about the Go Clear program and a literature review was completed to learn the effects of surgical smoke and the key takeaways from surgical smoke free facilities. Research was compiled and presented to surgical staff. Perioperative leadership contacted vendors for smoke evacuating pens and filters to trial. An info board was created and is on display in a high foot traffic area between the staff and physician lounges. A gap analysis was performed to determine the current state of smoke evacuation in the OR before the project began.
Assessment: The gap analysis revealed less than 10% of surgical cases producing surgical smoke was being evacuated. The current practices before this project included use of an obsolete smoke evacuator by one or two surgeons and an inconsistent use of smoke filtration tubing system in laparoscopic cases. In addition, not all OR suites had ULPA filters available for use with suction systems. A smoke evacuating pen was chosen based on ergonomic and application flexibility, as well as cost-effectiveness. Implementation: Project was introduced through a formal presentation by P. Tisuthiwongse at both AM and PM shifts to capture at least 90% of the main surgical staff. Physician support was obtained by Perioperative Services leadership. In-service was provided by vendors on smoke-evacuating pens and ULPA filters. Staff was instructed to pick smoke evacuating pens and to ensure ULPA filters were installed correctly. Clear compliance audit began in September 2019 and will continue for 12 weeks until data is complete to be compiled and sent to the AORN Go Clear Award. Outcome: Outcomes for this clinical improvement project are pending. Expected outcomes include the surgical team being able to demonstrate knowledge on the risks of surgical smoke, the benefits of using surgical smoke evacuating equipment, competence on the correct usage and disposal of smoke evacuating supplies. Additionally, there is expectation of compliance of a surgical smoke free environment within the Main Surgical department and eventually all procedural areas that create surgical smoke plumes. Implications: Becoming surgical smoke free is a team effort. Education can be provided to the staff however it is imperative to have the equipment and supplies available and staff compliance and commitment to providing a safe work environment for all.