250 - An Ergonomic Surgical Instrument Initiative to Foster a Healthy Work Environment
Clinical Issue: Health of the Work Environment Description of Team: The team consisted of operating room (OR) nurses, central processing department (CPD) personnel, perioperative leadership. Preparation and Planning: Streamlining the redundancy of surgical instrument kits is an important component of value-based care (Capra et al., 2019). In addition, the consideration of ergonomics when designing storage of instruments is critical in preventing employee injuries (Mohammad, Abbas, & Narges, 2019). Surgical instrument kits that are lighter in weight and thoughtfully located on racks for storage are less likely to cause stress or injury to operating room (OR) staff. Assessment: Over time, requests for the inclusion of additional instruments increased kit weight over the recommended limit of 25lbs (AORN, 2018). An interdisciplinary team of OR nursing, CPD personnel, and perioperative leadership was assembled to form a Collaborative Practice Committee (CPC). The goal of the committee was to evaluate current kit preparation and storage with respect to ergonomic principles. Surgeons, OR nurses, and surgical technicians were surveyed regarding opportunities to streamline kits to reduce redundancy and weight. Implementation: The CPC met monthly to identify opportunities for improvement. Initially, OR scrub personnel were instructed to review kit lists to highlight missing, broken, or incorrect instruments and evaluate whether the kit was satisfactory or unsatisfactory. In addition, all surgical instrument kits were weighed and those over or close to weight limits were flagged for reorganization. Subsequently, all the instrument kits were color-coded by weight and tagged. Green indicated kit weight below 10 pounds, yellow indicated kit weight between 10-20 pounds and red indicated kit weight between 20-25 pounds. Lastly, the instrument storage carts were color-coded to align with instrument kit weight. The top rack was green coded, the two middle racks were red coded and the bottom rack stored yellow coded instrument kits. Outcome: Following the implementation of the surgical instrument initiative, the percentage of unsatisfactory kits was decreased from 9.1% to 3.6%. A total of two instrument kits were streamlined to remove low use instruments and one large kit was reorganized into two instrument trays. New lighter outer containers were purchased and utilized for those kits at the upper weight limit which reduced their weight by 4 pounds. The reorganized storage carts were ergonomically aligned. Implications for perioperative nursing: Development of an interdisciplinary team with stakeholders across perioperative services was vital to the success of this initiative. The CPC provides a valuable mode of communication to identify and advance quality improvement projects within perioperative services. An explicit focus on ergonomics in the workplace is essential in promoting and maintaining a healthy work environment.