187 - Improving Laser Documentation in the Brainsuite
Description: Title: Improving Laser Documentation in the BrainSUITE Description of team: A team was formed comprised of interdisciplinary members in all aspects of the patient’s intraoperative care. Members included were clinical nurses, operating room (OR) management and OR laser safety officer (LSO). The team also collaborated with the institutional laser safety officer and the laser vendors. Preparation and planning: The BrainSUITE at a NCI-designated academic facility brings the most advanced neurosurgical technology to oncology patients. The BrainSUITE is an operating room with an image-guided monitoring system and magnetic resonance imaging (MRI). During surgery, the patient transitions into the MRI to confirm tumor location without leaving the OR. Lasers are used in the BrainSUITE for the removal/resection of tumors and lesions within the brain and spine.
Assessment: During the department check of lasers utilized in the OR, the assigned LSO identified documentation errors for procedures in the BrainSUITE. The documentation did not follow the American National Standard Institute (ANSI) laser safety standards. The LSO met with the OR leadership team to mitigate this issue in order to improve handling and documentation, thus increasing compliance and patient safety. Implementation: The team created a paper laser log/documentation specifically for the BrainSUITE using the ANSI standard for the laser operator to document laser use for the case. The log included the type of laser, watts and total joules. Additionally, total laser time used in the procedure was included, which was not part of the previous practice. The clinical nurses with BrainSUITE privileges were also trained on standard documentation. Outcome: Since implementation in April 2019, the department has reached 100% compliance with laser documentation during monthly random audits performed by the LSO. The team reached out to the institutional electronic health record (EHR) team to discuss incorporating the BrainSUITE laser documentation/checklist within the EHR. The LSO for the OR would then perform random EHR audits in order to check compliance and see if further education is warranted. Implications for perioperative nursing: It is very important that the institution follow ANSI standards, not only to comply with national guidelines, but to safeguard patient care. Perioperative nurses play a major role in assisting with the use of laser and must be knowledgeable on all aspects of laser usage and documentation.