Description: · Clinical Issue MetroHealth Medical Center (MH) is an academic Level One Trauma Center located in Cleveland, Ohio. Historically, the operating room (OR) sustained the majority of sharps injuries within the institution. For 2017, the institution experienced a total of 155 sharp injuries with 56 (36%) attributed to the OR. In 2018, 144 sharp injuries, 49 (34%) occurring within the OR. Suture needles are among the top related device at 55 (35%) in 2017 and 55 (38%) in 2018. Direct expenses for 2017 and 2018 relating to diagnostic testing and medications amounted to approximately $119,259 and $114,716, respectively. MetroHealth designated prevention of sharps related injuries an organizational goal for 2019. · Description of Team An interdisciplinary committee was formed to reduce injuries and standardize equipment. The committee consisted of members from Administration, the Simulation (SIM) Center, staff nursing, surgical technologists, the Director of Perioperative Nursing Services, Graduate Office of Medical Education (GME) representatives, Quality, and the Orthopedic Chairman. · Preparation and Planning We reviewed multiple years of MH data and discovered the highest at-risk population was residents, medical students, and advance practice students. In 2017 this population sustained 25 (45%) of the 56 OR injuries and 26 (53%) of the 49 events in 2018. The committee created an educational module and the program was deemed mandatory by top-level administration. The students had to complete it prior to starting in the OR and/or clinical rotations. The education included; a didactic power point, a YouTube video created by the OR and SIM Center illustrating best and worst practices, a quiz, a message from our President and CEO, and finally, a mandatory in-person review session. We also included a brief review of key Team STEPPS strategies and our surgical attire policy. Also, a MH staff member, who suffered devastating sequalae from a needlestick, came forward and asked to share her story. Instructors included Regional Director of Perioperative Nursing Services, OR Nurse Manager, OR Educator, and OR Education Coordinator. · Assessment We experienced limitations with consistent physical space and coordination of hundreds of participants. We developed routine scheduled appointments and added ad-hoc appointments based on instructor availability. · Implementation We advertised the program through email, flyers, and announcements on the internal hospital web page. The Clinical Coordinators of the GME office managed the scheduling of the participants. There was occasional push back due to scheduling, but we worked through those on an individual basis. Participants had to turn in a completed quiz to receive credit. Outcome The program officially commenced July 1st and has translated to one injury for July and two in August. Furthermore, as of August 31, 2019, the health system has experienced 95 sharps injuries with 30 (32%) categorized to the OR, a full 2% reduction. Year to date, suture needles are now closely tied with disposable injection needles as mechanism of injury at 31 (32%) and 30 (31%), respectively. Direct care expenses are currently at $66,857 year to date, compared to the same time last year of $71,629, reflecting a savings of $4,772. Many participants shared this was their first sharps education. Implications for Perioperative Nursing We feel this nurse-led program emphasizes interdisciplinary teamwork and functionality, increased awareness and communication related to sharps injuries, and served as a working reminder of our Team STEPPS principles.
Co-Authors: Jill Murphy, Daniel Seabold, John Wilber, Charlene Scott, Debra Sparks