313 - Human Factors of Disruptions and Interruptions Related to Suture Needle Injuries During Wound Closure in the Operating Room
Description: Since passage of the Needlestick Safety and Prevention Act in 2000, progress has been made in reducing hospital-based needlestick injuries by employing use of products designed for safety. Though needlestick and sharps injuries have decreased overall, percutaneous injuries in the surgical environment, particularly those involving curved suture needles have not decreased, and in fact increased by 6.5% in the eight years following passage of the Act. Data from Massachusetts Sharps Injury Surveillance System between 2010 and 2015 indicate that 40% of sharps injuries occur in the OR as compared to other areas of facilities. Suture needle injuries are the highest among needlestick injuries in the surgical setting with estimates in the literature between 43 and 77%. Prevention of injury has focused on engineering controls; safe zones, blunt tip needles, and hands free techniques, yet a reduction in injuries has not been achieved. Local data for 2018 at BIDMC mirrors global trends with 70 percutaneous injuries in the OR alone (34% of total injuries for the year at BIDMC). 51 injuries (73%) were sustained from curved suture needles with 46 injuries (66%) occurring during wound closure. The conceptual framework for this project is taken from Human Factors research and is known as Software, Hardware, Environment, and Liveware (SHELL) Model from the Civil Aviation Authority, developed by Elwyn Edwards in 1972, and modified by Frank Hawkins in 1975. The SHELL Model, is used in the aviation industry to understand pilot performance from the viewpoint of interfacing with elements in the system that represent the work domains during flight. Human factors are concerned with human limitations and capabilities that rise out of interaction with software; hardware; environment, and liveware (people) and result in variability of performance and present opportunity for error. A proposal was submitted and approved by the Institutional Review Board at Beth Israel Deaconess Medical Center (BIDMC) as a quality improvement project. The project will focus on disruptions and interruptions occurring during wound closure; specifically, communication; coordination (change of staff); and interruptions other (human or technological). Data collection will take place during the wound closure portion of surgical procedures; from completion of procedure (procedure complete and wound closure commences), to completion of surgery (wound closure complete) on a tool that has been developed. Data was collected from 5 pilot cases and 35 surgical cases in narrative format and a coding taxonomy has been applied post observation. Data will be analyzed by type of procedure, length of closure, number of interruptions, and decibel level.Current state is data collection complete; analysis, results and discussion to be determinedPeriop nursing implications focus on distractions as contributing to unexpected outcomes for patients and caregivers.
Co-Authors: Charlotte Guglielmi, Matthew Rabesa, Elena Canacari, Senem Hicks