Utilization of a Role-Based Head Covering System to Decrease Misidentification in the Operating Room.

OBJECTIVES: In a typical operating room (OR), there are many individuals who present all dressed in similar attire, making it extremely difficult to distinguish a person's role in the OR. Misidentification of an individual in the OR can make effective communication difficult, which could adversely impact patient safety. Furthermore, an inability to identify graduate medical students or distinguish students from OR faculty may hinder student learning opportunities within the OR. The purpose of this study was to determine whether implementation of a role-based, colored head covering requirement would improve identification in the OR and ultimately patient safety. METHODS: Operating room faculty and graduate medical students completed a four-question survey to assess opinions on misidentification in the OR, 1 month before and 2 months after a role-based head covering requirement was instituted in the OR. We analyzed the data from a total of 28 preintervention responses. RESULTS: Before intervention, students and OR faculty reported that it was difficult to distinguish students from OR faculty in the OR. After intervention, there was a significant decrease in the proportion of respondents who felt that it was difficult to distinguish students in training from trained OR personnel from 79% to 42% (P = 0.007) CONCLUSIONS: Implementation of a role-based head covering system in the OR significantly increased the ability to determine a person's role in the OR. This study provides evocative support for a simple, inexpensive solution able to improve patient safety and learning opportunities for graduate medical students.

Surgical smoke control with local exhaust ventilation: Experimental study.

This experimental study aimed to evaluate airborne particulates and volatile organic compounds (VOCs) from surgical smoke when a local exhaust ventilation (LEV) system is in place. Surgical smoke was generated from human tissue in an unoccupied operating room using an electrocautery surgical device for 15 min with 3 different test settings: (1) without LEV control; (2) control with a wall irrigation suction unit with an in-line ultra-low penetration air filter; and (3) control with a smoke evacuation system. Flow rate of LEVs was approximately 35 L/min and suction was maintained within 5 cm of electrocautery interaction site. A total of 6 experiments were conducted. Particle number and mass concentrations were measured using direct reading instruments including a condensation particle counter (CPC), a light-scattering laser photometer (DustTrak DRX), a scanning mobility particle sizer (SMPS), an aerodynamic particle sizer (APS), and a viable particle counter. Selected VOCs were collected using evacuated canisters using grab, personal and area sampling techniques. The largest average particle and VOCs concentrations were found in the absence of LEV control followed by LEV controls. Average ratios of LEV controls to without LEV control ranged 0.24-0.33 (CPC), 0.28-0.39 (SMPS), 0.14-0.31 (DustTrak DRX), and 0.26-0.55 (APS). Ethanol and isopropyl alcohol were dominant in the canister samples. Acetaldehyde, acetone, acetonitrile, benzene, hexane, styrene, and toluene were detected but at lower concentrations (<500 µg/m3) and concentrations of the VOCs were much less than the National Institute for Occupational Safety and Health recommended exposure limit values. Utilization of the LEVs for surgical smoke control can significantly reduce but not completely eliminate airborne particles and VOCs.

A Team Approach to Improving Tissue Management.

Tissue implant management can be labor intensive because of multiple storage locations and cumbersome tracking systems. The purpose of this quality improvement (QI) project was to enhance patient safety and nursing satisfaction by upgrading our tissue-management facility and processes. We created a centralized storage room for tissue implants and staffed this room during all shifts. Tissue management was executed using tracking software and transportation devices that supported tissue receipt, storage, disposition, documentation, and reporting. Our project resulted in our full compliance with tissue implant requirements from the US Food and Drug Administration (FDA) and The Joint Commission. We also reduced our documentation error rate from 3% to less than 1%, and decreased the tissue-expiration rate by 1.1%. Tissues are now delivered to ORs, which allows RNs to focus on patient care rather than retrieval of implants. Monitoring of the tissue inventory has improved, resulting in the reduction of tissue wastage.