Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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O C T O B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 1 5 Consider implementing these steps to help decrease the risk of needlestick injury during wound closures: • Pause to regroup. This ensures surgical team members get a quick break and are ready to proceed — a kind of "required safety break" to refocus on protecting themselves and their patients. • Eliminate distractions. Create a no-inter- ruption zone, such as what's done during medication administration. In this method, nobody would interrupt the team during clo- sure, so risks of errors would be minimized. By calling attention to the dangers of distrac- tions in the OR, you have a much better shot at preventing sharps injuries. • Hold off on breaks. Lastly, staff handoff and relief should be minimized during closure. It's challenging because nurses need lunch breaks, and they must ensure next cases start on time. But based on our observations, staff relief had a significant impact on increasing error risk during wound closure. Other staff members come in, take over the case and are expected to pick up where coworkers left off. There's always a chance of losing a critical piece of information in these transitions, and the disruptions increase error risk. — Barbara DiTullio, DNP, RN, MA, CNOR, NEA-BC wound closure. In the OR, people tend to minimize the importance of wound closure, thinking the pro- cedure is over and it's time to shift their attention to the next case. That can be a costly mistake. Wound closure is a vulnerable time, and it's also a time when a dizzying array of things are happen- ing at once. During the research project, we observed wound closures during surgical proce- dures. As a nursing director, I've been in the OR countless times, mostly looking at aspects of care or staff performance. But during this project, I paid closer attention to wound closure — and was amazed by what I saw. During one observation, a novice RN working in the scrub role was injured. The scrub was well edu- cated and had participated in wound closures previ- ously. On this day the scrub was working with a pre- ceptor and there were many competing demands and distractions. The team managed several tasks simultaneously as they received and passed suture. The scrub's attention was taken away momentarily, and it was enough to cause an injury. Looking back at the incident, it became clear to me how it happened. Simultaneous conversations were going on, surgical counts were occurring, and the scrub was a novice. There was also staff relief and hand-off. The scrub stayed to finish clos- ing while the preceptor left for another case. The nurses were engaged in the count with the scrub while at the same time, the scrub was receiving back passed suture. The scrub was distracted by the count and the resident handed back the suture — a collision occurred and the scrub was injured. Because the scrub was a novice, the activity at the field inter- fered with the ability to prioritize and in an instant, the scrub's personal safety was compromised. Fortunately the scrub was double-gloved and did not sustain a serious injury. Limiting disruptions That's the story of one of many sharps injuries healthcare workers suffer every year in the U.S. We don't have data to prove how many injuries are caused by distractions during wound closure, but there's an increasing amount of research that's SAFE ENDINGS Vigilant Until the Last Stitch Is Placed CRITICAL JUNCTURE Pay attention to risk factors at the end of a case, espe- cially when it's easy to begin focusing on preparing for the next patient.