 Good morning everybody. This is Donna Frost, our Chief Clinical Officer at the Patient Safety Movement Foundation. Today we're going to talk to you about workplace safety in the operating room. And we're joined by Caitlin Jackson, who is a circulating nurse at Puget Sound Liquid Surgery Center. Good morning, Caitlin, and welcome. Good morning. Thank you for having me. I wonder if you could start by telling us a little bit about your background. Sure. So I've been a nurse since 2013. I started at Medigan Hospital. I was a med-surg and oncology nurse for about three years. Following that, I did mother baby. Once I exited the military, I did about one year as a GI nurse. And then following that, I've been a circulator nurse for Puget Sound for about three years now. Excellent. Well, welcome to the Patient Safety Movement Foundation. Thank you. I wonder if you could tell us a little bit about safety in the OR. What are the special needs in terms of patient safety and healthcare worker safety in the OR that are different than other places in the hospital? So there are a lot of hazards in the OR. And we're definitely a multi-disciplinary team. So some of the roles include the surgeon, the circulator nurse, the surgical tech, and the PA, just to name a few. And I think it's really important that we are all aware of those potential safety hazards to ourselves and to our patients and not only knowing these hazards, but how to mitigate them. So just to name off a few potential hazards within the OR, we definitely have potential for physical injuries. So that would look like a shoulder injury or a back injury. This could be caused by not using proper body mechanics or from moving a patient inappropriately. Now that's not to say that that isn't an issue in other areas of nursing, but definitely it is something to be aware of in the OR as well. Another thing to be aware of is the potential for needle stick injuries. We're passing a lot of sharp equipment back and forth between the surgical tech and the surgeon. So just being very aware of how you're passing off these instruments definitely is of major importance within the OR. And I do believe that kind of is something specifically in the OR that kind of sets us apart from other areas of healthcare. Additionally, we have a lot of tripping hazards in the OR. There's a lot of equipment that's being moved around constantly. And unfortunately, we still have a lot of cords in the OR. So we really just need to be aware of where we're placing these cords to ensure safety of the staff while we're moving about in that environment. Moving on from physical potential hazards, we also have radiation in electrical hazards. Again, I think this is something unique to the OR. Radiation hazards can be caused by inadequate protection from our X-ray machine. And of course, we use electrical equipment. An injury could be caused by not grounding your patient appropriately or not checking your equipment out appropriately and there being some faulty wiring going on. Additionally, we have chemical hazards from the anesthesia gases. Cytotoxic drugs can also be used within the OR. And even some of the cleaning agents we use, obviously sterility is very important. So again, we just need to be extra careful that we're aware of those potential for harm. In addition to that, I would like to speak a little bit about organizational hazards. Again, I don't think this is necessarily unique to the OR, but also it's still very important. As an organization, we really need to make sure we're routinely caring for our staff and ensuring that they have a safe work environment that includes making sure they're getting their lunches, they're getting their breaks, they're not working very long, strenuous hours in the OR, giving them bathroom breaks, little things like this. And again, just making sure that we have a safe culture that promotes safety. Yes, just little things like being able to go to the bathroom. That would be great. Absolutely. So in an organization, a hospital or a surgery center someplace, if the executive leadership team or senior leadership team were concerned about OR safety, how would they go about doing an assessment to determine what the gaps are? Yeah, I really like this question. I think it's so important that organizations really look at their workplace environment and strive to develop strategies to gather workplace data and implement improvement strategies based upon that data. So I think just some examples of what an organization could do to assess the operating room for safety, conducting and analyzing routine surveys that assess the staff's feelings on workplace safety. Let's hear from the staff, what are their issues? What concerns do they have? And then following through with those concerns I think is really important as well, not just taking it for face value, just really taking it seriously and making adjustments as needed. I think another important thing is utilizing those incident reports, making sure that these again are taken seriously and that we're making adjustments as needed based upon findings that staff are coming to the organization with. And then lastly, I know this might sound like a small thing, but it actually has a really big impact, especially within the OR, is just ensuring that you're doing your monthly checklist on those routine tasks, such as your deep cleaning of your equipment, doing your outdates of your medications, things like that to really help one ensure that we're promoting safety for the patient, but also for the staff as well. So you brought up an interesting point about incident reporting. Do you feel like the folks in the OR where you work are honest about errors that happen in the OR or do you feel like that there may still be a little bit of fear about reporting some incidents? Sure. So speaking from just my experience in the OR, I feel like we very much promote patient safety. We talk about that. It's a highlight of a lot of our conversations and in order to promote patient safety, the staff need to be safe as well. So it's a matter of in order for us to reach our number one goal, which is to provide safe patient care, we need to ensure we have a safe environment. So we very much promote conducting incidents reports when they are needed and again, following through with them. It's all about having open communication again with our other team members and our management. And I think we get a lot of positive support, which has greatly benefited our environment. Well, good. That's great to hear. So any any idea for for those again who are looking to improve safety in their OR, are there any specific protocols that you would recommend to mitigate workplace injury? Yeah, I think there's a lot of really great resources out there to help prevent injury and illness within the OR. I think just some examples would be again, this sounds kind of small, but it's very important is just providing appropriate PPE to your staff that would include appropriate eye pro with the shields on the sides, gloves, of course, and OR appropriate masks. This would help prevent from, you know, splatter injuries such as blood in your eyes, things like that coming into contact with potentially infectious or dangerous materials. And then the practice of performing a timeout is especially important in the OR. This is a moment where everyone pauses and ensures that we are performing the correct surgery on the correct patient. We are aware of their allergies, any other additional concerns. This is a total must in the OR. I think another thing is maintaining serility in the OR. I think ensuring that your staff understand the importance of appropriately cleaning your equipment is very important. And again, going back to those checklists, we are performing those monthly checklists to make sure everything is clean and working appropriately. I think another protocol would be to ensure your staff know how to label any drawn up medications in the OR. We are using things like epinephrine, you know, morphine. These are serious drugs and we want to ensure that everything is appropriate labeled in order to ensure we're not accidentally giving the wrong medication to the patient or expired medications. I think another thing would be just ensuring that we have appropriate ventilation within the OR to help ensure that we are getting all those toxic gases and potentially airborne pathogens outside of the OR environment. And then lastly, I think another thing would be ensuring that your staff is wearing lead when we are using X-ray machinery and checking that lead. I think it's yearly. Excellent. Any other last thoughts for what organizations can do to improve safety in the operating room? I think the number one thing is just ensuring that you have a culture of safety and promoting awareness in that your staff knows where to find those incidents reports. They know what your policies are and if they have questions knowing who to ask those questions to. Great. Well, Caitlin, thank you so much for joining us today. We're so glad to hear from you and I'm so glad to have you in the movement. Awesome. Thank you so much for having me. It was a pleasure speaking with you. Great. Have a wonderful day. You too. Thank you.