157 - From Gaps to Greatness: Boosting OR Laser Skills with AORN Standards

Description: Description of Team:
This project was led by a perioperative improvement team at Tripler Army Medical Center (TAMC) consisting of a CNOR-certified champion RN, a CNOR-certified perioperative education nurse, and a clinical nurse specialist (CNS). The team collaborated closely with the OR Officer in Charge (OIC), NCOIC, ENT surgeons, and the newly appointed Laser Safety Officer (LSO) to implement and sustain improvements in laser safety training.

Preparation and Planning:
In early 2024, a gap analysis revealed that fewer than 10% of OR staff had documented laser operator competency, and competency records had not been updated since February 2022. The team selected the AORN laser operator competency tool as the standardized training resource and established a goal to increase the number of laser-trained RNs and surgical technologists by at least 50% by March 31, 2025. Planning included coordination for formal training access, assessment tool development, and stakeholder engagement to support implementation.

Assessment:
Pre-assessment surveys and a review of staff competency records revealed that only 9% of RNs and none of the surgical technologists were currently laser-trained. Identified barriers included expired or unavailable laser equipment, limited formal training opportunities, and low awareness of competency tracking expectations. The lack of trained personnel affected staff scheduling flexibility and preparedness for laser procedures.

Implementation:
The team facilitated enrollment for two RNs in the AORN Laser Safety Course and designated an LSO to lead competency verification efforts. On January 15, 2025, an in-service session was conducted, focused on AORN standards and safe use of Lumenis AcuPulse and UltraPulse lasers. Competency verifications were completed immediately following the training, and updated in the CAF. Pre- and post-intervention surveys assessed changes in staff confidence and readiness. Additional training on Iridex and TruBlue laser systems is planned for summer 2025.

Outcome:
As of February 8, 2025, the percentage of laser-trained registered nurses increased from 9% to 76% (19 out of 25 RNs). This marked a significant improvement in staff readiness and enabled the consistent assignment of dedicated laser operators for procedures. The rapid upskilling of RN personnel strengthened adherence to national safety standards and enhanced overall perioperative team capacity.

Implications for Perioperative Nursing:
Aligning practice with AORN's Guideline for Safe Use of Energy-Generating Devices (2023) enhanced perioperative safety, staff competency, and preparedness. This nurse-led initiative shows that structured education, formal competency tracking, and interprofessional collaboration can address gaps in specialty training and strengthen surgical team readiness. The model is scalable to other military and civilian ORs aiming to close competency gaps.