244 - Promoting the Adoption of AORN Guideline for Surgical Smoke Safety

Description: Title: Surgical Smoke Management: Promoting the Adoption of AORN Guideline for Surgical Smoke Safety

Introduction: Surgical smoke, also known as cautery smoke or surgical plume, is produced through the thermal disruption of tissue using electrocautery, laser ablation, and harmonic dissection.(1-4) It can also be comprised of aerosolized particles released from bone saws, drills, and ultrasonic devices.(5) This smoke is often both visible and odorous, with estimates indicating that 85% of surgical procedures generate surgical plume.(5) A seminal study found that the average daily usage time of smoke generating devices is 12 minutes and 43 seconds. Research supports that during this time the devices produce passive air pollution equivalent to 27-30 unfiltered cigarettes.(6) Like cigarette smoke, exposure to surgical smoke can result in cardiovascular and respiratory disease along with numerous other adverse health risks.(7-14) Therefore, it is recommended that steps are taken to reduce exposure.

Project

Description: This project delivered a comprehensive approach to protecting patients and personnel by promoting a smoke-free surgical environment. The design was adapted from the Association of periOperative Registered Nurses (AORN) Go Clear program and is consistent with the Institute of Medicine (IOM) strategies to promote adoption of clinical practice guidelines. The aims were to: 1) Develop an awareness of surgical smoke safety precautions and how to create and maintain a smoke-free work environment as evidenced by a minimum of 90% staff completion of didactic education on surgical smoke hazards; healthcare regulations, standards, and guidelines; and smoke evacuation in the perioperative setting with post-test scores of >80%. 2) Have available one smoke evacuator per operating room that generates surgical smoke. 3) Include smoke evacuation Bovie pencils in surgical packs for procedures that are known to generate surgical smoke. 4) Establish a minimum of 90% compliance rate on smoke evacuation audits as evidenced by utilizing an auditing tool and making direct observation of staff behaviors. 5) Update the units smoke evacuation policy to include the best evidence-based practice for managing surgical smoke.

Conclusions: The AORN Guideline for Surgical Smoke Safety has been adopted. The unit has thirty-eight smoke evacuation devices to equip 20 operating rooms, 98% of surgical packs have been converted to incorporate smoke evacuation Bovie pencils, and compliance rates have climbed to over 90%. With these improvements, the unit is able to provide a safer environment of care by reducing patients and personnel exposure to surgical smoke. In this initial PDCA cycle, 50% of staff completed the didactic education although the aim was for 90% staff completion to meet the requirement to apply for AORN recognition. A new PDCA cycle will be conducted to address staff resistance to online learning modules and smoke evacuation for minimally invasive procedures. The initiative is also being circulated to other departments and clinics. It is anticipated that the main operating room and mother infant care center will be able to apply for a Go Clear designation for the next award cycle. The Go Clear award is a three-year designation that lets staff know that the unit is committed to taking measures to keep them safe in the workplace.