293 - Evaluating the Impact of Formal Training on Staff Perception of Preparedness for Active Shooter Situations in the Perioperative Environment

Description: This project took place at a Level 1 Trauma Center and Transplant Center with 23 operating rooms, 2 procedure rooms, and 1 hybrid suite. A multidisciplinary perioperative team-including operating room nurses, surgical technologists, hospital assistants, anesthesia technicians, equipment coordinators, and nurse leaders-partnered with Security and the Workplace Violence Prevention team. The Main Operating Room (OR) Unit Practice Council (UPC) led the initiative to strengthen emergency preparedness and staff safety through department-specific training.

Ongoing national concerns about active shooter incidents in healthcare, especially in high-risk, high-acuity environments like the OR, prompted the team to assess current departmental readiness. Using the Iowa Model for Evidence-Based Practice, the team reviewed relevant literature highlighting a widespread lack of formal training and the ethical dilemma faced by surgical staff in crisis: patient abandonment versus self-preservation. The team designed pre- and post-surveys to measure knowledge, perception of safety, and policy awareness. A department-wide walkthrough with Security identified critical physical vulnerabilities, including a lack of lockdown mechanisms, unsecured fire escape doors, limited exits, and the isolation of the procedure rooms from the rest of the OR.

Staff participation spanned multiple roles within perioperative services. Out of 116 staff who took part in the surveys, the team analyzed 102 complete responses. The surveys included a combination of yes/no and Likert-scale questions to evaluate knowledge of emergency protocols, perceived safety, and institutional preparedness. The team also reviewed departmental safety culture scores and recent local "swatting" events to contextualize findings.

The Workplace Violence Prevention Program Manager and a representative from Hospital Security presented an in-service during a staff meeting, focused on department-specific response protocols and available resources. The session provided information on reporting pathways, physical vulnerabilities, and safety strategies, supported by printed materials and policy references. The team administered the pre-test immediately before the in-service and the post-test immediately afterward to capture changes in staff knowledge and perception.

Survey analysis revealed a statistically significant improvement in staff knowledge, with mean scores rising from 57% to 69%. Perception of safety, however, remained statistically unchanged (pre: 3.223; post: 3.230). Twenty-eight percent of respondents reported improved safety perception after the in-service, while 31% felt less safe—suggesting that heightened awareness may initially reduce perceived psychological safety. The team escalated findings to leadership to advocate for structural improvements across the OR environment.

This initiative demonstrated the value of tailored resource-based education in high-acuity surgical environments. While knowledge gains were evident after a single in-service session, improving and sustaining staff perception of safety will require ongoing drills, clearer communication, and continued collaboration between clinical teams and security. Perioperative nurses play a critical role in leading safety-focused innovation and driving a culture of preparedness in the operating room.