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Anesthesiology Clinics Sep 2020Climate change will be the defining health crisis of the twenty-first century, and environmental health is directly linked with human health. The health sector should... (Review)
Review
Climate change will be the defining health crisis of the twenty-first century, and environmental health is directly linked with human health. The health sector should lead the sustainability effort by greening itself and reducing its ecological footprint to improve global health and the health of the planet. Anesthesiology has an oversized role in production of greenhouse gases and waste, and thus its impact on affecting change is also oversized. Decreasing the waste of volatile anesthetic agents, medications, and anesthesia equipment is a powerful start to the many sustainability changes needed in health care.
Topics: Air Pollution; Anesthesiology; Climate Change; Greenhouse Gases; Humans; Operating Rooms; Sustainable Development
PubMed: 32792191
DOI: 10.1016/j.anclin.2020.06.006 -
European Urology Apr 2023Surgical activity contributes to global warming though the production of greenhouse gases and consumption of resources. To date, no clinical practice guidelines have... (Review)
Review
CONTEXT
Surgical activity contributes to global warming though the production of greenhouse gases and consumption of resources. To date, no clinical practice guidelines have been made to promote and implement climate-smart actions.
OBJECTIVE
To perform a systematic review of the available actions that could limit CO emission in the operating room (OR) and their potential benefits upon the environment, whilst preserving quality of care.
EVIDENCE ACQUISITION
MEDLINE and Cochrane databases were searched from January 1, 1990 to April 2021. We included studies assessing carbon footprint (CF) in the OR and articles detailing actions that limit or reduce CF.
EVIDENCE SYNTHESIS
Thirty-eight studies met the inclusion criteria. We identified six core climate-smart actions: (1) waste reduction by segregation; (2) waste reduction by recycling, reuse, and reprocessing; (3) sterilisation; (4) anaesthesia gas management; and (5) improvement of energy use. Quantitative analysis regarding the CF was not possible due to the lack of homogeneous data. For climate-smart actions, the analysis was limited by discrepancies in study scope and in the methodology of CO emission calculation. Improvement of education and awareness was found to have an important impact on waste segregation and reduction. Waste management is the area where health care workers could have the strongest impact, whereas the main field to reduce CF in the OR was found to be energy consumption.
CONCLUSIONS
This review provides arguments for many climate-smart actions that could be implemented in our daily practice. Improving awareness and education are important to act collectively in a sustainable way. Further studies are mandatory to assess the impact of these climate-smart actions in the OR.
PATIENT SUMMARY
We performed a systematic review of the available scientific literature to reference all the climate-smart actions proposed to improve the sustainability of surgical activities. Waste segregation, waste reduction and recycling, reuse and reprocessing, sterilisation, anaesthesia gas changes, and improvement of energy use in the operating room were found to be the main areas of research. There is still a long way to go to homogenise and improve the quality of our climate-smart actions.
Topics: Carbon Footprint; Operating Rooms; Environment; Waste Management
PubMed: 35151515
DOI: 10.1016/j.eururo.2022.01.027 -
Nursing Open Mar 2020To explore Norwegian operating room nurses' perceptions of how team skills in the inter-professional operating room team influence perioperative nursing in relation to...
AIM
To explore Norwegian operating room nurses' perceptions of how team skills in the inter-professional operating room team influence perioperative nursing in relation to patient safety.
DESIGN
A qualitative, descriptive study based on interviews.
METHODS
Ten operating room nurses ( = 10) employed in four Norwegian hospitals were interviewed individually. A qualitative inductive content analysis was conducted. The study was reported adhering to the Consolidated Criteria for Reporting Qualitative Research Checklist.
RESULTS
Three generic categories, containing three subcategories each, were identified illuminate the operating room nurses' perceptions. The operating room team's team skills influence on (a) the quality of perioperative nursing, about task performance, result for the patient and learning; (b) the progress of perioperative nursing, by keeping focus on the task, being prepared and task distribution and (c) the operating room nurses' work environment in the operating room, including confidence, stress and energy use and irritation or job satisfaction.
Topics: Humans; Job Satisfaction; Norway; Operating Rooms; Perioperative Nursing; Qualitative Research
PubMed: 32089854
DOI: 10.1002/nop2.422 -
PloS One 2021Effective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected...
BACKGROUND
Effective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected gains for patient safety or surgical culture. In order to optimize OR teamwork in a targeted and evidence-based manner, it is first necessary to conduct a comprehensive, theory-informed assessment of barriers and enablers from an interprofessional perspective.
METHODS
This qualitative study was informed by the Theoretical Domains Framework (TDF). Volunteer, purposive and snowball sampling were conducted primarily across four sites in Ontario, Canada and continued until saturation was reached. Interviews were recorded, transcribed, and de-identified. Directed content analysis was conducted in duplicate using the TDF as the initial coding framework. Codes were then refined whereby similar codes were grouped into larger categories of meaning within each TDF domain, resulting in a list of domain-specific barriers and enablers.
RESULTS
A total of 66 OR healthcare professionals participated in the study (19 Registered Nurses, two Registered Practical Nurses, 17 anaesthesiologists, 26 surgeons, two perfusionists). The most frequently identified teamwork enablers included people management, shared definition of teamwork, communication strategies, positive emotions, familiarity with team members, and alignment of teamwork with professional role. The most frequently identified teamwork barriers included others' personalities, gender, hierarchies, resource issues, lack of knowledge of best practices for teamwork, negative emotions, conflicting norms and perceptions across professions, being unfamiliar with team members, and on-call/night shifts.
CONCLUSIONS
We identified key factors influencing OR teamwork from an interprofessional perspective using a theoretically informed and systematic approach. Our findings reveal important targets for future interventions and may ultimately increase their effectiveness. Specifically, achieving optimal teamwork in the OR may require a multi-level intervention that addresses individual, team and systems-level factors with particular attention to complex social and professional hierarchies.
Topics: Adult; Attitude of Health Personnel; Communication; Cooperative Behavior; Female; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Interprofessional Relations; Male; Models, Theoretical; Operating Rooms; Patient Care Team; Patient Safety; Professional Role; Qualitative Research
PubMed: 33886580
DOI: 10.1371/journal.pone.0249576 -
International Journal of Environmental... Oct 2020Nursing staff working in the operating room are exposed to risk factors that can cause musculoskeletal disorders (MSDs) and work-related disabilities. The use of... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Nursing staff working in the operating room are exposed to risk factors that can cause musculoskeletal disorders (MSDs) and work-related disabilities. The use of ergonomics principles can help with the prevention of MSDs. This study aimed to examine the effect of an ergonomics educational program on MSDs among nursing staff working in the operating room. In this pragmatic parallel group quasi-randomized controlled clinical trial, 74 nursing staff working in the operating rooms of two teaching hospitals participated. The hospitals were randomly assigned to either the intervention or the control group and all nursing staff working in the operating room of each hospital were invited to take part in this research. They were initially assessed for the prevalence and risk of MSDs by using the Nordic questionnaire and the rapid entire body assessment (REBA) checklist. The intervention group received the ergonomics educational program and were assessed in two-week intervals over a period of three months. At the end of the study, the risk and prevalence of MSDs were compared between the intervention and control groups. Statistically significant differences were reported between the groups in terms of the prevalence and risk of MSDs. The overall risk of MSDs decreased in the intervention group after the educational program ( = 0.03). The reduction in the prevalence of MSDs in the different parts of the body in the intervention group was as follows: ankle ( = 0.005), hand/wrist ( = 0.041), low back ( = 0.000), the neck ( = 0.003), hip ( = 0.001) and shoulder ( = 0.043). The education of nursing staff about ergonomics can influence the prevalence and risk of MSDs. Therefore, it should be incorporated into the degree education and on-the-job training initiatives for nurses working in the operating theatre in order to reduce workplace injuries and associated absences, and increase the quality of care delivered by them. This clinical trial has been registered in the Iranian Registry of Clinical Trials: IRCT2015081823677N1.
Topics: Ergonomics; Humans; Iran; Musculoskeletal Diseases; Nursing Staff; Occupational Diseases; Operating Rooms; Risk Factors
PubMed: 33049927
DOI: 10.3390/ijerph17197333 -
Anesthesiology Mar 2019Operating room fires are rare but devastating events. Guidelines are available for the prevention and management of surgical fires; however, these recommendations are... (Review)
Review
Operating room fires are rare but devastating events. Guidelines are available for the prevention and management of surgical fires; however, these recommendations are based on expert opinion and case series. The three components of an operating room fire are present in virtually all surgical procedures: an oxidizer (oxygen, nitrous oxide), an ignition source (i.e., laser, "Bovie"), and a fuel. This review analyzes each fire ingredient to determine the optimal clinical strategy to reduce the risk of fire. Surgical checklists, team training, and the specific management of an operating room fire are also reviewed.
Topics: Electrocoagulation; Fires; Gas Scavengers; Humans; Operating Rooms; Oxygen; Plastic Surgery Procedures
PubMed: 30664060
DOI: 10.1097/ALN.0000000000002598 -
Nursing Open Jul 2021The aim of this study was to explore how operating room nurses (ORNs) experience operating room (OR) team communication concerning non-technical skills.
AIM
The aim of this study was to explore how operating room nurses (ORNs) experience operating room (OR) team communication concerning non-technical skills.
DESIGN
Based on the Scrub Practitioners List of Intraoperative Non-Technical Skill (SPLINTS), qualitative individual in-depth semi-structured interviews were conducted with 11 ORNs in a Norwegian university hospital. Braun and Clarke's six analytic phases for thematic data analysis were used.
RESULTS
Surgeons being unprepared or demanding different instruments than the preoperative information indicates, cause stress and frustration. So does noise and brusquely or poor communication. Ensuring good information flow within the entire team is important. When silence is required, the ORNs communicate with gestures, looks and nods. Creating a positive and secure team culture facilitates discussions, questions and information sharing.
CONCLUSION
Inappropriate dynamics, inaccurate and/or disrespectful communication and noise may reduce patient safety. Interdisciplinary team training may bring attention to the value of communication as a non-technical skill.
Topics: Communication; Humans; Norway; Operating Rooms; Patient Safety; Qualitative Research
PubMed: 33631059
DOI: 10.1002/nop2.830 -
Revista Brasileira de Enfermagem 2018To describe nurses' recommendations for good patient safety practices in the operating room.
OBJECTIVE
To describe nurses' recommendations for good patient safety practices in the operating room.
METHOD
Quantitative, descriptive and exploratory research developed from an online survey of 220 operating room nurses from different regions of Brazil. The data processing for textual analysis was performed by the software IRAMUTEQ.
RESULTS
There were eight recommendations: (1) Involvement of the multiprofessional team and the managers of the institution; (2) Establishment of a patient safety culture; (3) Use of the safe surgery checklist; (4) Improvement of interpersonal communication; (5) Expansion of nurses' performance; (6) Adequate availability of physical, material and human resources; (7) Individual search for professional updating; and (8) Development of continuing education actions.
CONCLUSION
These recommendations can be used as care management strategies by nurses for patient safety in the operating room.
Topics: Adult; Attitude of Health Personnel; Brazil; Female; Humans; Male; Middle Aged; Nurses; Operating Rooms; Organizational Culture; Patient Safety; Practice Guidelines as Topic; Quality of Health Care; Surveys and Questionnaires
PubMed: 30540056
DOI: 10.1590/0034-7167-2018-0449 -
Frontiers in Public Health 2022To predict the amount of teamwork that takes place throughout a surgery, based on performing a preoperative safety standards (surgical safety checklist and surgical...
OBJECTIVES
To predict the amount of teamwork that takes place throughout a surgery, based on performing a preoperative safety standards (surgical safety checklist and surgical count) and to explore factors affecting patient safety and staff psychological safety during a surgery, based on interprofessional teamwork.
METHODS
This mixed methods study included quantitative and qualitative analyses. Quantitative data included 2,184 direct observations of surgical cases with regard to the performance of safety standards during surgeries in 29 hospitals, analyzed using multivariate binary logistic regressions. Qualitative data were obtained from an analysis of 25 semi-structured interviews with operating room (OR) clinicians and risk managers, using an inductive thematic analysis approach.
RESULTS
Analysis of the OR observations revealed that a lack of teamwork in the preoperative "sign-in" phase doubled the chances of there being a lack of teamwork during surgery [odds ratio = 1.972, 95% confidence interval (CI) 1.741, 2.233, < 0.001] and during the "time-out" phase (odds ratio = 2.142, 95% CI 1.879, 2.441, < 0.001). Consistent presence of staff during surgery significantly increased teamwork, by 21% for physicians and 24% for nurses ( < 0.05), but staff turnover significantly decreased teamwork, by 73% for physicians ( < 0.05). Interview data indicated that patient safety and staff psychological safety are related to a perception of a collaborative team role among OR staff, with mutual commitment and effective interprofessional communication.
CONCLUSIONS
Healthcare organizations should consider the key finding of this study when trying to identify factors that affect teamwork during a surgery. Effective preoperative teamwork positively affects intraoperative teamwork, as does the presence of more clinicians participating in a surgery, with no turnover. Other factors include working in a fixed, designated team, led by a surgeon, which functions with effective interprofessional communication that promotes patient safety and staff psychological safety.
Topics: Humans; Operating Rooms; Patient Safety; Patient Care Team; Hospitals; Physicians
PubMed: 36620282
DOI: 10.3389/fpubh.2022.1060473 -
Nursing Open Mar 2020To discuss specialist operating theatre nurses' competence in relation to the general six core competencies and patient safety.
AIM
To discuss specialist operating theatre nurses' competence in relation to the general six core competencies and patient safety.
DESIGN
A discursive analysis of legal statutes and scientific articles.
METHODS
Swedish legal statutes and an overview of scientific articles on operating theatre nursing were deductively analysed and classified into healthcare providers' general six core competencies.
RESULTS
All healthcare professionals should possess the general core competencies, regardless of their discipline. The specific content within these competencies differs between disciplines. The specialized operating theatre nurse is the only healthcare professional having the competence to be responsible for asepsis, instrumentation, infection and complication, control and management of biological specimens during the surgical procedure. Besides operating theatre nurses, no other healthcare profession has the formal education, competence or skills to perform operating theatre nursing care in the theatre during the surgical procedure. Operating theatre nurse competence is therefore indispensable to ensure patient safety during surgery.
Topics: Humans; Nurse Specialists; Operating Room Nursing; Operating Rooms; Patient Safety; Sweden
PubMed: 32089845
DOI: 10.1002/nop2.424