OR Manager November/December 2021 - 19

Quality Improvement
Standardizing for patient safety
With 6.6.% of the US population being
latex sensitive, allergic reactions in
the OR can place patients and staff at
undue risk, leading to potentially fatal
anaphylatic shock. Failure to identify a
latex risk before a surgical procedure
can lead to the OR being torn down. Disposing
of all potentially contaminated
equipment, re-sterilizing reusable items,
and getting the OR ready for the procedure
to resume delays not only the operation
itself but also subsequent ones.
At the University of Rochester Medical
Center, we recognized that OR teardowns
because of latex allergies were
a growing and unnecessary burden
on staff time, resources, and patient
safety. We calculated that up to 90 surgical
cases per year were being cancelled
in one OR suite because of latex
contamination for an identified latex allergy
patient. The final cost burden of
OR teardowns can be hard to specify,
but depending on the case type, the
additional set up time and supply costs
were estimated to range from between
$350 to $1,500 per teardown.
Moves toward latex free clinical environments
have been taking place in
hospitals and health systems across the
country for several years, yet changing
decades old processes and preferences
of healthcare workers on the gloves that
they use can be a disruptive cultural
change for staff familiar and comfortable
with specific pieces of equipment.
Standardization must work for everybody.
Surgical gloves are often seen as
a very personal choice, especially by surgeons
who naturally have preferences for
certain products or those with the ability
to provide the very best patient care.
Implementing any kind of change within a
hospital or health system comes with the
natural challenge of staff acceptance of
new products or processes.
At minimum, we want this change
to be tolerated by staff, but that is
not enough. We want staff to be
fellow travelers on this journey. This is
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where the value of a LEAN methodology
evolves through utilization of the experience,
expertise, and the support of staff
to facilitate change.
Standardizing together
The University of Rochester Medical
Centre's LEAN Committee established a
project in which clinical champions were
recruited to assist with a 2-week trial of
more than 70 surgeons and residents,
as well as 200 nurses and certified technicians,
to try two samples of surgical
gloves. This approach was supported
by a nursing education program on fiscal
responsibility of case-to-case glove
usage, so they could act as patient safety
advocates. Communication across the
hospital, whereby nurses were included
in sizing and selections, was ensured
throughout the program.
Another essential element of the
standardization process is working with
an industry provider with the skills and
experience to help optimize the value of
patient care products at every step of
the standardization journey. Our manufacturing
partner, for instance, brought
in specialists to ensure that healthcare
workers were educated and supported
through the changes being made, removing
the burden from hospital staff.
This also enabled OR staff to have the
opportunity to understand the different
surgical glove options and be properly
sized, which facilitated the transition.
Following the completion of the program,
we reduced OR teardowns associated
with a latex allergy from 36 in
1 year to zero the next, with a cost reduction
of $43,020 on the second floor
SSC OR. We also drastically reduced
stock keeping units down from 13 to 3,
saving 111 cubic feet of space.
Conclusion
Whether in surgical or wound care products,
every institution should be considering
how to standardize to the highest
quality and help teams achieve more for
patients. While there is no one-size-fitsall
approach to standardization, adopting
a LEAN methodology provides the
basic framework to help any hospital
or health system achieve more for patients.
It allows staff to participate in
or facilitate the standardization journey,
providing opportunities for affected
members of the team to be empowered
as leaders, not passive bystanders, so
change can not only be tolerated but
embraced. ✥
Sam Sullivan, RN, CNOR, is Ophthalmology
Coordinator at Flaum Eye Institute,
Strong Memorial Hospital, part of the
University of Rochester Medical Center.
Much of his 13-year nursing career in the
OR has been devoted to ophthalmology.
Sullivan's interest in the LEAN process
began early and grew into his position as
Lead Lean Specialist for the last 7 years.
He is an expert in the LEAN process
and has published on process changes
achieved with its integration.
References
Vargas A, Foncea C, Astorga P. Latex allergy:
Overview and recommendations
for the perioperative management
of high-risk patients. J Head Neck &
Spine Surgery. 2017;1(1):1-6.
Di Leo E, Donne P D, Calogiuri G F,
et al. Focus on the agents most
frequently responsible for perioperative
anaphylaxis. Clin Mol Allergy.
2018;16:16.
Sullivan E. Utilizing the Lean Process
in Surgical Glove Standardization.
Published Poster, AORN 2020.
OR Manager | Nov/Dec 2021
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OR Manager November/December 2021

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