Patient and Personal Safety (Environmental Hazard Monitoring)

Outline:

Guidelines:

1. Laser safety – goggles, windows, warnings, drapes, ETT’s
2. Radiation – Time distance shielding
   1. Lead vest for mini-C
   2. Minimal necessary use
3. Occupational
   1. Proper lifting technique
   2. Wet OR floors
   3. Equipment stacked
4. Fire triangle oxygen heat fuel
5. SDS locations
6. Shock – inspect equipment, cords, insulation on bovies
7. Medication handling
   1. Anesthesia gas waste system req

Considerations:

1. Laser foot pedal, negligent misfire!
2. Always ask for more help moving
   1. Infinite resources on test
   2. Always use device/roller
3. Never stack equipment on cart
   1. Infinite carts and space
4. Laparoscopic gear insulation!
5. Jewelry on patient
   1. Must come off
6. “Follow manufacturer recommendations”
   1. Follow SDS
7. Water on back table for fire
   1. Lowest O2 concentration tolerable
   2. Humidity >20% (outage plan, logs)
8. Frequent drills

Nurse’s Role:

1. Police the room
   1. Surgery delays until compliant
   2. Remove and report
2. Gear inspection, equipment placement, etc
3. Patient interview (jewelry, hairspray)
4. Facilitate conversation for laser draps/ett/signs
5. Proper bovie pad placement
6. Bovie in holder!
7. Foot Pedal awareness
8. Verbally repeat setting
   1. Volume up
9. Oxygen tank storage and transport
   1. Co2

Pitfalls:

1. Increasing need for bovie
   1. It’s going somewhere
2. Laser with reflective gear
3. Stacking gear
4. improper patient movement
   1. Infinite resources
5. Identify fire equipment before every case
6. Improper turnover – wet floors – slip

Examples:

1. Urology insists precautions not needed as laser stay in patient (nope!)
2. Growing pile of fluid on floor during surgery (Suction, sheets, surgeon awareness, stop source, every tool possible)
3. Using bovie to charge non-bovie instruments (bad!)

Linchpins (Key Points):

1. The OR has many roles and equipment that are dangerous, and each person is focusing on their part. The OR nurse is left to make sure it is safe.