A coalition of organizations involved in surgery is worried about how new technologies increase the noise and distraction levels in the operating room and otherwise affect patient safety and privacy. So they created a chart they hope will help people stop and think before bringing a device into the theater.
“This has been an issue for the entire 38 years I’ve been practicing,” says Tom McKibban, CRNA, MS, Council on Surgical and Perioperative Safety (CSPS) chair of the American Association of Nurse Anesthetists (AANA) and a practicing nurse anesthetist at Mid-America Anesthesia Professionals, LLC, in El Dorado, KS. The AANA is one of the organizations in CSPS, which created the chart. “It has just gotten worse with the era of smartphones.”
Prior to the Digital Age, every new technology added beeps and alarms, he says. As stereos became portable, music entered the operating theater, and some surgeons like it loud. “But if I can’t hear my monitors, then there is a potential safety issue,” he says.
Smartphones, however, introduce the issue of privacy — they all come with cameras now — as well as infection. You can see a story on the local news just about every year on the cess pit of germs that is a cellphone. Is that something you want a surgeon touching, even if it is to look up something in the medical literature? asks McKibban.
The group recommends a multidisciplinary approach to creating a safe surgical environment, noting that too much noise can impede on the work that any one of the team members needs to do — like the surgeon’s music preferences hampering McKibban’s work.
Cellphones brought into the theater can be another source of distraction and noise, even if they were brought in with positive intentions. If they are brought in as a tool to use for looking up medical information, are they set on vibrate in case they ring during surgery? McKibban wonders. Do the ring tones mimic the sound of any of the monitors or alarms? Have they been recently cleaned?
He says there is no reason to have a cellphone or tablet in the theater. Any information you need can be relayed via a surgical technician.
There are not any hard data on whether these modern-day tools have led to any negative outcomes or patient harm. McKibban says it is not something that anyone has paid much attention to until recently. But, he would be shocked if it had not already had an impact somewhere, at some time. If not, then now is an ideal time to work preemptively before anything bad does happen, he says.
A little quieter operating room would not be a bad side effect, either, he notes: “There was a study last year in one of the surgical journals that showed that a typical surgical suite has a noise level of 131 decibels,” he adds. “Pain occurs at 140 decibels. Why not try to bring it down a little?”
The chart developed by the consortium is a series of concentric circles. The central circle includes a statement requiring a team approach. The first ring is divided into three sections: Cellular Devices in the Operating Room, Noises and Distractions, and Infection Control. Outside each section are supporting statements, such as how a cellphone can compromise the sterility of the operating room, or that the zone of silence may be disturbed by unnecessary noise.
The outer ring goes into more detail. For example, the section aligned with cellphones mentions how an “undisciplined” use of cellphones can compromise patient privacy, government regulations, or hospital rules. CSPS encourages hospitals to download a copy — or multiples — of the chart from the website at http://www.cspsteam.org/NoiseandDistraction/ElectronicDistractionLogo.pdf. CSPS suggests laminating it, especially if you post the chart in the OR.
While CSPS’s chart is a template, McKibban says every hospital will have to create policy based on its particular needs and environment. He works in one facility with a single OR, where everyone knows each other from town. Another has four ORs, and in Wichita, there’s a hospital with 36.
How the staff in each of those facilities interacts, how they do things, will inform how you create a policy around cellphones and tablets in the OR. “Sit down with the players — everyone who works in the theater — and talk to them about the noise and distraction issues you have in your hospital. Then work on ways to reduce them.”
The CSPS membership includes the American Association of Nurse Anesthetists, American Association of Surgical Physician Assistants, American College of Surgeons (ACS), American Society of Anesthesiologists, American Society of PeriAnesthesia Nurses, Association of periOperative Registered Nurses (AORN) and Association of Surgical Technologists.
For more information on this topic, contact Tom McKibban, CRNA, MS, CSPS Chair, American Association of Nurse Anesthetists (AANA), Mid-America Anesthesia Professionals, LLC, El Dorado, KS. Telephone: (316) 321-8772.