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Path to Green: Practice Improvement in the OR

2011; Wiley; Volume: 93; Issue: 6 Linguagem: Inglês

10.1016/j.aorn.2011.01.011

1878-0369

Janel C. Parham,

Geriatric Care and Nursing Homes

Hospitals are ethically obligated to look for new strategies to positively affect the communities they serve. Hospitals that subscribe to the tenets of Magnet™ actively seek methods of improvement for patients, staff members, and the community. The Magnet Recognition Program®, “developed by the American Nurses Credentialing Center (ANCC) to recognize health care organizations that provide nursing excellence,”1 is based on quality indicators and standards known as the 14 Forces of Magnetism. Many activities, such as identifying and implementing best practices, can be used by nurses and other health care professionals to demonstrate one or more of the Magnet forces. Force 4: Personnel Policies and Programs, Force 7: Quality Improvement, Force 8: Consultation & Resources, Force 10: Community and the Healthcare Organization, Force 11: Nurses as Teachers, Force 12: Image of Nursing, Force 13: Interdisciplinary Relationships, and Force 14: Professional Development.3 Kermit the Frog's signature phrase, “It's not easy being green,” holds true for many individuals, families, and businesses. I am one of many nurses and health care professionals who are coming together through education, committees, and professional organizations to make a change in the way society views the relationship between health and the environment (Force 12: Image of Nursing). I joined the movement for environmental health awareness not only because it affects the environment, but also because negative effects on the environment mean negative effects on society. I did not start my nursing career in environmental health or in the OR, but during my graduate studies at the University of Maryland School of Nursing, Baltimore, I took a course in environmental health that changed my life. “Environmental health addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments.”4 As we delved deeper into the topics of toxins, contaminants, and exposures, I became overwhelmed. I not only had to come to terms with what was truly going on in my environment, but I also had to determine how I was going to use the information to make a difference. After completing my master's degree in community and public health, I decided to continue my studies to complete a post-master's degree in environmental health nursing (Force 14: Professional Development). Environmental health nursing was not well known as a specialty in the nursing profession, even in the early 1990s, but there were certainly already champions, such as Barbara Sattler, DrPH, RN, FAAN, professor and director of the Environmental Health Education Center at the University of Maryland School of Nursing, who were working toward a common goal of creating a better environment. Dr Sattler is well known in the environmental health and nursing communities for creating the first graduate degree program in environmental health for nurses in the United States. We are in a new dawn regarding environmental health in the US and, in fact, globally. The public awareness and interest in all things “green” is creating a demand for nurses to understand the relationship between human health and the environment in which we live, learn, work, and play. We have moved beyond questioning the science of whether we are in environmental health peril to almost unanimous consensus that we must act and act now on many of the risks we are all experiencing. Nurses, who are one of the most trusted sources of information by the public, must be in a position to both respond to questions about the environment and its relationship to health with credible, evidence-based information, as well as provide leadership in making the necessary changes in our policies and practices. To that end, we must prepare nurses to be a cut above the average citizen with regard to their knowledge of environmental health issues.5 Since I entered into environmental health nursing, my passion for issues affecting health and the environment has stayed with me throughout different career positions (Force 11: Nurses as Teachers, Force 12: Image of Nursing). In 2006, I came to Sinai Hospital of Baltimore, a LifeBridge Health Center, to explore perioperative nursing. According to Practice Greenhealth, the OR generates not only approximately 42% of the hospital's overall revenue, but also 20% to 30% of the hospital's overall waste volumes.6 I could not have imagined the amount of waste generated for one surgical procedure. It made me wonder, “What are we doing here at Sinai Hospital to make a positive impact on the environment?” I first approached my advanced practice nurse (Force 8: Consultation & Resources) to ask about environmentally friendly initiatives; however, no procedures were in place at that time. In 2007, the green team was formed by key hospital administrators to address the environmental effects not only of Sinai Hospital, but LifeBridge Health as a whole (Force 4: Personnel Policies and Programs, Force 7: Quality Improvement, Force 10: Community and the Healthcare Organization). With no full-time sustainability coordinator, individual departments in the system were brought together to tackle the task of “greening” the system. The LifeBridge Health green team consists of staff members from various departments, including facilities, environmental services, food and nutrition, safety, marketing, nursing, transportation, purchasing, design and construction, and laboratory services. The interdisciplinary team members (Force 13: Interdisciplinary Relationships) initially met for idea sharing, and we found that many of us had already implemented green practices in our own respective departments and areas (eg, working with our energy supplier to reduce energy usage). The challenge was to bring the efforts together. I began to focus my work on waste management and reduction because it fell in line with the concerns I had for the OR. As the only nurse serving on the team (Force 12: Image of Nursing), I had the unique opportunity to share how proposed initiatives would function in clinical areas and also bring ideas back to the committee from various units (Force 4: Personnel Policies and Programs). The department of perioperative services was a logical choice for a pilot project focused on reducing the environmental effects of the clinical areas. Much of the waste in the OR is disposed of as regulated medical waste, even when it is waste that does not require special handling or that could be recycled. Disposal of regulated waste costs five to 10 times more in fees than unregulated waste, but cost was not the only issue. Waste ends up in landfills and can contaminate soil and groundwater. When landfills become full, waste is often shipped to less-populated areas, spreading the contamination outside the boundaries of its original source. The combination of effects on both the revenue and waste streams created an impetus not only to make a large reduction in our carbon footprint, but also in the operating costs of the department.6 Our reduction and recycling program for the OR is one of the initiatives that the hospital has undertaken to improve the quality of life for staff members, patients, visitors, and the community we serve (Force 4: Personnel Policies and Programs, Force 10: Community and the Healthcare Organization). The program is simple; the OR staff members carefully consider what disposables are to be opened for the procedure and separate the waste into clear bag waste (eg, soft packaging materials from surgical packs), red bag waste (eg, saturated laparotomy sponges and x-ray detectible sponges), and recyclables (eg, noncontaminated sterile saline, water bottles, hard plastic casings from disposable instruments and implants). The challenge was getting everyone to buy in to a change in practice. This process required staff members to think about where the trash belonged, not just throw things in the nearest receptacle. Few people realize how their everyday practices affect the environment, and even fewer know how toxins in the environment affect their health. Part of my job was to educate the staff members about the new procedures for waste management so they would understand how important their participation was to the success of the program. That education also included an introduction to environmental health nursing. I conducted inservice programs for staff members, coordinated programs for vendors, encouraged staff members one-on-one throughout the perioperative services department, and became a resource person for the program (Force 11: Nurses as Teachers). As staff members gained a better understanding that separating the waste did not have to affect efficiency, compliance with the program increased significantly. Anything opened before the patient entered the room was either clear bag waste or recyclable. Items opened during surgery needed to be evaluated for disposal because a large number of items still could be placed in the recycling bin or clear bag. Since September 2008, we have recycled 16,230 lb of blue wrap, an average of more than 675 lb per month. I attribute the success of the program to the staff's willingness to adapt to change and the support of our executives, from our department director all the way up to the president of LifeBridge Health. I continue to be a resource for our staff, providing information on our programs at Sinai Hospital and environmentally friendly practices in general. I also continue to teach staff and community members through lectures, articles, blogs, and interviews (Force 10: Community and the Healthcare Organization, Force 11: Nurses as Teachers, Force 12: Image of Nursing). I am still learning and attending conferences and seminars in environmental health (Force 14: Professional Development). The information and “greener” practices at Sinai Hospital provide benefits to staff members, patients, visitors, and the community as a whole (Force 4: Personnel Policies and Programs, Force 7: Quality Improvement, Force 10: Community and the Healthcare Organization). Sinai Hospital is one of many hospitals working to make a change by embodying a culture of environmental responsibility, including changes to policy and practice. As we prepare for redesignation as a Magnet facility, one of the exemplars for nursing practice will include the OR recycling program. The supporting documents for the redesignation process will not only highlight the positive environmental effects, but will also detail the nursing interventions, processes, and achieved results. The trailblazing green initiatives of Sinai Hospital, including our waste reduction program for the OR, will continue to positively affect the community as a whole by decreasing the carbon footprint of the hospital. Projects such as these demonstrate our commitment to the tenets of Magnet through our work to minimize our environmental impact. The hospital's initiatives can serve as a catalyst to encourage other hospitals in the area and around the country to make a positive change for our environment. Janel C. Parham, MS, RN, is OR liaison nurse at Sinai Hospital of Baltimore, MD. Ms Parham has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.