Making the OR a (back) pain-free zone
AORN offers ergonomic toolkit to nurses
The operating room poses unique challenges for patient handling. Anesthetized patients can't move, respond, or even complain of discomfort. The sterile field and crowded conditions limit the extra equipment that can be brought in. Meanwhile, nurses or techs must sometimes stand for hours, holding equipment or a patient's limb.
To help OR nurses avoid injury, the Association of peri-Operative Registered Nurses (AORN) is launching an awareness campaign and created an educational toolkit. Algorithms help nurses determine which equipment would be appropriate for safe patient handling.
"All the algorithms were based on research. It's truly evidence-based guidance," says Carol Petersen, RN, BSN, MAOM, CNOR, manager of perioperative informatics at AORN's Center for Nursing Practice, who worked with ergonomics experts such as Tom Waters of the National Institute for Occupational Safety and Health (NIOSH) and Audrey Nelson with the Patient Safety Center of the VISN 8 of the Veterans Health Administration. "One of the things everyone struggled with was how to maintain sterility and still maintain the safety of the perioperative personnel."
Patients larger, workers older
Risks in the operating room are rising as hospitals care for more patients of size and the nursing work force ages, notes Mary Ogg, RN, MSN, CNOR, perioperative nursing specialist. Some hospitals have responded by providing special equipment for their operating rooms, she says.
But nurses also need to be their own advocate, and they should be aware of proper lifting techniques and assistive devices, she says. "I would like for nurses to be aware of these algorithms to protect themselves and to keep their patients safe," she says.
In 2006, AORN issued a position statement calling for "ergonomically healthy" workplaces. They called on hospitals to identify ergonomic risks in the OR and implement injury prevention strategies. According to AORN, some of the OR-specific ergonomic risks include:
Static posture: Standing in one place for long periods or standing on hard surfaces such as concrete can cause muscle fatigue, pain, and poor circulation to the lower extremities. Possible interventions include special mats and footwear and support stockings. Employees also can shift their weight from side to side to give their legs some relief, says Petersen.
Awkward postures: Nurses and other OR personnel can develop neck or shoulder discomfort from maintaining an awkward posture, such as when holding a retractor or a patient's limb. In some cases, OR equipment may be repositioned to create a better ergonomic setting. Lift equipment also can be used to elevate a patient's limb, freeing the employee to assist in other ways.
Transfer from transport gurney to OR table: Even when two or more employees are working together to transfer a patient laterally, the force sustained by each person often exceeds the NIOSH lifting limits. For patient handling, NIOSH recommends that individuals lift no more than 35 pounds. Transfer devices, such as the Hover Matt, can be used successfully in the OR.
Cumulative trauma: As with other health care workers, OR nurses and techs may develop back, shoulder or neck injuries over time as a result of ongoing stress. That is why AORN recommends a comprehensive program that identifies hazards before significant injury occurs, says Ogg. Ceiling lifts may provide a viable solution for some ORs, particularly if the lift can be positioned so it doesn't interfere with other equipment needed for the procedure. The ceiling lifts also must meet standards for maintaining the sterile field, Petersen notes.
[Editor's note: The Association of periOperative Registered Nurses (AORN) is the national association committed to improving patient safety in the surgical setting. AORN is the premier resource for perioperative nurses, advancing the profession and the professional with valuable guidance as well as networking and resource-sharing opportunities. AORN promotes safe patient care and is recognized as an authority for safe operating room practices and a definitive source for information and guiding principles that support day-to-day perioperative nursing practice.]
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