Mrs. M, who is having a lumpectomy on her left breast, is receiving monitored care anesthesia. A smoker most of her life, Mrs. M is very anxious and is given sedation and oxygen via facemask that occasionally is turned up to 10 L/minute to keep her oxygen saturation above 90%. The anesthesia care provider did not notify the perioperative team that he increased the oxygen percentage. The surgeon is using a monopolar electrosurgical device and places the electrosurgical pencil on Mrs. M's chest when it is not being used. Would you know how to discuss fire safety in this situation?
Background
Fire prevention and education are important components of perioperative nursing. In 2003, The Joint Commission released their Sentinel Event Alert, Issue 29: Preventing surgical fires.1 The Association of periOperative Registered Nurses developed a Fire Safety Tool Kit.2 The fire triangle was introduced to nurses, along with information on the dangers of an oxidizer-enriched environment, the fuel sources around them, and ignition devices being used.
The tool kit contains a fire risk assessment that is completed by the circulating nurse before a procedure or during the time-out process. The tool kit includes fire prevention strategies for high-risk patients who are having surgery on the head, neck, or chest, and use of oxygen via an open delivery system such as a nasal cannula or face mask, with the use of a heat source.
Annually, the surgical staff reviews fire safety techniques with high-risk patients, fire risk assessments and participates in drills. Sometimes education is not enough because high-risk behaviors continue such as leaving the electrosurgical pencil on the surgical field instead of in the holster or turning up the oxygen to high flow under monitored anesthesia care rather than placing a laryngeal mask airway (LMA) in the patient.
The education
Additional tools needed for difficult conversations with providers or coworkers about fire safety are in the book Crucial Conversations: Tools for Talking When Stakes Are High.3
Some key elements of crucial conversations are:
Start with heart: Have the right motive for the conversation.
Make it safe: Bring mutual respect and purpose to the table.
Mastering your story: Rethink your story. Consider that there could be another conclusion.
State your path: Share the facts without being offensive. Show genuine interest in hearing another's story.
Move to action: Role play typical road blocks to safety and put concepts into action.
Putting it together
The circulating nurse recognized that Mrs. M was in danger and spoke up as the patient's advocate (start with heart). The circulating nurse approached the anesthesia provider and surgeon about her concerns with the oxygen-enriched environment, along with the use of the electrosurgical device (stating her path). She started by asking for opinions (making it safe) about other options for oxygenation using an LMA or endotracheal tube for Mrs. M.
Conclusion
Every day perioperative nurses may encounter situations where they need to step in before patients are harmed. These nurses need to learn about having that crucial conversation. Using these tools can save patients' lives.
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