At UCHealth University of Colorado Hospital, Catherine Kleiner focused her work on finding ways to improve safety in operating rooms. At a national awards ceremony in April, the focus was on her body of work.
Kleiner, RN, PhD, won the Nursing Research Award from the Association of periOperative Registered Nurses (AORN) at the organization’s Expo April 4 in Anaheim, Calif. The AORN honored Kleiner in part for studies she conducted as a research nurse scientist at UCH.
These included initiatives to improve communication among team members in the surgical and labor-and-delivery settings. Another examined areas at high risk of contamination in ORs. The work produced two published studies co-authored by Kleiner; another has been accepted for publication.
“It’s a great honor for Catherine, the staff involved in this work, and University of Colorado Hospital to be recognized this way,” said Katherine Halverson-Carpenter, RN, CNOR, UCH’s executive director of Perioperative Services.
For her part, Kleiner, who is now a research nurse scientist at Denver Health, credited Halverson-Carpenter, her former research colleagues at UCH, and hospital staff for the award.
“I felt very honored, but it was more of a department award,” Kleiner said. “I accepted the award on behalf of everyone who helped me accomplish the work.”
Communication: the operative word
In a study published in the October 2014 issue of the AORN Journal, Kleiner and her co-authors detailed the outcomes of a program at UCH that used coaching to improve briefings and debriefings between surgical team members. The goal: reduce the risk of medical errors through miscommunications. The project followed a methodology called Crew Resource Management (CRM) that was originally developed by NASA.
The study concluded that the coaching helped to improve the quality of communication in the OR at UCH. Halverson-Carpenter noted that CRM training is still offered to all perioperative nurses, faculty, and residents several times a year. She credited it with helping to boost inpatient OR nurses’ perceptions of the quality of care and of their collegiality with physicians, as measured by the annual National Database of Nursing Quality Indicators-administered nursing survey at UCH.
A manuscript detailing the findings of a separate study of CRM-based patient safety training in the hospital’s labor-and-delivery units was accepted by the Journal of Obstetric, Gynecologic and Neonatal Nursing.
Kleiner said she hopes to follow up on the CRM work. “Miscommunication continues to be the cause of most errors in hospitals,” she said. “Crew can be used to improve patient safety, as we demonstrated with this project.”
In a third study, Kleiner teamed up with Terri Link, RN, a Perioperative Services patient safety specialist at UCH, to identify common sources of contamination in the OR. “Our goal was to focus on policies and processes of cleaning in the operating rooms,” Kleiner said.
A literature review revealed that while there had been plenty of research done on identifying “high-touch” areas in medical/surgical units, not much had been done in perioperative areas, a very different environment.
“The big finding” of the study, Kleiner said, was that the computer and keyboard at the nurse’s station in the OR was the greatest source of contamination and infection because they were frequently touched by a half-dozen or more people. Anesthesiology equipment, by comparison, received frequent touches, but generally only by the anesthesiologist. The study reinforced the critical importance of good hand hygiene, Kleiner said, adding that the work promises to lead to additional investigations.
“This first project was limited to surgeries of short duration,” she said. “I’d like to do more in GI and colon surgeries, which CMS is interested in.” She cited cardiac units as another area where infections can greatly increase the risk of mortality.
The American Journal of Infection Control published the study this month. Halverson-Carpenter added that UCH is in the process of buying computer keyboards and mouses that are easier to clean.
“The study has had an impact on infection control and the importance of cleaning all surfaces in the OR to reduce the risk of cross-contamination,” Halverson-Carpenter said.
Kleiner’s AORN award is well-deserved and demonstrates the importance of research in moving health care forward, Halverson-Carpenter concluded.
“We are entrenched in evidence-based care, and it’s wonderful to see one of our nurses involved in helping us to set higher standards and making a mark in patient care,” she said.