Surgical Technicians Research Articles

Investigating the Relationship between Communication Skills of Treatment Staff and Patient’s Safety Culture: A Cross-Sectional Study

Background: One of the most important effective factors in increasing patient satisfaction and improving health and treatment results is proper communication between physician and nurse, and the patient. The present study was conducted with the aim of determining the relationship between the communication skills of the medical staff and patient’s safety culture. Methods: This was an analytical study conducted among 277 working medical staff including nurses, paramedics, full-time geographical employment doctors and anesthesia, and operating room technicians in Shahid Sadoughi Hospital in Yazd by stratified random sampling in 2022. The instrument used was the safety culture standard questionnaire made by the health care quality and research agency and communication skills of Barton J. Data analysis was done with SPSS 25 software, Mann-Whitney, Kruskal-Wallis, and multiple linear regression tests. Results: The overall mean and standard deviation of patient safety culture was 3.04 ± 0.23, which indicates the average status of safety culture in the studied hospital, and the overall mean of communication skills among medical staff was 3.36 ± 0.40. Which reports a relatively strong level of this skill. The results of linear regression showed that 2 components of communication skills (listening and feedback) have a positive and significant effect on the improvement of patient safety culture, so that they are able to explain 33 percent of the variance of patient safety culture changes. Conclusion: Based on the findings of the research, the communication skills of the medical staff have a significant effect on patient's safety culture. Therefore, in order to improve the patient’s safety culture among them, special attention should be paid to communication skills because effective communication is considered a vital element in effective care, and in the medical system it has a significant effect on the quality of care and consequently increases the satisfaction of patients.

Consensus guidelines on the bedside assistant skills required in robotic surgery.

While bedside assistants play a critical role in many robotic operations, substantial heterogeneity remains in bedside assistant training pathways. As such, this study aimed to develop consensus guidelines for bedside assistant skills required for team members in robotic operations. We designed a study using the Delphi process to develop consensus guidelines around bedside assistant skills. We generated an initial list of bedside assistant skills from the literature, training materials, and expert input. We selected experts for the Delphi process based on prior scholarship in the area of robotic bedside assistant education and experience facilitating robotic bedside assistant training. For each item, respondents specified which robotic team members should have the skill from a list of "basic" bedside assistants, "advanced" bedside assistants, surgeons, surgical technologists, and circulating nurses. We conducted two rounds of the Delphi process and defined 80% agreement as sufficient for consensus. Fourteen experts participated in two rounds of the Delphi process. By the end of the second round, the group had reached consensus on 253 of 305 items (83%). The group determined that "basic" bedside assistants should have 52 skills and that "advanced" bedside assistants should have 60 skills. The group also determined that surgeons should have 54 skills, surgical technologists should have 25 skills, and circulating nurses should have 17 skills. Experts agreed that all participants should have certain communication skills and basic knowledge of aspects of the robotic system. We developed consensus guidelines on the skills required during robotic surgery by bedside assistants and other team members using the Delphi process. These findings can be used to design training around bedside assistant skills and assess team members to ensure that each team member has the appropriate skills. Hospitals can also use these guidelines to standardize expectations for robotic team members.

Effect of simulating training of the fundamentals of laparoscopic surgery on the attitude of operating room nurses students: an intervention study

Abstract Objective Clinical education plays a key role in preparing students for patient care. Laparoscopy is one of the most important minimally invasive surgeries (MISs) wherein surgical technologists are responsible for camera navigation and assistant surgeons are responsible for peg transfer. Therefore, it is necessary to improve the attitude of the operating room students toward these skills during their study period. The present study was conducted to determine the effect of simulating training in the fundamentals of laparoscopic surgery (FLS) on the attitude of the operating room students. Methods This interventional study was conducted on 28 operating room students of Iran University of Medical Sciences in 2019. The census sampling method was used. The data-collection tool included the “Intrinsic motivation inventory (IMI) questionnaire.” The educational intervention was carried out in theoretical (booklet design) and practical (simulation) sections. Data analysis was carried out using descriptive and inferential analyses including the paired t-test, Mann–Whitney U test, and independent t-test. The collected data were analyzed using R and SPSS software. P-value <0.05 was considered as the significant level. Results The mean ± SD of the participants’ age was 22.93 ± 2.14 years, and the majority of them were women (67.9%). There was a significant difference in the mean scores of students’ attitudes toward the FLS before and after the educational intervention (P < 0.001) in all dimensions (interest, perceived competence, perceived choice, and tension). There was also a significant correlation between gender and interest dimension (P = 0.005). Conclusions The results of the present study showed that simulating the training FLS curriculum positively affects students’ attitudes. Therefore, the researchers suggest that for creating a positive attitude, increasing students’ interest in laparoscopic surgery, and ensuring a more effective presence in the operating room, this training should be considered in the operating room curriculum.

Blood on the drapes: A multispecialty comparison of blood spill estimates.

Estimated blood loss (EBL) is an important part of the perioperative process. This project aims to determine the accuracy of perioperative team members to estimate blood volume on drapes and the operating room floor. Aliquots of unused human blood were used to create surgical scenarios, and standardized pictures and videos were taken. Physicians, residents, nurses, medical students, and surgical technicians were surveyed and asked to estimate the blood volume for each series. Accuracy and consistency of responses was analyzed. One hundred and forty five responses were recorded: 57 attending physicians, 36 residents, 27 registered nurses, 17 medical students, and seven circulating surgical techs. Median percent error (PE) for all cases was 211.11%, demonstrating a global overestimation of blood volume. PE for the 150mL images was statistically significantly lower than that of the 50 and 100mL images. Circulating Surgical Technicians were the most accurate group, with a median PE of 125%, followed closely by Medical Students (PE=158.33%). The most accurate specialty was Orthopedics (PE=168.06%). The least accurate groups were Attending Physicians (PE=286.11%) and General surgery (GSGY) (PE=327.78%). The most accurate orthopedic surgery and GSGY subspecialties were Hand (PE=237.64%) and Vascular (PE=108.33%), respectively. Statistical analyses showed no significant differences by clinical role, surgical specialty, or subspecialty. This study demonstrates a global overestimation of blood volume when using the visual method, with improved accuracy at higher volumes. Our findings highlight the limitations of visual estimation methods for EBL.

Impact of Live Tissue Training on Provider Confidence for Operative Trauma Management.

Readiness of military health care providers is essential to maintain a prepared fighting force and remains a central issue for today's military. Maintaining skills regarding operative management of trauma is becoming more difficult if not located at an urban trauma center. Live tissue training may be used to practice skills in a facility that does not have exposure to high acuity trauma. The goal of our live tissue skills course is to train health care providers and ancillary staff in the management of various injury complexes and improve confidence and familiarity with management using a porcine model. A live tissue skills course using a porcine model was offered to surgical residents, attendings, and operating room technicians. Before completing the course, each participant completed a survey assessing comfort level, previous training experiences, and deployments. Operative management was simulated with a standardized sequence of abdominal and thoracic injuries. After the course, each participant then completed a survey assessing comfort level, benefit of the course, and comparison to inanimate simulation training. Survey information was obtained via participant completion of a multiple-choice confidential questionnaire. Responses were collected from 34 participants at our institution. Average abdominal trauma comfort increased from 2.79 to 3.73, with no participants reporting feeling not comfortable at all post-lab. Average thoracic trauma comfort increased from 2.47 to 3.48, with one participant reporting feeling not comfortable at all post-lab. Overall, 85% of participants reported the course to be very beneficial in improving their knowledge, 83% reported the course to be very beneficial compared to inanimate simulators, and 92% reported high fidelity of the live tissue training course. Perceived as highly beneficial, live tissue training increased comfort with operative trauma management by surgical residents, attendings, and technicians supporting continued utilization. Further evaluation of live tissue courses would be advantageous in assessing surgical skill improvement, including comparison with simulation training.

Establishment of a 24/7 robotic acute care surgery program at a large academic medical center.

For many years, robotic surgery has been an option for various elective surgical procedures. Though robotic surgery has not traditionally been the first choice for acute surgical patients, recent work has shown promise in broader applications. However, there are limited data regarding how to establish an institutional robotics program for higher acuity patients. This project aimed to map a pathway for the creation of an acute care surgery robotic program at a large academic medical center. Various stakeholders were gathered jointly with our surgical faculty: anesthesia, operating room leadership, surgical technologists, circulating nurses, Central Sterile Supply, and Intuitive Surgical Inc. representatives. Staff underwent robotics training, and surgical technologists were trained as bedside first assistants. Nontraditional robotic operating rooms were allocated for coordinated placement of appropriate cases, and pre-made case carts were arranged with staff to be available at all hours. A workflow was created between surgical faculty and staff to streamline add-on robotic cases to the daily schedule. Six faculty and two fellows are now credentialed in robotics surgery, and additional surgeons are undergoing training. Numerous staff have completed training to perform operative assistant duties. The operating capacity of robotic acute care surgeries has more than doubled in just one year, from 77 to 172 cases between 2022 and 2023, respectively. Two add-on cases can be accommodated per day. Select patients are being offered robotic surgeries in the acute surgical setting, and ongoing efforts are being made to create guidelines for which patients would best benefit from robotic procedures. Launching a successful robotic surgery program requires a coordinated, multidisciplinary effort to ensure seamless integration into daily operations. Additional assistance from outside technology representatives can help to ensure comfort with procedures. Further studies are needed to determine the acute patient population that may benefit most from robotic surgery.

The predictive role of resilience and the ethical climate of hospital in the fatigue of surgical technologists working in operating rooms

BackgroundFatigue in surgical technologists is of paramount importance and is known as a priority because it can be regarded as a threat to the nurse’s health and patient’s safety. The fatigue level of healthcare workers can be affected by some factors, while the role of part of these factors is less known. This study aimed to determine the predictive role of resilience and the hospital ethical climate in the fatigue of surgical technologists working in operating rooms (ORs).MethodsThis is a cross-sectional study conducted on 217 surgical technologists working in ORs of hospitals affiliated with Shiraz University of Medical Sciences. Data were collected using Connor-Davidson’s Resilience scale, Olson’s Hospital Ethical Climate Survey, and the Multidimensional Fatigue Inventory, and then analyzed using Pearson’s correlation coefficient and multiple regression analysis.Results87.1% and 12.9% of surgical technologists reported low and high fatigue, respectively. All fatigue subscales had significant and negative relationships with resilience (p < 0.05). Moreover, the relationship between fatigue and ethical climate was significant (p = 0.02). The multiple linear regression model showed the predictive role of resilience in fatigue (β=-0.29, P < 0.001). According to the model, 10% of the change of fatigue was related to resilience and ethical climate.ConclusionThe present study demonstrated the relationship between resilience and ethical climate with fatigue. Moreover, resilience was a predictor of the surgical technologists’ fatigue, so that their fatigue decreased with increasing resilience. However, future studies are recommended to determine other factors influencing fatigue in surgical technologists.

Surgical Intraoperative Handoff Initiative: Standardizing Operating Room Communication Using SHRIMPS.

Operating room (OR) handoffs are not universally standardized, although standardized sign outs have been proven to provide effective communication in other aspects of healthcare. We hypothesize that creating a standardized handoff will improve communication between OR staff. A frontline stakeholder approached our quality improvement team with concern regarding inadequate quality surgical technician handoffs during staff changes. An audit tool was created for a pilot cohort of 23 cases to evaluate surgical technician handoffs from May 2022 to November 2022. Handoffs occurred in 82.6% of cases. Elements of handoff varied significantly, with an average of 34.4% completion of critical handoff elements. Audits were reviewed with stakeholders to develop a standardized communication checklist, including domains regarding sponges, sharps, hidden items, replaced items, instruments, implants, medications, procedure overview, and specimens. An acronym of these domains, SHRIMPS, was affixed to each OR wall. In the initial Plan-Do-Study-Act cycle, piloted in urology, general surgery, and neurosurgery, 100% of the 15 observed cases included handoff, averaging 76 seconds per handoff. Additionally, 100% of cases announced a handoff to the surgeon, and all elements were addressed 99.6% of the time. Plan-Do-Study-Act cycle 2 involved implementation to all service lines. Of the 68 cases observed, 100% included handoff, averaging 69.4 seconds per handoff, with 98.2% of elements addressed, though only 97.1% of handoffs were announced. Little communication standardization exists within the OR, especially regarding intraoperative staff changes. Implementation of a standardized handoff between surgical technicians resulted in substantial improvement in critical communication during staff changes.

Addressing Knowledge Gaps on Surgical Site Infections: A Multi-Center Study in District Hospitals of Khyber Pakhtunkhwa, Pakistan

Background: Surgical site infections (SSIs) pose significant global health challenges, increasing mortality and healthcare costs. Effective prevention of SSIs is imperative for ensuring patient safety and maintaining high-quality surgical care standards. Objective: To evaluate the knowledge levels of SSIs and associated wound infection risks among surgical staff in district hospitals throughout Khyber Pakhtunkhwa, Pakistan. Methods: A comprehensive 20-item multiple-choice questionnaire was developed collaboratively with certified surgeons and based on extensive literature review. The survey assessed knowledge concerning SSIs and related risk factors among a diverse group of surgical staff, including consultants, specialists, residents, and medical interns, at various district hospitals. Results: Out of 250 participants, the distribution by job role was as follows: 132 interns (52.8%), 50 resident doctors (20%), 20 surgical technologists (8%), 33 surgical technicians (13.2%), and 15 specialist doctors (6%). Overall, 113 participants (45.2%) correctly identified the definition of an SSI. Regarding knowledge levels, 50 participants (20%) demonstrated good knowledge, 166 (66.4%) had fair knowledge, and 34 (13.6%) showed poor knowledge about SSIs. Conclusion: The study identifies critical gaps in the knowledge of surgical staff at district hospitals in Khyber Pakhtunkhwa concerning SSIs. These findings underline the necessity for targeted educational interventions to elevate knowledge levels, enhance patient safety, and advance infection control practices.

An Initiative to Prevent Surgical Site Infections After Cesarean Birth With a Quality Improvement Care Bundle

ObjectiveTo reduce surgical site infections (SSIs) after cesarean birth through a bundled care approach. DesignQuality improvement project. Setting/Local ProblemIn a community hospital obstetric unit, an increase in SSIs after cesarean birth was observed. ParticipantsNursing leaders, obstetricians, certified nurse-midwives, physician assistants, nurses, scrub technicians, a nursing professional development specialist, and an infection prevention practitioner. Interventions/MeasuresAn interdisciplinary team was formed in early 2022, and an evidence-based care bundle including practice changes, education for the team, and enhanced education for patients undergoing cesarean birth was developed and implemented after a review of the literature was completed. All cesarean births were tracked pre- and postintervention to determine the rate of SSIs per 1,000 cesarean births. ResultsA decrease in the rate of SSIs after cesarean birth was observed from preintervention (18.2 per 1,000 cesarean births) to postintervention (11.8 per 1,000 cesarean births). ConclusionAn evidence-based quality improvement care bundle using a multidisciplinary team approach was associated with reduced SSIs in an obstetric unit.

Operating room technologists' knowledge, attitude, and preparedness for disaster management of a Zahedan: Implications for nursing disaster education.

During the occurrence of accidents and disasters, the role of hospitals and healthcare centers is very sensitive and they are among the first units that with their quick, optimal, and timely healthcare services provision can reduce mortality and increase the number of survivors. For this purpose, this study was conducted to investigate the knowledge, attitude, and level of preparedness of operating room technologists of educational hospitals of Zahedan University of Medical Sciences in relation to disasters. The present research is a cross-sectional descriptive study that was conducted with the participation of 60 operating room technologists of Zahedan educational hospitals from January 2022 to December 2022. The sampling was performed by the census method. The data collection tool was a demographic characteristic and a researcher-made questionnaire for the assessment of attitude, knowledge, and preparation against the occurrences of accidents and disasters was completed during 2 months by referring the researcher to the hospitals. For the data analysis, descriptive statistics and analytical statistical tests were used. The data were analyzed using IBM SPSS Statistics 26. Corp., Armonk, NY, USA. The significance level was considered P < 0.05. The results showed that the average scores of attitude, preparation, and knowledge are 9.3 ± 6.1, 75.8 ± 9.9, and 5.7 ± 4.1, respectively, and the majority of operating room technologists have a favorable level towards attitude and have relatively favorable level towards preparation and knowledge during the occurrence of disasters. The average score of knowledge and attitude of operating room technologists with work history had a significant difference from each other (P < 0.05). technologists with less work experience have more knowledge and a more positive attitudedisaster. Measuring the level of knowledge, attitude, and preparedness of surgical technologists to deal with disasters as one of the ways of receiving feedback from employee training can be a useful reflection of the success of training programs in creating the necessary capabilities in various fields of disaster preparedness, and it can be a powerful tool for increasing individual and group dynamics and organizing individual learning in coping training. Furthermore, disaster education should be incorporated into the operating room curriculum, which would play a seminal role in preparing them for future disaster management. It is also suggested to investigate the impact of intelligent training on the level of knowledge, attitude, and preparation of operating room personnel regarding disasters and obstacles in this regard in future research.

Impact of a Task-Grabbing System for surgical technicians on operating room efficiency

The purpose of this study was to evaluate the effect of the Task-Grabbing System on operating room efficiency. Based on the competition-driven concept of the ‘Uber’ app, an Task-Grabbing System was designed for task allocation and quality assessment. We implemented the Task-Grabbing System in our hospital operating room and compared the differences in consecutive operation preparation time, turnover time, and task completion time performed by surgical technicians for tasks such as patient pick-up, operating room cleaning, medical equipment recovery, three-piece set delivery, as well as blood gas analysis and intraoperative specimen submission before (October 2019) and after (December 2019) the implementation of the Task-Grabbing System. After the implementation of the Task-Grabbing System, the consecutive operation preparation time was reduced from the average of 43.56–38.55 min (P < 0.05), and the turnover time was decreased from the average of 14.25–12.61 min (P < 0.05). And the respective time consuming of surgical technicians for patients picking up, operating room cleaning, medical facilities recovering, the three-piece set delivering, blood gas analysis sending and intraoperative specimen submitting was significantly shortened (P < 0.05). The Task-Grabbing System could improve the operating room efficiency and effectively mobilize the enthusiasm and initiative of the surgical technicians.

Differing radiation exposure in scrub technicians and rotating staff in Cardiac catheterization laboratory: occupation matters

BackgroundRadiation exposure is a significant hazard associated with invasive Cardiology, with most studies based on primary operator exposure. This prospective, observational study aimed to find out over lead radiation exposure as effective dose acquired by non-physician staff comprising scrub technicians and rotating staff in the cath laboratory. Effective dose (ED) measured per procedure via Raysafe i2®dosimeter badges worn by both rotating staff and scrub technicians over lead aprons along with dose area product (DAP), fluoroscopy time (FT) and procedure time (PT) in minutes was collected prospectively over forty-six invasive Cardiology procedures.ResultsThis study shows that rotating staff acquire higher ED in comparison with their scrub technician colleagues in diagnostic, interventional and electrophysiology cases. However, a statistically significant difference in radiation exposure of both staff groups was demonstrated in diagnostic and interventional Cardiology procedures, with p values of 0.04 and 0.01, respectively.ConclusionsThese findings highlight occupational role and mobility around fluoroscopic sources as major factors in radiation exposure, which should be addressed within current radiation protection practices.

Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study

BackgroundA high workload may negatively impact the surgical team's performance and jeopardize patient safety. The aim of this study was to measure the workload of the surgical team across different surgical roles, specialties, and techniques in several hospitals.MethodsThis cross-sectional multicenter study was performed in the operating rooms of eight teaching hospitals affiliated with Isfahan University of Medical Sciences, Iran. At the conclusion of each surgical procedure, all members of the surgical team completed the Surgery Task Load Index (SURG-TLX) questionnaire to assess workload levels. Descriptive statistics, analysis of variance (ANOVA), and Pearson correlations, were performed to compare surgical roles, specialties, techniques, and surgical time on workload overall and by subscale.ResultsA total of 409 workload questionnaires were obtained from 76 surgical teams or cases, involving 346 surgical team members. The total workload among all participants was 32.41 ± 17.21. Surgical complexity, physical demands, and mental demands were the highest workload subscales and distraction was the lowest workload subscale. Cardiovascular specialty had a higher workload compared to other specialties. Open techniques resulted in a higher workload compared to minimally invasive techniques. Surgical technologists who act in both the role of circulating and scrub nurse (C&Ss) experienced the highest workload, followed by surgical residents and surgeons.ConclusionsThe results of the study showed that the workload for some members of the surgical team is disproportionately high and is influenced by factors such as specialty, technique, role, and surgical duration. By knowing the distribution of workload among the members of the surgical team, efforts can be made to optimize the team members’ workload.

Assessment of Knowledge and Attitude Regarding World Health Organization (WHO) Surgical Safety Checklist (SSC) in Operating Room Personnel of Medical Teaching Institutes (MTIS) Peshawar Pakistan

Background: World health organization surgical safety checklist is basically the guideline for the operating room personnel. These guidelines are properly started by WHO in 2007-8. The purpose was to improve the outcomes of the surgical procedures, communication, decline the mortality and morbidity ratio perioperatively. Using WHO checklist plays a very important significant role in patient safety especially in perioperative time. One study shows that about 47 % reduction occur in mortality and 36 % in morbidity while using the SSC. In the developed countries having proper safety system and knowledge complication rate was reported 0.4 to 0.8% while in the developing countries this ratio was about 3 to 16 % (2004 report). Objective: To Assess the knowledge and attitude regarding WHO SSC of operating room personnel of MTIs Khyber teaching hospital (KTH) and Hayat Abad medical complex (HMC) of Peshawar Pakistan. Methods: Cross sectional study conducted. Data collected through semi structured questionnaire from operating room personnel including surgeons, anesthesia provider, surgical technician, technologist, and OT nurses working in MTI KTH and MTI HMC. Results: According to the study about 30(14.6%) OT personnel having good knowledge,115(56%) having average and 60(29.2%) of personnel having poor knowledge regarding WHO SSC. The result of the attitude of OT personnel regarding safety checklist was 141(6.7%) positive means they agreed with WHO rules and want them to be implemented in the OT while 64 (31.2%) showed negative attitude. Conclusion: Adverse events are common in the preoperative period. This is due to poor organizational, limited, knowledge respect less attitude of the staff toward their duty, and patient self-mistakes. But the great responsibility of the staff is to care for the patient in the proper while according to the rules and regulation set by the WHO in the form of surgical safety checklist. By using safety checklists properly, the adverse events can minimize up to a great number. For the best result the personnel must have proper knowledge, awareness, importance and need of practical implementation. By default, our health system is still going on previous knowledge base and not properly adjusted in the advanced system. In these two hospitals most of the HCPs are not aware of the importance of the WHO checklist and some are against the practical implementation of the checklist. This is an amazing and questionable point that can be overcome through education.

Surgical Technologist Prepares the OR for a Case

Surgical Technologist Prepares the OR for a Case

Investigating the Level of Knowledge and Attitude towards Basic Life Supports and Related Factors in Surgical Technologists and Nurses of Anesthesia at Imam Khomeini Hospital at Tehran during COVID-19 Pandemic

Introduction: Cardiorespiratory arrest is one of the most dangerous conditions that requires immediate action. Therefore, it is important for healthcare staff to have the necessary knowledge and skills. The purpose of this study was to determine the level of knowledge and attitude of basic life supports (BLS) in the surgical technologists and nurses of anesthesia of Imam Khomeini Hospital in Tehran during the COVID-19 pandemic in 2022. Material and Methods: In this descriptive-analytical cross-sectional study, all surgical technologists and nurses of anesthesia working at Imam Khomeini Hospital in Tehran participated during the COVID-19 pandemic. The data was collected using a questionnaire designed by the authors. Parametric and non-parametric statistical tests were used for data analysis via SPSS 24 software (α=0.05). Results: The results of the study in 195 participants showed that the average knowledge score of anesthesia nurses was significantly higher than surgical technologists (4.99 ± 1.20 vs. 4.12 ± 1.39, P=0.001). The average score of the attitude of anesthesia nurses and surgical technologists were 12.62 ± 1.92 and 12.43 ± 2.34, respectively, which were not significantly different from each other (P=0.624). Conclusion: The level of knowledge of the majority of surgical technologists and anesthesia nurses about basic resuscitation was not appropriate, and considering the importance of BLS and the above disciplines, it is necessary to make arrangements for its training by educational policy makers.

Not Just Non-Consensual Pelvic Exams

Not Just Non-Consensual Pelvic Exams

Challenges and prerequisites of risk management program in the operating rooms of Iranian hospitals: A qualitative study

BACKGROUND: The World Health Organization (WHO) considers a safe operating room as one of the necessities of hospitals that support patients. Achieving safety in surgical operations in all countries of the world is the basic goal of healthcare centers and organizations; hence, the present study investigated the challenges and prerequisites for the implementation of an active risk management program in the operating rooms of Iranian hospitals. MATERIALS AND METHODS: This qualitative-phenomenological study was conducted in 2022. Data were collected using semi-structured interviews, targeted sampling, and the participation of 20 experts (health policy and management experts and academic officials and faculty members of universities) and executive staff (nurses and operating room technicians, doctors and surgical specialists, and officials of surgical departments) and were analyzed using the framework analysis method. RESULTS: In the resulting qualitative study, the challenges and prerequisites for active risk management in the operating room from the point of view of experts and executive staff were divided into three sub-themes. These three themes include managerial challenges and prerequisites, organizational resources (financial resources, human resources, equipment, and facilities), and cultural issues. CONCLUSION: Considering managerial prerequisites, organizational resources (financial, human, equipment, and facilities), cultural issues, and removing challenges, an active risk management program in the operating room can be implemented correctly. With the correct implementation of this program, injuries in the operating room for personnel and patients will be greatly reduced, and the satisfaction of beneficiaries and the productivity of the hospital will be greatly increased.

Implementation of a Shielding Guideline for Pediatric Patients Receiving Intraoperative Ionizing Radiation

Introduction Approximately 350 million diagnostic radiation imaging procedures are performed on pediatric patients annually. This population is at a greater risk of developing cancer after exposure to ionizing radiation because of a higher intake, accumulation, and increased sensitivity to radiation as well as a long-life expectancy postexposure. Methods This quality improvement project used convenience sampling with a pre–post design to evaluate two independent samples: (a) pediatric intraoperative staff members including registered nurses and scrub technicians and (b) pediatric patients receiving intraoperative ionizing radiation imaging. Outcome measures included pediatric intraoperative staff knowledge and confidence of education for intraoperative shielding (preimplementation: n = 9; postimplementation: n = 6). Shielding audits were performed to assess for frequency of shield placement to radiosensitive organs and accuracy of shield placement (preimplementation: n = 26; postimplementation: n = 27). Results Data analysis showed improvement in staff confidence related to gonad shield placement ( p = .013) and self-reported frequency of gonad shield use ( p = .032). Knowledge scores showed nonsignificant improvement ( p = .076). Shielding audits showed statistically significant improvement in shield placements for thyroid, gonads, and breast tissue ( p &lt; .05). Discussion The pediatric population has unique characteristics to consider when making decisions about shielding practice. This project discusses these characteristics, considerations for “exception-based shielding,” and how to improve the rates of shielding in situations where the practice is appropriate.