Quality Improvement Project June 2016: 9/9/2018 2:31 PM Quality Improvement Project June 2016: Injuries from Breaking Glass Ampoules Containing Medications Justin Merkow, MD Ben Abrams, MD Melvina Cheung MD Faculty Advisors: Dr. Tony Oliva, Dr. Maung Hlaing © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

Injuries from Glass Ampoules Background - Understanding the Problem Methods - Proposed Interventions Findings : metrics to measure outcomes - Outcomes, Process and Balancing Measures Conclusions & Recommendations - Recommend Areas of Improvement - Plan, Do, Study, Act cycle

Background – Sharps Injuries from Glass Ampoules Over one quarter of sharps injuries occur while opening glass ampoules. The costs of injuries is high and may include suture of laceration, weeks of rehabilitation and loss of salary (Matson, K. (2000) “States begin passing sharps and needle-stick legislation to protect health care workers.” AORN Journal 72(4): 699-703, 705-7). One in four anesthesia staff have been injured in the past (Parker, M. R. (1995). “The use of protective gloves, the incidence of ampoule injury and the prevalence of hand laceration amongst anaesthetic personnel.” Anaesthesia 50(8): 726-9).

Background: Understanding the Problem What : Injury from opening glass ampoules Why : affects providers often Who : anesthesiologists, pharmacists, hospital, anesthesia techs When : Daily risk Where : OR, outpatient clinic, wards

Background: Process Map

Background: Root Cause Analysis

Methods to Improve Interventions proposed

Methods : Revised Process Map

Findings: Metrics to Measure Outcomes SMART Goals (Specific, Measurable, Aggressive, yet Achievable, Relevant, Time Bound)

Recommendations Area of Improvement Overall Goal 1. Increased availability of tools to open vial safely Reduce no. of injuries 2. Improve knowledge on safety and correct way to open vials Educational program 3. Create a protocol Universal compliance to protocol 4. Prioritize safety focus Understanding that improving safety improves efficiency and lowers cost

Conclusion & Recommendations Plan, Do, Study, Act (PDSA) cycle Determine whether vial breakers are effective Costs Different brands of vial breakers Change educational methods Pharmacy or dept. inertia Identify target settings Check box on block note Report on QI form Reduce number of injuries related to glass vials 1. Plan 2. Do 3. Study 4. Act

References Carreretto, AR. et al. “Glass Ampoules: Risks and Benefits”. Rev Bras Anestesiol. 2011; 61: 4: 513-521 Haldar, R. et al. “Opening Snap Off Ampoules – A Safer and Uncomplicated Method”. Letters to the Editor. Brazilian Journal of Anesthesiology (English edition). Nov-Dec 2014. 64(6): 448-449. Matson, K. (2000) “States begin passing sharps and needle-stick legislation to protect health care workers.” AORN Journal 72(4): 699-703, 705-7. Parker, M. R. (1995). “The use of protective gloves, the incidence of ampoule injury and the prevalence of hand laceration amongst anaesthetic personnel.” Anaesthesia 50(8): 726-9. Stroker, R. “Preventing Injuries from Glass Ampoule Shards: Advances in Ampoule Safety”. Managing Infection Control. Oct 2009; 45-47.