April FY22

[kristenhorsman]

This month's journal article is presented by Aileen Mendez. She chose this article because the topic the topic of the sustainability of plastic in the OR is very important to her. She has been involved with the OR sustainability projects at Hopkins for 15 years now, and we as providers need to do our part, as well.

Please use link and answer the following two questions:

1. Please list one way you help the sustainability initiative in each of the areas (if none then write none):
    A. Reduce:

    B. Reuse:

    C. Recycle:

    D. Reprocess:

2. A. Rate how important sustainability is in your day to day practice (scale is 0-10, where 0 is not important at all and 10 is very important.)

    B. Do you educate SRNAs about sustainability when you precept?

[Dahlia Rouchon, CRNA]

A great article. Thank you. To answer above questions I help with:
1.
A. Reduce- I do not draw up medications unless I will definitely use them ie. propofol, for ephedrine/phenylephrine, succinylcholine. I will prepare them unopened with syringe, label, unopened flush ready to go however.
B. Reuse- I reuse emesis basins for dirty supplies (syringes to be disoposed of) if not visibly soiled and I will wipe it clean.
C. Recycle- none, the hospital has stopped its green bin collection for the recycling effort.
D. Reprocess- I reprocess pulse oximeter stickers
2. Sustainability is a 10 for me. Yes, I educate SRNAs about sustainability when precepting to only draw up drugs to be used, not to be wasteful of medications/supplies.

[Kels]

1.
A. I also do not draw up medications unless I need the med.
B. I also reuse emisis basins when I can
C. None. In the past I used the green bin all of the time but now red bags are in this bin or the bin is no longer in the room
D I use our clean/ non dispoasabel blades and handles

2.
A. 10
B. I use to teach ayone who I worked with or anyone that shadowed me about the geen bag/bin when they were in the room with me

[LarSharVeA Bailey]

A. Reduce: I have the epi bristojet available, but I never make baby epi on a "just in case" basis, stopped opening blue towels to use as tablecloths for airway setup, and keep oral airways in the packaging unless needed.

B. Reuse: If a patient comes down with a nasal cannula or facemask, I save it for reuse after wake up. I don't use the basins.

C. Recycle: I put the blue towels in the linen cart.

D. Reprocess: None

2. A. Rate how important sustainability is in your day to day practice (scale is 0-10, where 0 is not important at all and 10 is very important.): 10

B. Do you educate SRNAs about sustainability when you precept? Yes

[A Schutter]

1. A Reduce: I only prepare my meds on a as needed basis. I do not draw up meds ie. phenylephrine/ephedrine/succ unless they are being used for the current case. I also do not open my airway equipment unless I am using it. ie, oral airways, tongue blades, green facemask etc...
B. Reuse: I will reuse the BP cuffs and nasal canulas or facemasks the patient has already had.
C. Recycle: Sadly, the green bins have been removed so recycling is not possible within the OR.
D. Reprocess: If I use blue towels (which is rare), I place them in linen cart and not garbage.
2. A. 10
B. I always educate SRNA's on waste. I encourage them to not open equipment unless using and to not use blue towels to just cover the cart and machine work areas.

[Anne McNulty CRNA]

I am very concerned that JHU has stopped recycling OR waste. I will take a guess that there was no profit and probably a monetary loss. Trash can be turned in to cash if you know how to do it. Baltimore County has a huge recycling facility!! What is wrong with JHH? (1) reduce : Most of our meds are drawn up and placed in the pyxis. The current advisory on reuse of syringes is something I follow. I don't draw up meds until I know I am going to use them. I calculate how much more propofol I will need and open a smaller bottle if indicated. It seems that when a trauma room is set up , someone opens the sterile blue towel packet, pig tail and syringe for Aline insertion. This is not necessary. Just have supplies available in an orderly fashion. I reuse anything that I possibly can , such as NC, BP cuff. Nothing is recycled or reprocessed. I try to stress saving the planet when I teach SRNA's saving the planet gets a 10 from me.

[Katya]

1. I hate any waste. I don't draw extra meds unless I am going to use it, even Propofol I use small 20 cc for IV infusion if case will end up soon. I totally agree with Anne statement, not to open but have it ready to open.
2. I educate students every time I see them opening packages or tubing or blue towels or drawing extra medications. I understand they follow different people and try to please us, but I continue to tell them it takes a second to open for example oral airway.

[Lee Carroll]

1.
A. Not preparing or opening drugs and materials unless intent to use. I don't use a  Bair hugger if the case is under an hour. I don't put NGT in every patient. 

B. Reuse EKG pads pt already have intact and send O2 delivery devices with patient. 

C. Try to place proper recycles in the proper container. I see a lot of trash and inappropiate items in the recycle bins and needle boxes.

D. Keeping same initial blade near by incase you need to re-intubate instead of opening a new one. 

2.
A. 10, Its not just in OR but also in the lounge. I see people drink 2 sips from a cup and throw it away. I has to go somewhere. 

B. Yes

[Wai-Ling Lo]

1. Please list one way you help the sustainability initiative in each of the areas (if none then write none):
A. Reduce: Like everyone, I only draw up meds that I intend to use. I won't open ET tube, oral airway, temp probe or NG tube until I'm ready to use them. I use bolus function in Alaris pump to deliver meds (e.g. propofol or remi) to save some syringes and needles.

B. Reuse: I too reuse kidney dish for used vials. Reuse BP cuff and pulse ox from ICU or recovery.

C. Recycle: No recycle in my area.

D. Reprocess: blue towels

2. A. Rate how important sustainability is in your day to day practice (scale is 0-10, where 0 is not important at all and 10 is very important.) 10
B. Yes

[aileenm4]

good morning everyone
thank you all so much for the amazing ideas and answers to the sustainability questions, I love to see you all on board and teaching this to our SRNAs and not yelling at them to have "everything drawn up" as many of them claim occurs.....
some follow up to posts
Hopkins used to recycle a lot more but now it is only true paper or cardboard.... nothimgwith a wax coating or anyhting that is questionale of what it is made out of.so you can stillput paper of coard board into the grren recycle bin that the Nursing have
thak you for not opening up blue towels to place on the anesthesia machine... only use for sterile procedures and when finished throw into linen cart like most of you already do
i really like that you are re usning masks and nasal cannulas that a patient comes with as well
keep up the great work and teaching our SRNAs as the future

[kelseyleonard]

1. I do not draw up medications until I am ready to use them. I also do not open oral airway/tongue depressors until I need them in the moment.
2. I reuse EKG leads, SpO2 probes, BP cuffs that come with the patient from preop or the ICU.
3. Unfortunately we cannot recycle items in the OR as we used to.
4. I do try to place blue towels used for Alines in the linen cart as opposed to the garbage.

I encourage SRNAs to be thoughtful about what supplies they open and meds they are drawing up and how relevant it is the to the current patient. I do feel, however, that as beginners in anesthesia the need to be prepared outweighs the need to recycle and reduce waste. If an important med or supply was not readily available because they were concerned drawing it up was wasteful and delay in care took place, I consider this a problem. With experience comes wisdom and that 6th sense of knowing if a patient "really needs this med". In the meantime, we should keep it on their radar but it is not the main focus in the OR.