Date of Graduation

Fall 12-11-2020

Document Type


Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Dave Ainsworth



Problem: In the operating room (OR), complex procedures and processes are performed under time pressures, which presents unique challenges regarding ergonomic-related injuries. Handling surgical instrumentation trays with awkward postures is one of the high-risk tasks performed in the OR that can result in upper extremity (UE) strain. A healthcare system-based hospital in Northern California had five reported upper extremity strain injuries by the surgical technologists (STs) in workplace safety (WPS) performance year (PY) 2018-2019. The project aims to decrease UE strain injuries among STs by improving the quality of surgical instrumentation trays and promoting the culture of safety through staff effective communication and engagement.

Context: Microsystem and culture assessments with gap analysis were performed to assess the need for quality care improvement. The team's current performance on safety was reviewed, and it revealed a quality gap that needed a key improvement effort to achieve the desired outcome. In the main operating room (MOR), UE strain injuries occurred in surgical technologists (STs) are associated with handling surgical trays and lifting instruments. Four of the five injuries resulted in prolonged leave and absence of skilled employees that significantly impacted patient care. The cost associated with backfilling injured employees and the claims related to employee recovery is causing significant financial constraints to the department and the organization. Also, there was an inconsistent reporting and data gathering process for identified safety risks and near misses.

Interventions: The quality project aimed to safeguard the STs for future UE strain injury was initiated to mitigate the microsystem’s identified problem. Initial data were collected through a questionnaire survey and from the sterile processing management (SPM) database. The team identified the most commonly used two-tiered laparoscopic instrument trays and performed tests of change to improve the trays' condition and make them user-friendly. An adjunct rapid cycle test on ring stands was also performed to reduce the arm lift height when removing instruments from the container pans. A team satisfaction post-survey was collected to determine overall improvement feedback. A biweekly safety huddle was incorporated in the OR daily readiness review.

Measures: The outcome measure was defined as the number of reported upper extremity strain injuries related to STs instrument handling obtained from Supervisor's First Report of Injury (SFR). The target aim for injury reduction was 50% by October 2020, a goal based on two employees' 2019 injury incidence. The process measures were conducting pre and post Survey Monkeys to determine STs concerns on surgical trays and their overall feedback, creating an ergonomically and user-friendly surgical tray and establishing a safety biweekly huddle. The balancing measure is identified as the project's impact on the workflow, efficiency, and safety of the sterile processing department (SPD).

Results: The implemented intervention positively impacted the outcome. In over a year from the last reported injury in July of 2019, the improvement project maintained the zero UE strain injury in STs in the MOR. The process goals were also achieved, and the team improved the quality of all laparoscopic surgical trays in the MOR. The engagement of the OR staff on huddles reflects an increased awareness and robust feedback on safety.

Conclusion: Risk mitigation and effective communication are significant measures to improve safety and prevent the costly impacts of work-related injuries. The quality project was a success, and it resulted in notable changes and improvements in safeguarding STs from UE strain injuries. The reduction in an injury rate of 46.26% in PY 2020 opens more opportunities for the OR team to perform 6S lean processes and harm-reducing initiatives.