When Safe Isn't Safe Enough

Despite cabinets full of safety needle options, staff were still experiencing needlestick injuries. Propelled by a desire to improve safety and needlestick injury (NSI) data, a plan was initiated to enhance and standardize sharps at a 32-site ambulatory care organization.

In 2000, the Occupational Safety and Health Administration (OSHA) Needlestick Safety and Prevention Act was established as was the work of “Safe Needles Save Lives,” a campaign launched by the American Nurses Association and signed into law on November 6, 2000. This act requires the use of “safety-engineered devices or sharps” engineered sharps injury protection (SESIPs). Congress felt that a modification to OSHA's bloodborne pathogens standard was appropriate and set forth in greater detail OSHA's requirement for employers to identify, evaluate, and implement safer medical devices.

Inventory at sites and departments within the organization uncovered various safety needles, up to five different types. Despite having these safety needles readily available, staff were experiencing NSI on average of 33 per year. The needles were evaluated and it was recognized that all had different safety mechanisms. Safety mechanisms on sharps have improved over the years. Were these safety needles up to current standards? Another concern was the lack of uniformity throughout the sites. Staff deployed to a different site might encounter a needle with an unfamiliar safety mechanism for which they had not been trained.

Based on research on the different safety mechanisms available, the organization selected a retracting syringe to trial at three internal medicine department locations over a three-month period. The trial resulted in a 98% favorable response from staff. Finding a safer product accomplished one part of the mission to decrease NSI. It was decided to also standardize the needles used on pre-filled syringes, and a retractable needle was selected. Enlisting the support of the VP of ambulatory care services and the purchasing department, bumpers were placed within the ordering system to facilitate ordering of the new safer needles instead of the vast selection of needles previously available.

Ensuring that staff became knowledgeable of the product change and were properly trained on the use of the safety mechanism was a priority. A multifaceted training plan was implemented. An introductory notice of the change was sent electronically and included brief training videos for the products. A team of nurse educators then deployed to the sites to provide training sessions with key stakeholders who would become the trainers in their departments. Additional “‘elbow” support was provided to staff on an ad hoc basis.

Staff were encouraged to report concerns, which included the needle not retracting properly and the needle becoming detached during use. All were investigated, and the majority were related to improper use of the safety mechanism, and remediation was provided.

The response to the new products has exceeded expectations. Staff voice increased sense of safety when using products that retract in the patient and the potential for decreased NSI. There is confidence that the data, once available, will support this.