The downside of staff workarounds, which can draw the ire of AOs
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March 1, 2018
Editor’s note: In this guest column, Dan Scungio, MT(ASCP), SLS, laboratory safety officer for Sentara Healthcare, a multihospital system in Virginia, and otherwise known as “Dan, the Lab Safety Man,” discusses the important issues that affect your job every day.
Laboratorians are resourceful, and if you followed them through their workday, you would be amazed at some of the processes they have put into place to perform the tasks they’ve been assigned to do. Not all of these processes follow the written lab procedures, though. Some are not acceptable by lab accrediting agencies, and many are simply unsafe. Lab quality auditors will often tell you that when there is an error, look to the system (e.g., the procedures, the equipment, the layout, etc.) before you look to the person(s) who committed the error. The problem most likely lies with the system, and if you’re having safety issues in your lab, that system may be the source of the problems there as well.
If you look at the total number of blood and body fluid splash exposures you’ve had in the past year, you may see a pattern. For example, it is a common practice to uncap chemistry specimen tubes behind a counter-mounted splash shield and then place them into a rack. What typically occurs next, though, is that the rack is carried — usually by someone wearing no face protection — over to the analyzers for testing. I often see lab techs pipetting quality control (QC) material while using no face protection. What is the system issue here? In some cases, it may be that goggles or face shields are not available. It may also be that there is no education about when splashing can occur (any time there is an open specimen or chemical) or about the dangers of splashes of specimens and QC material. If PPE or education is not provided, staff will create an unsafe workaround to get the job done.
If staff in the lab use a sharps container to throw away paper and other items that don’t belong there, this can be expensive for the lab and ultimately bad for the environment. Sharps waste removal is charged to the department by weight, and often the waste is incinerated. Throwing away trash incorrectly is another workaround process. The system issue may be education, but usually it’s an issue of staff not having enough of the necessary types of waste receptacles. If we set up the lab to make it easy for people to do the right things (for safety or for quality), there will be better overall compliance.
There are many other examples of staff workarounds that affect personal safety. Does your staff wear lab coats into clean areas? Hang some coat hooks by the exits and signs to remind people about the proper process. Do employees get injured when changing cryostat or microtome blades? Provide implements such as forceps to use when handling the dangerous sharps. Investigate the causes of your lab employee incidents, and you may discover other unsafe workarounds as well.
Laboratorians are smart, and they are driven to get their work done. Unfortunately, barriers exist within our lab systems that may seem to hinder their goals. Human nature and ingenuity will take over, and workarounds will arise. Sometimes the workarounds function well, and they may be legitimate and safe. When the workarounds become dangerous, though, it’s time to analyze them and look for repairs to the broken system to prevent injuries or exposures. Making it easy for staff to follow lab regulations is another step toward an improved overall safety culture.