By June Curley

As a perioperative nurse working in the operating room of a Level 1 trauma center,   I want to share some of the challenges of implementing a laser safety program and inspire new Laser Safety Officers (LSOs) to develop systems that will assist them with enforcing laser safety compliance.

First, I recommend Medical Laser Safety Officer Training and taking the Board of Laser Safety (BLS^®) medical certification exam. Being a Certified Medical Laser Safety Officer (CMLSO^®) validates not only our knowledge, but also our commitment to laser safety.  Then, utilize all the available resources: ANSI Z136.3, AORN Standards and Recommended Practices, books on lasers by Dr. Kay Ball and publications referencing eye protection or best practices offered by the Laser Institute of America.

Next, form a committee. Our committee includes the Vice President of Surgical Services, a physician, an anestheologist representative, nurse managers, the employee health nurse and a biomedical engineer. Together we made a plan to meet quarterly, review the laser policy, create competencies for each laser and decide who the laser users would be − RNs, Surgical Techs or both. For logistics, we decided it would be the RN circulator. The responsibilities of the LSO were defined to include training and education, monitoring policy compliance, resolving non-compliance issues and chairing laser safety committee meetings.

Over the past recent years, I found many challenges while organizing the laser program. I began by taking inventory of the lasers and listing them on a spreadsheet which identified their manufacturer, year of manufacture, model and serial number and preventative maintenance due date. The lasers were further identified by wavelengths with each assigned a color code. For example, the CO₂ lasers were assigned the color blue. Blue instrument tape was then applied to the front of the laser and all of the CO₂ accessories including signs, protective eyewear, keys and CO₂ laser log books. The accessories, except for the keys, are stored in a CO₂ laser accessory cart. The keys are attached to blue key chains and are stored in a locked box in the control office.

It is an extra burden for laser operators to document in a laser log book as well as in the electronic medical record, but necessary in the event of an audit by a regulatory agency. The laser operators at Tampa General Hospital are also the circulating nurses. As such, our policy states that when the laser is activated, the operator will have no competing responsibilities. This is to say, that if a laser operator needs to answer the phone or a pager, or if they need to leave the room, the laser will be placed on standby.

Other issues that we have dealt with include keys left in lasers and inappropriate laser signs, such as a paper towel with the word “laser” handwritten on it. Although seemingly minor in nature, fines imposed by OSHA, of up to $5,000 for each of these occurrences, could result.   Solutions implemented include taping Velcro to the back of the laser signs to promote easy placement on the door and a log that must be signed off by the laser operator documenting that the keys have been returned to the locked box.

Another issue surfaced when we discovered a variance between the instructions provided by the vendor representative and the instruction manual that came with a new laser. The laser rep told the surgeons that eye protection “really wasn’t necessary.” A phone call to the manufacturer validated that indeed eye protection was required and the vendor rep was re-educated by his company.

A lesson learned along the way was to create a safety checklist that included checking the eye protection filter used with a microscope. A brief back flash occurred, fortunately without injury, when the filter’s cable was not connected to the laser. Our checklist should preclude this in future cases. In addition, I later learned from an engineer during a coffee break at the 2009 International Laser Safety Conference (ILSC®), that a simple safety interlock could be installed on the laser to prevent this from happening in the future. I cannot overemphasize the value of networking at these conferences!

Recently, with the collaboration of the Department of Anesthesia, we have developed Laser Airway and Fire Management Guidelines. These guidelines were laminated and attached to each anesthesia cart. They were then presented at a joint OR staff/anesthesia in-service on Laser Airway Safety.  Yet another recent development was the recruitment of laser operators to act as laser “super users.”  In exchange, they receive clinical ladder credit for being an expert resource for the staff.

In conclusion, laser challenges will always arise. Develop systems to keep lasers and laser safety on track. Listen to your co-workers and welcome their feedback; some of the best suggestions come from them, for example, the idea of color-coding the lasers. By listening, we empower a sense of making a difference. Model desired behavior for your staff and be there to listen and support them.

If you care at all, you’ll get results. If you care enough, you’ll get incredible results.

June Curley is a nurse and Certified Medical Laser Safety Officer with Tampa General Hospital.