tRash talkiNg: RN-Driven Waste Reduction

Oregon Health and Science University, Portland, Oregon

Nov 20, 2024

CSI Summary

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CSI Presentation

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CSI Toolkit

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Project Topic:

Reduce excessive medical waste in the ED environment

Hospital, City and State:

Oregon Health and Science University and Doernbecher Children’s Hospital, Portland, Oregon

Unit:

Pediatric Emergency Department (Peds ED)

CSI Participants:

  • Lauren Dupre’, BSN, RN
  • Casey Edwards, BSN, RN, CPN
  • Brianna Mattson, BSN, RN, CPEN

Project Goals/Objectives:

  1. Healthy Work Environment Assessment Tool (HWEAT) outcome: Post-project HWEAT will have increased scores by 10% in Authentic Leadership and True Collaboration standards
  2. 75% reduction in disposable BP cuff use by project completion
  3. Simplify and improve unit recycling and waste disposal using signage and education (pre- and post- qualitative survey for RN staff)

Project Outcomes:

  1. HWEAT Authentic Leadership score was unchanged, True Collaboration score increased 7.4% (note: all other 4 standard scores increased)
  2. At one-month post kick off, 53% reduction in monthly use of disposable BP cuffs
  3. At six months, 76% reduction in monthly use of disposable BP cuffs
  4. At project completion, 83% reduction in monthly use of disposable BP cuffs
  5. Increased staff knowledge, engagement and team bonding
  6. Increased recycling signage and education in the department
  7. Potential (annualized) fiscal impact is a savings of $16,950

Project Overview:

Historically, a minimum of one, new, disposable BP cuff was utilized for each patient that visited the pediatric emergency department (PEDS ED). Each cuff, wrapped in plastic packaging, was thrown in the garbage after use. A 2020 article from the Environmental Protection Agency quotes, “direct pollutant emissions from waste disposal in the ED were estimated at 304kg of carbon dioxide per day”. The OHSU Peds ED is a small, cluttered space, with limited central area support and cleaning. The content within the recycling bins and trash cans was indistinguishable, as products that could be recycled were put in trash bins, and vice versa. There was an obvious lack of knowledge and complacent behavior regarding waste and recycling practices. Decreasing waste and clutter can improve the Peds ED physical environment, staff mental well-being, the efficiency and sustainability of the department, as well as have a positive fiscal impact. As a result, the CSI team chose to address a topic that could benefit their peers, their hospital and the environment.

The CSI team began informing and educating Peds ED staff prior to their project kickoff. Education and information regarding the roll out of reusable BP cuffs was provided. This education included appropriate and inappropriate use of the reusable cuffs and proper cleaning techniques. In collaboration with the OHSU University Custodial Team, CSI members provided education regarding OHSU recycling and sustainability practices. Signs and new recycling bins were added in the department to facilitate proper practices. Project kickoff involved the replacement of disposable BP cuffs with reusable BP cuffs, increased organization on the unit, and education, reorganization and signage related to proper unit recycling.

Data was collected monthly via monthly supply reports regarding the number of disposable BP cuffs utilized. The average cost of a disposable and reusable BP cuff was calculated for data and cost saving analysis. CSI members updated the unit with changes and reminders at multiple staff meetings. A visual thermometer poster was added to the unit to reflect waste and cost savings. To help encourage staff participation in surveys, stickers and cookies were distributed to staff members who attested to completion. At project completion, the CSI team was proud to see an 83% reduction in disposable BP cuffs ordered and stocked on the unit. At project completion, there was a cost saving of $9,536.98 over the 7-month project period and estimated to have a $16,950 annual fiscal savings. It is anticipated that further savings will be achieved as time moves forward, with less need to replenish reusable BP cuffs that were sometimes thrown away or missing during project rollout and transition as the unit adjusted to change.

Permission to Reuse Materials
The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

Disclaimer
The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.