Getting Greener in the ED

Getting Greener in the ED

Amy Tyler, RN, BSN, CEN

Amy Tyler holds a BSN from The College of New Jersey. and has worked as a direct care medicalsurgical, perioperative and emergency nurse over her 14 year career.
Certified in Emergency Nursing. Amy has spent the last 10 years in the Christiana Hospital Emergency Department.
In her current role as a Staff Development Specialist. Amy provides educational and clinical support to the Emergency Department and Clinical Decision Unit and co-coordinates simulation based education programs on Moderate Sedation and Code Blue. She is also the chairman of the Emergency Department Green Team. Amy can be reached bye-mail at amtyler@chrlsUanacare.org or in her office at (302) 733-1030.

Early in the morning. I drag my garbage and recycling to the street. turn off lights in my house. and even pull the plug on my coffee pot. I drive a more fuel efficient car than I did a few years ago, and I even have some of those reusable grocery bags rolling around in my trunk. Like many. I have made some changes to my old habits to live "greener".

However. when many nurses start their shift. those practices are abandoned, contributing to our nation's hospital's average output of approximately 6.600 tons of waste per day'. Nurses concerned about healthcare's environmental footprint can improve our impact on the environment. It only takes one concerned nurse to make a difference.  At the ChIistiana Hospital ED. we have created a Green Team whose role is to look around the department with a more critical eye. This initiative was championed by Linda L. Laskowski RN. MS. APRN. BC. CCRN. CEN. Vice President: Emergency. Trauma and Aeromedical Services.

The team was created to apply the same "green" principles you use outside of work, in the department. The team is comprised of staff nurses. patient care technicians.and unit clerks. and department materials supervisor. The team has been in place for over 2 years and has identified and implemented initiatives to decrease paper use in the department, provided input to hospital wide initiatives, and has assisted in the role out of new technology tnstalled in the department aimed at reducing plastic use.

Decreasing paper use is one way to decrease waste. Although Christiana Care has had paper recycling in place for many years, there are other opportunities beyond recycling. The ED Green Team supported an initiative to eliminate default lab result printing tn the department. Before eliminating this print, this print function generated many sheets of paper for each patient seen in our high volume ED. Staff now obtain lab results from the electronic medical record only. A telephone notification process has been implemented notify nurses and physicians of critical lab values.

After the success of eliminating the Jab print. members of the ED Green Team found other defaulted print functions to eliminate. In most cases. these printed documents were not used by staff in the department and were unnecessary. Eliminating this print was a fairly simple process by working with information technology staff. In addition. many department and system wide manuals and references are no longer printed and physically stored tn the department.
Updating these materials is greatly simplified jf no hard copies exist. Updates can be made and posted electronically. Frequently used references can be linked to your personal sign on profile. allowing instant access with one click of a computer mouse.

These changes to how we view and use paper have simplified practice. decreased clutter in both the paper chart and physical environment, and lowered cost through decreased consumption of paper and toner. Finally. staff are freed to perform other tasks. rather than plactng paper records on charts. While some of these initiatives were system wide and others ED Green Team initiated, having a unit based team of early adopters supported lhese new processes and contributed to successful positive, change.

The most exciting change in the Christiana ED has been the replacement of flushing hopper sinks with macerators from Vernacare. of Toronto. Ontario.
Canada. The company produces paper pulp based patient care items to complement the macerators.

These paper pulp patient care products include male and female urinals. wash and emesis basins. and commode and bedpan liners. Vernacare patient care products are made from molded paper pulp. similar to egg carton material. The pulp is made from recycled newspapers and telephone books,without using dyes or bleaches. Natural resins keep the utensils leak-proof. Bedpans require a plastic base, since the pulp-paper device cannot support a patient's weight. Prior to this change. the ED Green Team assisted to develop education. inservice staff and troubleshoot the process.

The Emergency Department has been using Vernacare since April of 2008 with success. The high volume. 78 bed Emergency Department saw over 112.000 visits in 2009 and all patients in the ED use these single use products. After a patient uses a Vernacare product. the nurse disposes of it in a machine called a macerator. The macerator resembles a small top loading washing machine.
After the lid closes. it adds water and grinds the product into fine paper fragments and sends them and the human waste out through the sewer system.

Nurses no longer clean and reuse bedpans or scrub commodes in the ED. Installing the macerators and bringing in the Vernacare products in the Emergency
Department resulted in 50% reduction in the number of plastic patient care items leaving the ED in t.he first year the macerators and products were installed. This reduction totaled approximately 4000 pounds of plastic duIing the first 9 months of use in 2008. The ED plastic usage for 2009 was just 17% of the 2007 usage and equates to over 45.000 fewer plastic items going into landfills. Plastics cannot be totally eliminated. because bedpans must be used to support the weight of the patient.

Having engaged staff in the department contributed to the success of this project. Based on the success and reduction of waste in the Christiana ED. the Cltnical Decision Unit at Chrtsttana Hospital and the Wilmtngton Hospital Emergency Department implemented the Vernacare System last Autumn. Nurses concerned about healthcare's environmental foolprint can take a variety of approaches to improve the world we live in for our current and future generations. It only takes
one concerned nurse to make a difference. Look around your workplace with a more critical eye.

Consider where you can apply the same "green" principles you use at home and apply them in the workplace. Talk with your manager about creating a multidisciplinary team to look at the practices in your work place and start with small achievable goals. The team can function formally or informally.

You may begin just by soliciting staff for ideas and compiling a list and presenting it to your leadership team. You can take ownership of implementing one
of the ideas and then move down the list, drawing on other members of your team for support. Identifying and implementing small changes can go a long way
in improving our environment.