Cognitive Aids Provide Sharp Safety Awareness

Roy H. Constantine  PA-C, MPH, PhD, FCCM, DFAAPA

Former CSPS Representative and Chair

Article originally printed in Sutureline: Jul/Aug 2014 p. 11

As a member of the Council on Surgical and Perioperative Safety (CSPS) the AASPA is actively participating in a “Sharps Safety Campaign.” The AORN has developed a two-year sharps safety campaign strategy that will decrease the number of sharps injuries in the operating room. To be successful CSPS members will work collaboratively to promote educational tools and resources that can be used by each member of the surgical team. The four focus areas will include Engineered Sharps Injury Protection Devices, Double Gloving, the Neutral Zone and the use of Blunt Suture Needles.

In this submission I will touch on the use of “Posters” as a cognitive aid to provide “Sharp Safety Awareness.”  Cognitive aids act as prompts which can affect team function (Marshall, 2013). A review of the literature reinforces how cognitive aids can improve routine and emergent performance. The format for information can be as simple as a paper reminder (Stanford, 2014).

Professional posters can attract staff and provide essential reminders concerning sharps safety. Specific risks can be reinforced with staff members illustrating proper and improper safety approaches. Incorporating graphs, charts and data further supports outcomes and enhances staff knowledge regarding positive / negative trends (CDC, 2014)

Selected posters should be displayed in several locations to maximize awareness. Five types of selected posters can be printed from the CDC links: General Awareness, Data display, Correct Technique, Fast Facts and informational Display.

I reviewed the “General Awareness Posters” and they are excellent. A team members picture can be inserted within the poster. The “Data Display Poster” allows institutional data to be posted, but a unique feature of these posters includes the testimonial quotes from members that have experienced or witnessed a sharps injury. The “Correct Technique Poster” demonstrates several safe work processes that should be reminded and incorporated in daily practice. The “Fast Fact Posters” provide brief informative statements. In the era of Electronic Medical Record (EMR) these types of messages can easily be floated on computer screen savers. Finally, the “Informational Display Board” provides more sophisticated graphics in order to customize a poster display (CDC, 2014).

The Lucian Leape Institute at the National Patient Safety Foundation (NPSF) was established in 2007. NPSFs mission is to improve safety of care provided to patients. An excellent publication that I recommend reading is entitled, “ Through the Eyes of the Workforce” – Creating Joy, Meaning, and Safer Health Care (2013).”  Vulnerable workplaces occur because of an omission in design and inattention. Recommendations for Developing Effective Organizations include:

Strategy 1: Develop and embody shared

core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom through the front lines.

Strategy 2: Adopt the explicit aim to eliminate harm to the workforce and to patients.

Strategy 3: Commit to creating a high-reliability organization (HRO) and demonstrate

the discipline to achieve highly reliable performance. This will require creating a learning and improvement system and adopting evidence-based management skills for reliability.

Strategy 4: Create a learning and improvement system.

Strategy 5: Establish data capture, database, and performance metrics for accountability and improvement.

Strategy 6: Recognize and celebrate the work and accomplishments of the workforce, regularly and with high visibility.

Strategy 7: Support industry-wide research to design and conduct studies that will explore issues and conditions in health care that are harming our workforce and our patients.

Improving and redesigning systems strengthen interdisciplinary processes and prevention. Accident causation can be a direct result of system failure and human error. Cognitive aids can help to overcome personal, structural, cultural and social barriers. Select and evaluate interventions that meet the needs of your patients and the multidisciplinary team. Patient safety is the responsibility of everyone. Physician Assistants are important “patient safety” stakeholders. It is imperative that  “You Participate” in your Patient Safety and Quality Care Programs.



  1. CDC (2014). Poster Templates – Centers for Disease Control and Prevention. Retrieved on May 13, 2014 from
  2. Marshall, S. (2013). The Use of Cognitive Aids During Emergencies in Anesthesia: A Review of the Literature. Anesthesia and Analgesia. Nov; 117(5): 1162-71.
  3. Stanford School of Medicine – Cognitive Aids in Medicine, Retrieved on  June 22, 1014 from
  4. Through the Eyes of the Workforce- Creating Joy, Meaning, and Safer Health Care, Lucian Leap Institute – Report of the Roundtable on Joy and Meaning in Work and Workforce Safety,  (2013), National Patient Safety Foundation