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ALL FOR ONE The OR-Central Sterile Process Improvement Team: (clockwise from back left): Nicole Glass, RN, Angela Cleveland, Tracy Morris, Nikki Lawrence, LPN, Joy Pickens, Linda Daniels and Lynne Class, RN. (Not pictured: Ashley Oden, Pat Daniels, RN)The Callahan Eye Hospital Health Care Authority in Birmingham, Ala., just renovated and reorganized its instrument reprocessing area, but what really makes the room tick is the OR-Central Sterile Process Improvement Team, says Cherry Maloney, RN, director of central sterile. It's a collaborative effort to resolve conflicts that arise between groups that don't always see eye to eye.
The team, which includes 2 RNs, 4 scrub technicians, 1 instrument technician and 1 instrument specialist, is facilitated by the hospital's administrative director of perioperative services. They identify issues between the OR and central sterile concerning staff communication, instrument trays, case carts, preference cards and materials management. They note concerns in a spreadsheet to track resolutions, and also agree on responsibilities for the OR and central sterile staffs.
Members of the OR team, for example, must check that needed items aren't already in peel packs in the OR before calling central sterile to make a request. They must meet a central sterile tech halfway between the OR and reprocessing area to grab fast-tracked items. They must check all ORs and substerile rooms at day's end and return all leftover instruments and peel packs to central sterile for reprocessing.
Among the central sterile staff's responsibilities: Look at the total number of instrument types instead of the total number of instruments when assembling sets to avoid incomplete trays being sent back to the OR; alert the surgical staff when instruments can't be located in central sterile so they can look for needed items in other ORs; and understand the urgency of getting reprocessed items back to the OR and into busy surgeons' hands.
Ms. Maloney says 3 issues have already been resolved since the team was formed earlier this year: The custom pack inventory is replenished to maximum par level at the end of each day, 4 RNs in subspecialties update preference cards so they're more current and only preferences cards needed for the day's cases are printed.
"The team focuses on education and quality, safe patient care," says Ms. Maloney. "We're very proud of the members for their time and effort."
— Daniel Cook
Hand Hygiene's Numbers Don't Lie
WATCH AND LEARN Present staff with quarterly hand hygiene compliance data.Assign a staff member to secretly observe the hand hygiene practices of physicians, anesthesia providers, techs, nurses or members of the housekeeping staff before and after low- and high-risk patient contacts over the course of a month, says Clinical Director Carol Cappella, RN, MSN, CNOR. Have the staffer record her observations on a grading sheet (outpatientsurgery.net/forms) that breaks down the total number of physicians and staff members who used soap, hand rubs or nothing before and after patient encounters, which you can use to calculate the percentage of staffers and physicians who practice proper hand hygiene. Post the overall quarterly results on a prominent bulletin board and share the data at staff meetings, but don't reveal who was observed. Staff will enjoy the feedback and will think it's a great way to address bad behavior without putting people in the spotlight.
"Shoot" Non-Compliant Staff
WARNING SHOT PACU Manager Carolyn Carroll, RN, tells Paige German, RN, to keep her hands where she can see them.Who says monitoring hand hygiene compliance can't be fun? Administrator Jessie Scott, MBA, gives the facility's managers "Presidio Police" badges and arms them with water guns filled with alcohol gel so they can "shoot" staff members who fail to practice proper hand hygiene. The managers shout warnings like "Caught red handed!" or "Hand hygiene police!" before pulling the trigger. Ms. Scott says Mena Reese, RN, DON, came up with the creative and fun way to point out missed opportunities.
Circulators Know When to Start Antibiotics
IN THE BAG Staff at the Springfield Clinic start antibiotics on time before 94% of cases.For Mary Stewart, RN, BSN, chief clinical officer, improving your on-time antibiotic starts begins with measuring the extent of the problem. "We were positive our metric was going to be fine," she says. "But we were wrong. Our first metric was less than 60% of the time." To turn things around, Ms. Stewart suggests you share low compliance rates with your staff, identify weaknesses in your delivery method and develop practical steps to improve the process. For example, base antibiotic delivery on the OR schedule in real-time instead of the proposed scheduled time of cases, and have the circulator start the drip instead of the pre-op nurses. Ms. Stewart says circulators have their fingers on the pulse of the OR schedule and know when drips should begin for upcoming cases.
Earn Passing Grades
FRONTLINE FEEDBACK Report cards hammer home the importance of proper hand hygiene.Director Jenny Pietrick, RN, has her staff secretly watch the hand hygiene practices of a colleague or physician throughout an entire day, which usually involves caring for 7 patients from admission to discharge. A tech might keep watch in the OR while nurses maintain surveillance in pre- and post-op areas. Give staff and physicians quarterly report cards so they can track their performance and progress.
Create Closing Trays
CLOSING TIME Instruments dedicated to skin closure help keep surgical sites contamination-free.Duke's general surgery team collaborated with surgeons to reduce SSI rates for colorectal surgery from 9.6% to 2%. If you want to see similar results, Beverly King, MSN, nurse manager of operations for general surgery, suggests your scrub team put on clean gowns and gloves after anastomosis is complete. She also says a tray of instruments dedicated to skin closure prevents contaminating the surgical site. Keep the closing tray on the back table until the surgical team re-towels around the incision and seals blood vessels.
Make Tracking SSIs Easier
SIGN HEREGive surgeons pre-filled paperwork to complete.Make SSI reporting easier for your docs by giving them pre-filled infection control forms to complete each quarter, suggests Nurse Manager Jane Bell, RN, BSN. Have basic patient information already completed, including their names, surgery dates and any complications that occurred. Filling in part of the forms saves surgeons time and help jogs their memories about particular cases. Your physicians must simply indicate which patients developed complications, note their interventions and sign and date the forms. Place the documents in folders and hand them to your docs. Include a handwritten note thanking them for their time.
Chart Keeps Reprocessing Staff On Track
HEADS UPHang reprocessing directions where they're needed most.Hang a quick-reference chart in your reprocessing room that details the necessary steps for reprocessing all the equipment used in your facility, says Center Manager Joyce Mackler, RN, MSN, CASC. "We reviewed all our manufacturers' directions and compared them to our current procedures, and decided it was a good idea to highlight the key steps," she explains. The table should note how each piece is pre-cleaned, manually cleaned or cleaned with ultrasound, lubricated, packaged and sterilized.
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