Celebrating Nurses’ Monumental Impact
There is a myriad of ways to participate in National Nurses Week, which is celebrated May 6-12, from honoring your staff RNs with a gift or event to taking steps to let...
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By: Daniel Cook
Published: 11/14/2019
Last month at OR Excellence in New Orleans, attendees packed the conference’s main presentation hall for an open forum discussion about ways to improve the performances of their facilities’ sterile processing departments. Melony Prince, BSN, RN, CNOR, clinical nurse educator at Littleton (Colo.) Adventist Hospital, raised her hand.
“Why is it,” she asked with a mix of wonder and exasperation, “that my daughter made more as a lifeguard in her first job out of college than my hospital pays our reprocessing techs?”
Peter Nichol, MD, PhD, an associate professor of pediatric surgery at the University of Wisconsin School of Medicine and Public Health in Madison, peered down from the dais, smiled and leaned toward his mic. “How much time do you have?”
Rewind several years. Dr. Nichol is on vacation in Southern California when he received a series of emails from an orthopedic surgeon who was complaining about repeatedly receiving instruments back from sterile processing with bone fragments still on their surfaces. “I was pissed off, frankly, and decided I needed to spend time in the department to figure out what was going on,” says Dr. Nichol.
When he returned to work, Dr. Nichol worked shoulder to shoulder with hardworking reprocessing techs and was shocked by the sheer complexity of the operation as instruments came and went amid a dizzying and disorganized swirl of activity. “Trying to understand what was going on made my head spin,” says Dr. Nichol. “Sterile processing departments need to be run like high-tech 21st century manufacturing plants. Right now, it’s like pre-Henry Ford.”
He was also incredibly impressed with the dedication of techs who often toil in relative obscurity. “They have tremendous drive and perseverance to master their craft, and are very aware that the instruments they take care of are touching human beings,” says Dr. Nichol. “They’re critical to the delivery of safe and efficient surgical care. It’s egregious what we pay these people.”
He’s right. Earning near minimum wage is simply not enough for the responsiblity of making sure the instruments that invade patients’ bodies are properly sterilized. Knowing how to care for thousands of devices is difficult enough without the external influences and challenges that make their jobs even more challenging — surgical schedules designed to increase case volumes and revenues, loaner trays showing up at the last minute, and countless regulatory requirements and recalls to manage.
“They work in a fast-paced, pressure-filled environment surrounded by bacteria-slicked instruments,” says John Beakes, chairman of Operational Performance Solutions, a lean process consulting firm in Westminster, Md. “And they’re barely making a living wage. It’s time to appreciate and value the work they do.”
Dr. Nichol says his 2-hospital system hosts 19,000 cases each year, and loses nearly $1,000 per case in hard waste and decreased OR capacities caused by instrument reprocessing errors and inefficiencies. “There are 51 million surgeries performed in the United States each year,” says Dr. Nichol. “This is a potential $50 billion waste problem that we have the know-how to solve in the next 10 years.”
But how? Dr. Nichol’s hospital is at the forefront of efforts to reimagine sterile processing and is still having trouble making meaningful changes.
Increasing how much techs earn is a good place to start. Some Chick-fil-As starts its workers at $17 per hour, according to Ms. Prince. She says her hospital used to pay reprocessing techs $4 less. The director of surgical services rewrote the job description based on the complexity of the responsibilities of the job and was able to bring them up to a slightly higher pay grade.
Paying more for surgery’s dirtiest job addresses only part of the issue. Adventist Hospital’s director of surgical services is also working with local community colleges to develop an associate’s degree program for sterile processing, but that’s far from the norm across the country. “The real problem is that there is not a national standard with respect to post-secondary education,” says Dr. Nichol. “Reprocessing techs need advanced training in subjects like chemistry, informatics, instrument identification, infection control and waste disposal. The reason there is no standard curriculum is because people don’t get paid much to do the job. Why would deans of colleges start a program for professionals who are making $15 an hour? How will they pay for their education?
“Developing education and solving the salary issue will be critical to where we need to go,” he says.
Those are big solutions to a layered and complex problem, but you can make a difference in your facility by spending time in the sterile processing department and finding solutions within your own space.
“It never ceases to amaze me what happens when you get all of these people in the same room and start visually assessing the process,” says Rachel Mandel, MD, MHA, an independent healthcare consultant based in Washington, D.C. “People look at each other and say, ‘I didn’t know that you did all that.’”
When people from different departments and roles start talking, they break down silos and begin to understand how the entire instrument care process works and how their roles fit into the big picture.
“The people who do the work are the subject matter experts who know what their processes are,” says Dr. Mandel. “They just need somebody to help them change their way of thinking, the way that they look at a problem and how they can solve it.
“Respect the opinions of the people who are doing the work. It’s their expertise that’s crucial to driving the changes that will result in real improvement, and they’re the ones who will sustain it.” • Build a bond. There’s a disconnect between the operating room and central sterile because the 2 sides might not appreciate what the other ones do and go through on a daily basis. You can bridge the communication and culture gap by looking at Dr. Nichol for inspiration.
“Not every surgeon is willing to walk through sterile processing to see how it really works,” says Mr. Beakes. “That’s magic, and it doesn’t happen everywhere. It’s those humble leaders who want to know how they can improve the jobs of $15-per-hour techs who will change health care.”
Have staff members from each area walk in the other’s shoes for a day, so they gain an appreciation for the responsibilities they have and the pressures they face. “If both groups can see that and appreciate how much they depend on each other, it really helps to develop the teamwork needed to keep instrument flow going,” says Dr. Mandel.
Efforts to improve the performance of sterile processing will fail if you don’t address related issues in the OR. For example, pre-treating instruments with enzymatic cleaner immediately after they’re used in the OR keeps bioburden from hardening and hinged tools from locking up.
“That’s an enormous help to the sterile processing staff, who work extremely hard to decontaminate instruments before sterilization,” says Mr. Beakes.
Part of Littleton Hospital’s orientation program for all new reprocessing techs involves shadowing an OR nurse for a couple days. “It gives them an opportunity to see how instruments are used during surgery and meet members of the surgical team, including the surgeons,” says Ms. Prince. “The best surgeons pay the most attention to those people when they come into the room because they know how important they are.”
Surgical techs and nurses must also complete ongoing competencies to demonstrate that they pretreat instruments properly with enzymatic cleaner and string sharps together to limit injury risks for reprocessing techs. Ms. Prince also explains why bioburden makes instruments impossible to sterilize, a factor she says many OR staff don’t fully comprehend.
“It’s counterintuitive to move individual carts, but continuous flow is a robust engineering principle,” says Mr. Beakes.
Reprocessing techs will move on from your facility if they don’t get the support they need to excel at their jobs. Keeping them happy and satisfied by giving them the professional and financial respect they deserve will save your facility long-term dollars by avoiding the constant hiring and training of new techs, who will someday feel underappreciated if you don’t change your attitude toward the essential role they play in your facility’s success.
“A facility’s operational, financial and clinical pressures overlap, and all are equally important,” says Dr. Mandel. “Having instruments arrive in the appropriate way and in the appropriate timeframe without overburdening the staff who’s processing them is incredibly important.”
Important enough to finally stop viewing techs as glorified dishwashers and begin treating them like invaluable members of the surgical team. OSM
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