"Surgeons and nurses are married to their surgical gloves. This can be a difficult change," says Denise Korniewicz, DNSc., a professor at University of Maryland School of Nursing and a recognized glove expert.
"Surgical gloves are highly personal for healthcare workers," says Robert James, national sales manager for glove manufacturer Regent Medical. "It's difficult for them to embrace a change."
Yet facility managers may believe a change is needed. When three nurses who attended a professional meeting all reported about the effects of glove powder on wound healing, Cynthia Ullery, RN, CNOR, thought a powderless glove trial might be in order.
"We believed the facility would be better off with a powderless environment - less allergies, less adhesions and better patient outcomes," says Ms. Ullery, manager of surgical services for Sutter Tracy Community Hospital in Tracy, Calif.
Other facility managers have change placed in front of them. When McKee Medical Center in Loveland, Colo., had a change in national contracting, management was directed to choose gloves from that contractor.
"We had some physicians wearing the contracted glove, and others not in those gloves. We wanted everyone to switch to the contracted glove," remembers Debbie Stewart, RN, BSN, MA, CNOR, McKee's director of surgical services.
Experts say a glove trial can help you resolve important issues, but it's fraught with opportunities for error. Here are seven mistakes that can sink your surgical glove trial.
1. No plan.
Like so many management initiatives, much of your trial's success is in the planning. To begin with, clarify your objectives.
"Ask yourself, ?What are the five to 10 things I'd really like to know about these gloves?' These could include fit, durability, powder and skin problems," says Dr. Korniewicz, who recently conducted a surgical glove trial in 23 ORs that evaluated the use of nonlatex gloves for all surgical specialties. She planned that study for six months prior to collecting data, and recommends that surgery centers follow a similar ?plan-the-work, work-the-plan' approach.
Ms. Ullery worked for several months with her nurse manager, Carol Morrison, to plan and design their glove trial. With four or five gloves in use, they wanted to narrow down the field to just one manufacturer, and no more than three gloves.
"We didn't know if it was feasible," says Ms. Ullery. "Carol went to our vendors and got glove samples. We had to identify one vendor with a powder-free glove that had good feel, durability and would meet most surgical needs."
Once they accomplished that, Ms Ullery included the manufacturer's rep in the planning process. The rep can usually provide you with or help develop an evaluation form, which should be as simple as possible.
"Keep it simple," says Dr. Korniewicz of the evaluation form. "List your clinical criteria, and then ask the participants to rank the gloves from 1 to 10."
2. Poor timing.
Experts say you have to time your glove trial "just right." Obviously, you don't want it to conflict with any other major initiative, such as an accreditation survey, or adding a new procedure or surgical specialty. You also don't want to run a trial when a lot of staff or doctors will be absent.
"It's better to run a trial when a lot of procedures are scheduled so the gloves are used by many people and you get a lot of feedback. You can accomplish your trial in a week, if all surgeons are present during that time," notes Donna Haskell, National Training Manager for glove manufacturer Maxxim Medical.
You also want to time your communication about the trial very carefully. Don't tell your staff and surgeons too far ahead of the trial date, but don't spring it on them, either.
"Be strategic about this. If you tell them two months ahead of time, they'll forget. If you tell them on the day of the trial, they'll be ticked off. About a week ahead of time seems right," says Dr. Korniewicz.
You might time your communication in stages, suggests Regent Medical national sales manager Robert James: "About 30 days ahead of time, you can hang posters and send letters. During that month, you'll issue other reminders and schedule in-services."
3. Poor communication.
Along with good planning, effective communication is a key component of a surgical glove trial. First, you must clearly explain why you're conducting the glove trial. "Healthcare workers almost always assume you're conducting the glove trial to cut costs, but usually a change in gloves costs the facility more," says Mr. James.
If you're running a powderless or latex-free trial, explain that it's in the best interest of patients, staff and surgeons to have a powderless or low-allergy glove. Even if the trial is in response to a change in contracting, you can point out benefits for the surgeons and staff.
"We let them know that this was their chance to choose a glove that they like, and that we would work with them to resolve issues," says Ms. Stewart, adding that the contracted vendor in her case re-molded the glove in response to surgeon comments.
She worked in another goal that the staff was already behind: They only looked at powder-free gloves from the contracted vendor (although the powder-free gloves raised the facility's overall costs, it did bring them into compliance with the national contract.)
Experts say you should take these specific steps:
- Send a letter to surgeons explaining the purpose of the trial. Include a sample of the glove or gloves being tried in the surgeon's size.
- Hang posters or flyers in the facility, which do the same job as the letter.
- Announce the trial at staff meetings, and lead a discussion about the trial's purpose and some of the logistics.
- Hold a staff in-service where you will discuss the specifics of the trial, and size staff members for the glove being tried.
- Meet with surgeons ahead of time to size them for the glove being tried, and to answer any questions.
4. Going it alone.
Because a surgical glove trial will affect so many people, never try to go it alone. Establish a team inside the facility who will work on the glove trial with you, says Dr. Korniewicz.
"It's ideal to have one surgeon, one nurse and one tech working with you. To get staff buy-in, ask the staff to help design the trial," she says.
Ms Ullery says her staff bought into the trial right away - because they initiated it. "It was our nurses who suggested a powder-free environment. They wanted it, and they really put themselves behind the trial," she notes.
Get an influential surgeon or nurse to champion your trial. These are the top "players" in your surgery center, and they will help to obtain acceptance and participation.
"You need a champion for the cause, not the product. Latex sensitivity can be career-altering, and those who understand this are the best to have on your side. We've found that nurses and scrub techs wear surgical gloves for longer periods than surgeons, and they are the most valuable champions," says Mr. James.
5. Lack of experienced help.
If you or someone on your staff has not already run a glove trial, make sure you get expert help. Usually, the glove manufacturer can supply an experienced rep to work with you.
"Our rep was invaluable," says Ms. Ullery. "She provided us with posters, met with our staff and answered questions, and provided an evaluation form to use,"
Ms. Stewart says the role of the rep is so crucial, you should be picky about whom you accept: "Make sure your vendor sends a knowledgeable person. The surgeons will ask some tough questions, and the rep has to be qualified to answer them."
Make sure the rep will be on-site during at least the first three days of the glove trial, and preferably for the entire trial, experts say. Also, be sure to tell the rep what amount of help you need, and how you'd like him or her to deliver it.
"The rep should do whatever the facility dictates, from being stationed in the OR to just hanging out in the lounge, waiting to answer questions. We teach our reps that this is a high-stress environment, and they shouldn't do anything to add to the stress," says Ms. Haskell.
6. Dismissing the nay-sayers.
In every facility there will be someone who is opposed to changing gloves, or even trying different ones. Be careful not to dismiss this person's potential impact on the staff.
"The person who is reluctant to change is usually quite vocal. If they scream long enough and loud enough, they will have an impact on the entire facility. The key to dealing with this person is to personally inform and talk with them, and emphasize the reason for the change," says Mr. Janes.
Ms. Stewart says a level head and private talks with the nay-sayers helped a lot. "Gloves and sutures are two things you don't change without a lot of thought, she says. "It can get ugly; I had some doctors screaming at me. We kept the lines of communication open, and always followed through on physician issues."
7. No bodies present.
You must have staff present that will make sure the trial goes right. Ms. Ullery or her nurse manager was present before and after procedures, and they equipped the glove rep with a cart stocked with the glove types and sizes.
"The rep made sure each person had the right size and type of glove before going into the OR. Then she would talk to each person after the procedure, making sure evaluations were filled out," says Ms. Ullery.
Non-clinical staff members can help, too. In Ms. Stewart's facility, the business manager obtained the evaluation data and comments from OR personnel.
During the trial, you and your helpers must make sure only the gloves on trial are being used by removing all other gloves from supply shelves. After the trial, even if you've elected to go to the new glove, you can return the other gloves to the shelf, and use them up before replacing them with the new glove.
At the end of the day
Your glove trial may turn out just as you hoped, or it may be more of a mixed bag. Ms Ullery's facility went with the three types of powder-free gloves that were tried, and still are using those gloves. Ms. Stewart's 40 surgeons used the trialed gloves for about four months, but some surgeons were not happy with them. Now the facility is using about 80 percent of the trialed gloves, and 20 percent of other gloves. "Our corporate office is agreeable to this because we had run a good trial," says Ms. Stewart.
Whatever the outcome, a glove trial will demand your skilled leadership. Ms. Ullery says it tested her skills in many ways: "Accomplishing a glove trial takes great teamwork, the very essence of teamwork. It's a lot of work, but it's worth it."