Informed Consent: A Sterile Processing Perspective

Hello and welcome to Informed Consent, a Sterile Processing perspective. This is a Beyond Clean webinar, and I'm your host, Hank Balch.

What is Informed Consent?

Or more importantly for our purposes on this webinar, what does Informed Consent have to do with Sterile Processing?

Well, that's an important distinction. We're gonna spend the next 60 minutes or so really fleshing out why this topic matters to the public at large, but in particular, why it matters to our industry.

And to us as individual frontline Sterile Processing professionals. So in general, when you bring up the topic of Informed Consent, there's a couple of things that come to mind.

You know, first and foremost, it's primarily a legal term. So when we discuss things like Informed Consent, and that's in the context of protecting different interests at stake. So when organizations outside of Sterile Processing speak of Informed Consent, typically they're speaking of things such as information, understanding.

Agreement and documentation, those are the four pillars that tend to make up Informed Consent. And on this webinar, we're gonna go through those four pillars in a different way. We're gonna go through it and look at how those 4 can and should apply to who we are as a Sterile Processing industry and as I said earlier, to who we are as frontline Sterile Processing professionals.

At the end of the day when we speak of Informed Consent in the context of the patient.

We want them to have the information they need to make informed choices. Informed Consent really just means informed choices. In Sterile Processing, however, we know and have more information, more critical information.

Than our patients do about their surgeries. So we're going to talk a little bit more about what that means in the context of this webinar, but I want to put that out on the front end that we know what's going on more than anyone else, even the operating room and even the surgeon in regards to Surgical Instruments for these procedures. We have that information, so.

What does the typical patient know? So if you're getting a procedure uh tomorrow or next week as a surgical patient, let's just say that you don't work in Sterile Processing. What do you know?

How much information do you have about your Surgery? Well, likely you know the name of the hospital, but you know, many times if you were to ask a patient, they may not even know the full name of the hospital or if there's one hospital in town, they just know that I, I'm going to the hospital, quote unquote. They may not know that it's the university hospital.

In a particular building a name or a particular floor, you know, they just know that I'm going in general to the hospital. There's potential if it's a very informed patient, they may even know or look up the grade of the hospital, the quality grade, if it was the 5 star rating from CMS that came out a couple of years ago, or if it's the leapfrog ratings.

There's a number of different grades. If it's on the US News, World Report, you know, top 10 hospitals, they may know that grade of that particular hospital. Potentially, depending on how educated they are, they may know this hospital is accredited by a group such as.

The Joint commission such as DMV. Now, it's uh, uh, typically unless a patient's involved in some kind of healthcare themselves, you know, that accreditation status is, uh, probably assumed in some sense, but not, not necessarily understood. It's very likely, hopefully, that they know their surgeon name, but I'll give you.

Great example. When I had my appendix out a couple of years ago, I didn't know my surgeon cause I'm coming in through the emergency room and I'm scheduled for a procedure the next day. So I met my surgeon for the first time a couple of minutes before my Surgery as he walked in my room and said, this is what we're about to do.

Right, so, uh, even knowing who your surgeon is, you know, it tends to vary. Now, every patient is gonna have some experience with how the hospital looks, right? Is it easy to find a parking spot? Are the floors clean? Is my room clean? Does it look new? Does it look old and dingy? And they're gonna have that type of information just from being.

In the building itself, even if they don't know the hospital name or if they know the name, if it's a part of a larger hospital brand, there's a reputation that comes into play, so it may be known as the Community Hospital.

May be known as the academic, the university hospital where all this high-tech Research goes on. Might be known as part of a larger, very reputable health system, and this is just the, this is a particular hospital that's a part of that larger health system in my hometown or in my neighboring city. And then, as I mentioned earlier, depending on the procedure and the consciousness of the patient.

Uh they're probably aware of the procedure that's going to happen to them, and this is a big part of the traditional understanding of Informed Consent. You know, nurses come in, physician comes in, and they tell you what they're going to do, how they're going to do it, what the risks are involved, and they make sure that you understand this is the procedure that's about to happen to you, you know, so that is kind of baked in and built into a traditional informed.

Consent encapsulated in all of this on the part of the patient, they have an assumption of safe care. Whatever is about to happen to them, they're assuming that it's going to happen safely, and they are in good hands in this healthcare facility, even if they don't know the name, if they don't know the grade, if they don't even know the surgeon, there's an assumption that this is going to be a safe experience now they.

Maybe nervous, and that's, you know, just human nature. I was nervous going in to get my appendix out and perhaps I was nervous because of a lot of the things that I'm about to tell you in the following slides, but either way, it's natural to be nervous, but it's also natural because of the trust, especially as Americans that we have in our healthcare system. We know we're, we provide some of the best healthcare in the whole world.

The most high-tech instrumentation and Technology, the best pharmaceuticals, the highest level of training for nurses and for surgeons. There's an expectation there, and then, you know, a realistic one.

We're gonna have safe care in these procedures. Moving outside of that Patient experience though, let's talk a little bit about what we know as Sterile Processing professionals on the frontline. And over the next couple of slides, we're gonna go through these categories that you see in front of you now. We're gonna talk about what we know that maybe no one else knows about instrument quality.

In our facility and we're going to talk about what we know about instrument availability in our facility in equipment functionality, and time constraints around the reprocessing of these Medical devices. We're gonna talk about the impact of adequate reprocessing tools on patient care. We're gonna talk a little bit about staff training and competency.

And appropriate Technology and how all of these points come together to give us as Sterile Processing professionals some of the clearest pictures of the true state of affairs, the state of the union of surgical safety in our facility, and I believe, and I hope that you will agree at the end of this session that we have some of the most important information available.

To that final stage of a truly informed patient, and I'm going to argue at the end of this presentation that there are some things that we can and should be doing to help share some of this information that only we have access to. Let's kick off this first category and talk a little bit about instrument quality, but obviously because it's our job to reprocess.

Number one, but also inspect instruments out of everyone in that continuum of surgical care, we have the opportunity outside of the surgical field to take time and take effort to evaluate the quality of our instrumentation, and we're looking for a number of different things.

I used to tell technicians when I was training them on the assembly area for the first couple of weeks of their training that you're looking for 3 things. What is this instrument?

How does it work? How is it supposed to get cleaned? Now, that last point, if you're in the assembly area, you're expecting instrumentation, right? You're not gonna be doing any cleaning there, but it's important for you to know.

How it does get clean because as you're inspecting, if you know that this piece comes off of the distal tip or you know that this accessory screws off, that is a key point to zero in on evaluating the cleanliness or the quality of the cleaning that happened on this instrument and on this device. So if we know in our particular facility.

That instruments are regularly coming out to the clean side, quote unquote, to the assembly area, but they're coming out and they're not clean, and that could be an issue that's targeted on a particular shift. So let's just say for instance, and this is not a knock on any shift.

But let's just say that 2nd shift comes in and on a pretty regular basis, they identify instruments from the 1st shift that had come through the Decontamination process onto the clean side, and they're regularly seen.

Multitude of devices that are just not thoroughly cleaned. Maybe it's lumens that have not been flushed appropriately. Maybe it's renjours that still have residual bone. All of those kinds of things can snowball into a mountain of knowledge.

That the department knows the frontline Sterile Processing technician knows, but maybe no one else knows in the health system. Maybe the operating room doesn't know. Maybe the C-suite doesn't know. Maybe the surgeons in the OR don't know because what happens is in Sterile Processing, we stop the line in that scenario. We identify these instruments are coming out and they're sub-quality.

And so they're going back, they're going back in the process to be re-decontaminated, to be re-cleaned, and then they're coming out again and they're meeting quality standards, and then they're going on through the flow, but we're aware of the challenges on uh cleanliness of our devices more than perhaps anyone else in the facility. We're also aware on,

Issues of functionality. This is a balance on who may be more aware because a lot of these issues are identified in the operating room from surgical techs and from OR nurses perhaps, or from surgeons, right, who they go to make a cut on a pair of scissors and it's not operating up to their standard, so they're going to let us know. We get that awareness from functionality issues directly from our customers.

In the operating room, however, there's also an opportunity for us to proactively identify issues of functionality at the assembly stage. So we're testing scissors and we realize, hm, there's a burr on the tip of these scissors, or we're testing around jors and we realize they're not.

Completely cutting through that test strip or that test card, and as we're processing as technicians, we can identify potential trends of functionality. Perhaps all of our scissors are having issues in the box locks or perhaps many of our scopes are coming.

Through damaged or have a like some type of water coming into the scope and so the view is getting.

Um clouding, we're able asster processing technicians to catch that ahead of time before it makes it back to the operating room. In addition to this, we're aware of all kinds of repair issues, preventive maintenance schedules. Maybe they're good, maybe they're not. We're aware of the sourcing of instrumentation, perhaps to save a couple of bucks, we're sourcing instruments.

Outside of the traditional high quality uh countries of origin from instrumentation that have names that go back decades and decades for a quality instrumentation.

Perhaps we're sourcing from Other Other countries that are not quite known for that high standard of quality. In addition to that, we know the age of our instrumentation perhaps better than anyone else. We know that one mallet that has been in the set since 1943, not only because some of us has been there that long.

Perhaps, but also because it's still engraved on the bottom of the mallet, and so we're aware even of engraving issues in our trays. And then finally, and this is obvious, perhaps outside of cleaning and functionality, this may be the most obvious, any staining or pittinging or issues of rust.

On our instruments we see these instruments and intentionally inspect these instruments every single day in every tray. We know if our facility has issues with staining, rusting, and pitting. Additionally, perhaps more than anyone else on the perioperative team.

We know the issues with instrument availability. We can tell you as frontline Sterile Processing techs how many procedures we're doing every day and how many orthopedic drills that we have to support those procedures.

And if you asked us, we could tell you how many more drills we need to safely support those procedures, and we can also tell you the impact that missing instruments have on our inventory. Perhaps we have 4 sets.

Of a particular tray, but 2 of those sets are missing critical items, so even though the inventory list says we have 4 trays, really we have only got 2 trays that can be operationalized because.

Those Other two trays are missing some critical instruments, and we can tell you that information in a way that hardly anyone else can. We're also aware of instruments that are out for repair. Again, they may show up on the inventory list, but they're not actually active in our inventory today to support surgical volume. We can also tell you any inventory that is potentially lost or otherwise unaccounted for.

It may say that it lives in this hospital or it may say that it lives on that shelf, but the last time that anyone has seen that tray was 3 years ago. That too can have a dramatic impact on patient care if a physician or anyone else on the perioperative team.

is calling for this one tray. They want this one particular tray, and yet they don't know that it has been lost. 3 years ago. No one's seen it. There's no scan records. There's nothing, even though they assumed and they thought that they had this.

It's nowhere to be found. Then, as I alluded to earlier, we can also tell you the challenges that are posed due to poor scheduling Practices, and I'll call them poor scheduling Practices, you know, perhaps they're just scheduling Practices outside of a consideration, collaboration with Sterile Processing.

Because many times we feel like an SPD that the schedulers or perhaps the OR Leadership are just scheduling cases, you know, blocking in time whenever the surgeon's available, whenever there's patients, you know, they're throwing them out there regardless of any.

Consideration for the status of our inventory or the status of our staffing and Sterile Processing, like with the expectation on, well, somehow, some way Sterile Processing is going to get it done and there's a couple of things when if this happens in conjunction with the issues above.

Such as flipping rooms or really scheduling dramatically heavy orthopedic days and have a dramatic impact on our ability to safely support this volume that could result in a lot of flips and turns of inventory all throughout the day, which

If all things being equal could work. However, 11 failure to communicate, one instrument washer goes down, one sterilizer aborts the cycle, and then a whole scope of dominoes just falls, and those are the situations with that as Sterile Processing professionals, we have information about that's critical again.

To that um final goal and result of a safe Surgery for our patients. Closely related to instrument quality and instrument availability, as I just mentioned a second ago, is equipment functionality. Many of y'all and I see this on the Facebook groups and I hear it on LinkedIn and we see it in facilities that we end up consulting in struggle with your equipment.

Right? Either it's a uh 40 year old cart washer or like when I started in Sterile Processing.

A little over 10 years ago now there were autoclaves in our department.

That were older than I was that have been there every single day of my life, right? Sterilizing Surgical Instruments and they've just been there chugging along. I'm sitting in kindergarten and I'm hearing a story, you know, during story time and this autoclave is uh sterilizing surgical trays and then.

Good, you know, 30 years later, there I am walking in as a new Sterile Processing technician and that autoclave is still there. So we have insider knowledge to the age of the equipment and that impact, of course, on our ability to safely sterilize Surgical Instruments for these procedures. We understand optimized performance if these things are running.

As they should be. In addition to that, we know the insider knowledge about RPM schedule preventative maintenance and repair of these devices. How often are they going down? I highly recommend, if you're not already doing this, to be documenting the downtime of your washers and your ultrasonic washers and your autoclaves.

And write that down from the hour that it goes down to the hour that it comes back up again, because that type of data can help tell a story to your C-suite or to the operating room Leadership on why your Other statistics look the way they do. All right? Why do you have so much overtime? Oh well, it's because we had 120 hours of downtime from a cart washer.

And that resulted in a lot of manual labor. So those are the types of information that only Sterile Processing technicians know.

About what's going on in their department. Even if you've got a new piece of equipment, you got great optimized performance. The repair time, the downtime is very limited.

If you're not using that equipment properly, loading and unloading, if you're not using the right chemicals, all those things can have a dramatic impact on the output of this equipment, and a great example of that is the often systemic stacking of trays.

Through these washers, I can't tell you how many facilities that we've been to that have maybe 1 washer, 2 washer, even more than that.

But the volume is so high.

And the pressure on these technicians is so high that they have decided to stack trays going through these washers, multiple levels of trays, Loaner trays, all still in their container, not separated level by level, pushing them through this equipment, and we did some videos and some articles about that, but that kind of action.

Can critically impact.

A patient at the end of that tray because this equipment was not built to wash through multiple levels of instrumentation. It's built for contact water contact, clearing the IFUs for loading of these types of equipment, but we know it's still processing when these types of of shortcuts are going on with our equipment. That's very, very important.

Information. In addition to that, we're aware of the recommended quality testing and if we're doing that testing on a regular basis, if those are the correct tests, if they're being correctly loaded, if the tests themselves are being correctly read. I've seen at least a handful of facilities over the last year where we go in and we look at a documentation log and they're running the test.

They're putting the test in the log. I look at the test and I realize these tests have not passed.

They'd been failing for weeks or months on end, and no one in the department had either realized it or taken action upon it. They had been dutifully doing the task and documenting the task, but they'd been documenting systemic failures and taking no action. As Sterile Processing professionals on the front line, we see those things and we have that information.

Again, as we'll talk about here in a minute, I think we need to act upon it. Then finally, we're aware of any facility issues that come into play with this type of equipment. So perhaps we've got a poor Water quality. We have a hunch that there may be poor Water quality, OK. So maybe we see film coming up on the inside of our washers or maybe

The nozzles on our cart washer starting to cake up with calcium deposits or some Other kind of deposit that we don't know what it is, and so that tips us off.

Have been in facilities and actually worked in facilities where we began to to smell something on the instruments as they were coming through onto the clean side and it had a little almost fishy smell, right, and so that was tipping us off that um there's something going on, you know, perhaps it's the chemicals, perhaps.

It's the water. Perhaps it's the equipment, but there's something going on that we need to look a little closer on because that smell is not the smell that you should be getting from instruments that have come through the Decontamination and cleaning process.

So as frontline professionals, those are the types of things that we know from our equipment alone that there might be something here that's not completely operational, that's not meeting the quality standard that we would expect.

For our own surgeries and definitely for the surgeries of the patients who have put themselves in our care. Speaking of time constraints, and this goes a little, we alluded to this earlier about the, uh, poor scheduling Practices in the operating room, but I think it's enough to flesh out in particular here, and there's been a recent, um,

Study, I say recent, I guess it came out the last year or two from the Corey Ofsted Group, and it was a survey that was asking different professionals who reprocess endoscopes if they felt pressure.

From the indoor suites or from providers to take shortcuts or to skip steps on scopes, and I love that question in that survey, and in fact, I ask when we're out in the field consulting, I almost always ask frontline technicians this question and I try to do it when the manager or the supervisor is not right behind me, but when I can uh.

Uh, try to get more of a one on one, you know, truthful answer, and I say, do you ever feel pressure or have you ever seen your coworker feel pressure to skip steps due to time constraints? This is a reality from operating room customers, whether they know it or intend it or not.

I'm not saying that every time a circulator calls to SPD 3 times in 1 hour, that they're trying to to force you to take shortcuts.

I don't think that is the intent for most of these circulators, right? Their intent.

It is to get the tray that they need for their procedure and their assumption is likely that you can do something to get them that tray faster and yet still be compliant and not necessarily coming out and saying I want you to skip steps, Sterile Processing. I want you to skip steps dangerously and I want you to get this tray back to me, whatever it takes. That's not what they're saying.

However, that pressure from circulators, from surgical techs, from whoever it is on the Other end of that phone line can be real, and that pressure can be very heavy for a Sterile Processing technician, especially if you're one of the few technicians in the apartment. Perhaps your supervisor is not there, your manager is not there.

And all you hear is there's a surgeon in front of me who wants this tray. The patient is on the table, or the patient is about to be on the table. Get me this tray.

Now, the impact that has on a Sterile Processing team and frontline technicians can range across a large spectrum. There will be people who will just forget everything that training taught them and, you know, do whatever it takes to get that tray.

Back to the OR and I think, you know, we're putting them in a situation where that pressure is unrealistic and it's unhelpful. Perhaps they've not been trained for that situation or not adequately supported for that situation, but either way, there will be people who respond in a way that's not safe to these pressures all the way to the Other end of the spectrum, and there would be people who

We do not respond at all to emergent situations in in the way that an emergent issue would require. There are certain actions that we can take compliantly to still meet needs on a time constraint, but not cut corners. That may mean how we prioritize. That may mean leaving different autoclaves open.

For processing throughout the day rather than just keeping them going regardless of the priority of instrumentation, there may be different positions that we can create like operating room liaisons who help us be more proactive on our daily turnovers, quick turns. I don't like that phrase.

I know many of y'all don't like the term quick turnover because that's assuming that we're cutting corners or cutting steps, but whatever it is, that pressure from the operating room at the end of the day is coming from a real felt need.

That our customers want their devices as soon as possible.

And we know intern processing the impact that is having on our team. The same thing can be said for Productivity expectations. If a department feels like they have to be processing 4 trays an hour nonstop every day, regardless of what's going on, regardless of the phone calls, regardless of the Other issues coming in. Maybe loaners are dropping off or maybe vendors are dropping off Loaner trays and we're having to sign in those trays, whatever.

The sideline issues are if we're feeling a pressure of Productivity coming in to our frontline technicians, that too can have just as a dramatic impact on the quality output of our instruments. If people are thinking more about completing a tray and they're thinking about completing a tray with a high standard of quality.

That could impact negatively the overall quality of our traces. Likewise, staffing shortages.

Definitely can impact a Sterile Processing department negatively when it comes to time constraints.

It's been many a night on 2nd shift where we walk in and there's been callouts. It was a heavy day today. It's gonna be a heavy day tomorrow.

And we're looking around at each Other and saying, well, we know one of y'all has to go to Deacon Tam, and we know one of y'all's got to pick case cards. Well, that leaves one of y'all for the assembly area. It's just not realistic to assume this one person is going to be able.

To carry the entire assembly load for some of these larger facilities, but that's what staffing shortages do to teams, and it snowballs all those Other time constraint issues that we talked about. So if you've got limited staff in the assembly area or limited staff in the Decontamination area.

And they're getting phone calls for quick turnovers and there's expectations from Productivity placed on them that they get a certain amount of trades done or or you know, they zero out at the end of the night if that's the expectation. All of those pressures just come together amidst staffing shortages and it causes your people to think more about.

100 Other things that they shouldn't be thinking about and less about the one thing that they should, which is there is a patient, there's a human being at the end of this tray who deserves my full attention, and every instrument in this tray could be used on them, and that's what they should be focused on, and that's what time constraints forces someone.

To forget a final point on this slide is that IFU timeline.

And this is the difference between can and compliance. It really goes back to the story that we started on this slide about that phone call from the operating room, and the question goes like this, Can you get me that instrument tray back in 30 minutes? Well, the answer to that question is different depending on if.

Compliance is at play. So can we rinse it off and push it through the washer or hand it through the hand wash window and package it and throw it in an IUS autoclave and get it back to your room in 30 minutes? Probably so. That is possible.

Now, can we compliantly do that is a completely different question. Compliance is not assumed in that scenario of can you do something? And you know, I don't want to, I don't want to focus too much on the particular language of the award, if they're asking the right way, if they're asking the right things. We know internal processing.

What those questions really mean when it comes to time constraints, we also know that there are certain things that we just cannot do quicker. We cannot shortcut the timeline on an IFU, for instance, if we have instrumentation that specifically says that it takes.

Uh, 3 hours of total processing time through Decontamination just to get out to the clean sun, right? If that were in the IFU.

Then we know that we cannot short circuit that, and the answer, can we get this tray back in 30 minutes is always going to be no.

Frontline thrill processing technicians know better than anyone else.

Do we have the adequate tools that we need to meet the expectation of quality, that assumed safety that patients have as they walk into our facilities? Do we have the right cleaning tools? How many times have you walked into your Decontamination area?

Suited up into your PPE, got started skating case cards, and you put your first instrument into your sink and reach for your brush.

And you realize the brush is not there, or if there is a brush there, it is not the right diameter, and if it is the right diameter, it is not the right length. This scenario plays itself out again and again and again and again in in hospitals around the country, and that's just talking about brushes. So many of us are being forced to.

Compliantly process, we're being told to compliantly process, and yet we're not even being given the tools that we need to do so effectively. The same thing is true for inspection tools. How are we supposed to see everything that we need to see on our instrumentation if we're not being given proper inspection tools such as microscopes or boroscopes to look inside of these devices.

Right, so we're supposed to clean something on the inside that we can't see, likely with brushes that are not quite the right length, they're not quite the right diameter, and then we're supposed to put our name on it and confirm that yes, indeed it is.

It has met the quality standards that you expect, and yet I cannot confirm that because I do not have a boroscope or I do not have a microscope to look on these micro devices and tell you for sure that those forceps on those eye instruments are straight and that they're clean. We know those challenges for those of you who are in facilities.

Who do not have these tools, you can speak to those challenges. Same thing is true for testing tools. Do you have testing kits at each one of your processing tables that have the material to test your scissors on or to test the sharpness of runjours? And if you do have those testing kits, are you being given time?

To test your devices, have you been given training on how to test your devices, and is there an expectation from department leaders that you do test? Or let's talk about transport tools. Are you being asked to transport devices with case cards or open cards that are not compliant to industry guidelines and standards?

Perhaps they're rusted out at the bottom. Perhaps they don't lock when they should lock. Perhaps the bags to cover your carts are not quite long enough to cover that bottom shelf. You know, those little things as it pertains to transportation when no one else does. Are we compliant on our temperature and humidity?

In sterile storage, do we have enough room? Now many of y'all are probably sitting there thinking, who has enough room? This is important. If a hospital wants to be operational, if they want to support the volume of surgeries that they do, and I don't know many hospitals that are turning down surgical volume right now, but if they want to support a growing surgical volume.

But not invest the time and resources to have a sterile storage area that is compliant and of the right size so that we're not cramming pill packs into limited bin space, so we're not cramming wrapped items into limited shelving space.

All of these things are important and only Sterile Processing technicians can really speak to the level of compromise in these areas, such as in sterile storage ergonomics.

Love this topic. Are you thinking more about how much your feet hurt or how sore your back is or how sore your neck is? Are you thinking more about those things in that pair of forceps that's in front of you? If so, then your facility has failed you as a Sterile Processing technician. If you don't have anti-fatigue mats at all of your areas, if you don't have adjustable sinks and adjustable.

Assembly workstations, if you don't have those basic ergonomic tools to make it as easy and safe as possible for you to do the right thing that can and does compromise the final quality product that you can put out. We don't want technicians thinking about how much it hurts to work instead of thinking about the work that's actually in front of them.

That is an area that is very, very important information that we need to bring to light. Speaking of light, right, we need light to do our jobs, and the older we get, the more light we need. There's a helpful little graph in AME ST 79 that outlines.

This and the amount of lighting that's necessary depending on our age and depending on the area of processing in our departments, you need a lot of light in the Decontamination stage to safely and adequately clean those devices inside of those dark sinks.

With chemical coloring in the sink, you don't want to stick yourself, but you also want to adequately see all the visible bottle burden that you can to clean it.

Same is true in the assembly area. How are we expecting our technicians to properly clean in the shadows? If you haven't done it recently, take a stroll around your department in the prep and pack area in the assembly area and take a look at how dark your tables are and if they're dark.

You owe it to your technicians to get some ancillary lighting in, and that's not just a preference, that's coming out of industry standards. Staff training and competency is another one of these issues that frontline.

Personnel have a particular angle on and perspective on that's very, very important, critical information to the quality outcome of everything that we're doing in Sterile Processing.

So.

We know if and when the onboarding process is not up to snuff.

Is your onboarding process come in, get your badge, and within a week you're on the floor by yourself doing work? Are we releasing people off of orientation after just a couple of weeks or maybe even a month?

Are we compromising in those scenarios because perhaps just to the point of one of the previous slides, we're short on staff, so we hire these new people, we don't have enough preceptors and we don't have enough time to give them a full training session, whatever that may be, and so we're short circuiting these onboardings or perhaps the onboarding program is just not sufficient.

Maybe you don't cover all of the points and all the training that you should in your onboarding package. Maybe it's more of.

This is how you find your way to the cafeteria. This is where your locker is, and this is what time you need to be here every day, and that's what we call onboarding, when in fact this person has never done Sterile Processing before in their life, and they've got a lot of remaining questions. As frontline Sterile Processing technicians, we know.

If there's issues as it relates to staff training, the same thing is true again about the different equipment or the Technology perhaps that we're using. If we're throwing people, even if they are experienced people in our department, so let's say they've been working there for 5 or 10 years, but.

It's only Miss Mary that runs the autoclaves, or it's only Johnny that checks in vendors in the vendor tracking system, and you know, Johnny's the only one who knows how to do that. So when Johnny's off, anybody else checking in vendors, it's likely that they're gonna miss a step or they're not going to do it, uh, correctly. Or when Susie takes her PTO the one time in 5 years.

And Susie is the only one that QAs all the biological indicator logs, and when Susie comes back, she's spending two weeks trying to clean up all the errors and issues in the biological indicator testing. Those are areas of real risk.

And that's real information that's important to share through this process of growing information out of the frontline technician and up through the chain of command that we'll talk about here in a minute. Are there issues with our annual competencies? Are we doing them at all? And if we are doing them, are they actually encompassing all that is involved in our departments, or are they really just uh check a box and get joint commission off our back?

But it's not necessarily measuring true competency. Can everyone on the team do everything in the department all by themselves? That's the question that we know the answer to. Are we getting certified as a team? Are we involved in Continuing education as a department and as frontline professionals? How are we balancing?

New products and equipment coming in and the competency and training that's required to support those. I'll give you a great example of this.

How many times do you walk in as a Sterile Processing tech, and you do the daily huddle, and there's someone in front of you holding up a device that you've never seen before and they say, OK guys, we started using this device today. It's in the OR 12 right now and it's gonna be coming down to decontam tonight, and this is how you process it and this is where it's gonna live.

I have a feeling many of y'all out there have been through that experience, and that's not the way that we should Approach new products and new Technology. There's a lot of training that should happen ahead of time. There's a lot of policies and procedures that should be created around these devices, not just dropped in the workflow the day of or perhaps the day after they've already been used.

So we know again.

If these kinds of things are going on and we know the impact that that can have on the quality outcome. Then finally, travelers, this is a big topic and it's a big topic for the joint commission as well.

A couple of years ago in the state of California, there was a hospital that was cited by the Joint commission because they had not verified the competency of travelers that were working in their department. Its facility had contracted for travelers to help them with their staffing issues. The travelers had come in.

They were released to be working in the department and the joint commission came in and said, uh, uh, uh, anyone who's in your department needs documented competencies for your department to make sure that they know how to use your equipment, and they're aware of your policies and procedures and that they're, and that they're compliantly following those. And again, this hospital in Colorado.

Was cited for that because they did not have those things in place. So this is an important part. Nothing against travelers. There's a lot of great travelers out there, but just because someone is a traveler does not mean that they know everything that they need to know about any department that they step into.

Uh, to compliantly and with high quality process instruments in that facility. So it's very important to keep a pulse on that. And if you see travelers, um, struggling in areas of quality to take that information and to do something with it. Appropriate Technology, so.

I get questions about this all the time and it's a very important piece of this webinar. Do our facilities have things such as instrument tracking, the latest biological indicator monitoring systems, do we have updated processing equipment? Are we using any type of residual protein testing? Do we have those boroscopes that I mentioned earlier? Are we tracking vendor trays in a high-tech manner, you know, directly from the surgeon?

Request from the tray delivery through the whole process back up to Surgery. These are the types of technologies that can really have a dramatic impact on quality or if we don't have them likewise can have a negative impact on our quality if we're trying to do all these things manually and the process is just not working. So at the end of the day.

We know as Sterile Processing professionals, are our instruments safe.

The question though coming out of this webinar that I want you to be able to answer is what do we do with that information. If we know that the answer to this question is no, our instruments are not safe or they're not safe every day or they're not safe every shift, what do we do about it? How do we help inform

These surgical patients so that they can make informed choices about their procedures, because if your instruments are not safe, the question that they may want to answer is, do I want to have my Surgery there? So what do you do as a Sterile Processing professional.

With this information that you have, no one else has. First and foremost, you need to go through your internal hospital channels. I don't want you to walk away from this webinar and think, oh my goodness, I see everything that's going on in our department and there's so many areas of compromise and there's so many quality issues. I've got to call Fox News. I've got to call CNN. I've got

We call uh investigative reporter, right? That should not be the first step. You owe it to your facility, to your department supervisors and managers to your C-suite to go through the official chain of command.

In your hospital, go to your supervisor first and make sure that they're aware of the specific issue of concern that you have. Go to your manager. Outside of that, there's Other chains of command that you can address. And again, start with your department first. But if you get no response or even in those conversations, if your leader tells you.

To go speak to Other folks in the hospital about these situations, then you can, you can go to people like your Infection prevention and control team, and you can talk to those nurses there and you can share your concerns about the practice or the policy that you have specific questions about or that you think are negatively impacting the quality outcome of your instruments.

I would say 99% of hospitals have some kind of quality and risk department. If they don't have a whole department, they're gonna have a quality and risk person. And if you don't know them, it's easy to track them down, ask your Infection prevention nurse, and they typically work very close hand in hand with your quality and risk professional, but this is a person again, who can give you a lot of support.

In taking the next step for what to do with these issues that you have concerns with. You can also do things such as create work groups and root cause analysis meetings around specific issues that may have happened that cause quality concern. I would address them as a department in department staff meetings and even potentially create process improvement projects around something like if.

If you know that you get pressure every Tuesday on your heavy orthopedic days and you know you don't have enough drills, start talking as a team and perhaps get one of these projects together and say, OK, let's brainstorm together for how we can support this Tuesday high volume orthopedic instrumentation and drills and get a game plan in place.

For either borrowing drills from Other facilities, getting loaners in from the manufacturers, putting in a capital request next year for additional drills and gathering data to make that case to your C-suite. There's a lot of things that you can and should be doing first and foremost internal to your hospital.

To share this information with the people who can help you make the changes necessary from information to understanding, how do these risks impact a patient's surgical safety and what have we done or can we do to remove this risk.

So if you're seeing dirty instruments come through every 2nd shift, that's not necessarily something that you walk outside the doors of the hospital and you just start telling patients in public, right? hey guys, just so you know, our 2nd shift is not very good at Decontamination, right? That's a, that's not the, the um step to take, right? Because his final question on here is probably the most important one on this line.

Is how can we communicate this information that we have in a way that informs but does not unduly frighten the public in general and our patients in particular. So how do we share this information in a way that gives them the information they need to understand.

But again doesn't frighten them or or scare them away from surgical procedures in general. I think it's important to work together to create greater public awareness and of course inform patients through that awareness. What does this look like? It could be things such as a Sterile Processing open house in the hallway of your hospital, in the cafeteria to set up a table.

And just talk about who Sterile Processing is, what you do, why it's important, the challenges inherent in the industry, and the things that your department has to make it easier, maybe highlight some of the inspection Technology that you have or maybe talk about the new construction and how it's going to

Help your team better serve surgical patients, but do that with a public facing conversation in your facility again in the cafeteria, in the hallway, have that open house. In addition to that, you can have informational events, maybe even outside of the hospital setting, perhaps with your local Sterile Processing.

Group or chapter that you can set up an informational event at the mall and it's a booth and you're having the same conversation. Hey, did you know that there is such a job as Sterile Processing, and do you know what we do and how important what we do is to your safe Surgery? Likely you're going to run into a lot of people who have never even heard of.

Us have no idea what we do, but they're gonna walk away after that conversation, knowing how valuable our jobs are and then growing that awareness in the public of our industry. And no surprise here, I'm a big fan of podcasts and videos and articles.

All of the new tools that Social Media has given us to get our message out very quickly and very creatively into the masses. Now, this does require a level of uh strategy. How do we have a conversation that's going to be engaging and interesting to someone in the public.

who's not in our industry, who's not going to be in our industry, but could be interested in learning more about the impact of our roles, and I think a recent example of this that just did a terrific job is a gentleman who has done some Research on the sterilization of implants and the single-use.

Are the single package sterilization. So instead of these screws and plates coming into the caddies, these devices are coming in single sterilized and packaged, and he's been on the evening news on a couple of different networks talking about the impact that this has for surgical patients and for safety. But those are the kinds of conversations outward facing in the public that's going to help create this public awareness to increase understanding.

So that we can move these patients from information understanding onto agreement so that they agree.

What Sterile Processing does matters and therefore because it matters, the hospital that I go to should have a high functioning, high quality Sterile Processing team. We want our patients to make decisions based on safer Sterile Processing departments in the same way that they're looking for a high quality surgeon and a great reputation hospital.

The dream state, the end goal is for patients to look for hospitals that have a well-known Sterile Processing department. We want the billboard outside of our hospital to say top 10 Sterile Processing department in the country or Healthcare purchasing news Department of the Year. Like that's the kind of outward facing.

Public type of Marketing that would be great for our industry to connect patient awareness Informed Consent if they're coming to this hospital, knowing and not assuming.

Their Surgery is going to be safe because our sterile department is so high quality. It would be awesome to move our industry and our patients to the point that they're requesting particular types of reprocessing based on their knowledge of the industry. So for instance, the same way that they're asking for robotic procedures now for their providers and just because they ask don't mean that they get.

Right, but that is the type of Marketing that has happened. So a lot of patients say, well, I want the robot because that means a quicker recovery time. That means smaller incisions in the same way to have patients so informed that they're asking for specific things like I want a terminal scope for my procedure. I want a single use scope for my procedure.

That's the level of comfort with information in our industry that we want from patients ultimately. Another thing that will help get us there are things such as department level certification, in addition to technician certification to be able to share that information with the patient, with the community around us, to say our department here holds a department levell certification that like only a handful of departments in the whole country have.

That puts us apart, and this is the reason why, as we said at the beginning.

Our role in Informed Consent is different. This is not the type of Informed Consent that we need the patient to understand and say, yes, I still want my procedure. This is the type of Informed Consent that really informs them.

Not about all the legal aspects of their Surgery, but it informs them of the most intimate parts of their Surgery, the instruments that are going to be touching their hearts, the instruments that are going to be cutting into and dissecting their brain or inserting the aneurysm clip.

That's the type of information that Sterile Processing professionals can help share and inform so that those informed choices that our patients make are truly informed that we move them to a true form of Informed Consent.

It involves what we do as an industry and values what we do as an industry. As I said at the beginning, as we've showed through this weapon arm, we know more, way more than any patient ever will about their Surgery, and we owe it to them as Sterile Processing professionals to share that information. Our patients expect a safe Surgery.

So let's continue working toward making this an informed reality by fighting dirty every instrument every time. I want to thank you so much for participating in this webinar. I hope it encourages you to take that information that you see on the front lines and do something with it, not only.

Change your department and get those things fixed that are falling short on quality, but also change the perspective of the public and the patients around you for who we are as an industry and our value to safe surgical care. Keep fighting dirty. We'll see you again next time.