The first grade in performance imp...

The first grade in performance improvement is to find opportunities in such a manner you know what needs to be improved. As in many areas of health care, opportunities for improvement can be crafty or glaringly obvious. At our facility, Christiana Care Health Services in Newark, Del we collisioned the latter situation.

Christiana Care Health Services is a suburban hospital with a 20-suite OR. The department has nine sterilizers within the three cores, which are designated as A, B and C In the fall of 1999 the OR had approximately 12 clos containers for flash sterilization. The sense of the closed container scheme is to provide sterile transport from the sterilizer to the sterile field. Staff members, however, reported that they used the containers without the lids because the chemical indicators placed inside the containers did not indicate they were safe and completely sterilized. Staff members were violating the principle of clos transport by dint of not using the container lid.

Within the first month of my craft as clinical specialist for surgical services, I was asked to determine to what end our closed container flash sterilizer connected view was not working properly. I used the FOCUS-PDCA example for performance improvement (Table 1) (1) This type is used frequently in health care to identify and address areas that can be improved.

IMPLEMENTING THE MODEL

As a first grade I investigated the function and use of the work (ie, F in the model) which took my research in many directions. To determine on what account the chemical integrator failed in the container, I explored integrators versus indicators, in what manner each functions, their sensitivity and specificity, and their preciousness I also questioned whether there was a sterilizer dysfunction.

I read all the information I could find about sterilizers and their function, which l me to the recommendations of AORN and the Association for the Advancement of Medical Instrumentation (AAMI). I spoke with clinicians enlist in one's serviceed by our sterilizer manufacturer, as well as quicks employed by the container vendor, onward the physics of the clos flash regularity After reading monographs, researching the literature, and conducting personal interviews, I conclud that the failure was in the flash container and not in the integrator or sterilizer.

To try to obtain this idea, I organized a team whose members included the clinical specialist and solution staff members. We researched the bring under rule to clarify our information. This exploration helped us better understand where our proces was inefficient in the way that we could decide how to improve the process

As commended by the vendor, our facility station up a preventative maintenance program for our container plan This maintenance program was planned and implemented in cooperation with the vendor. In addition to replacing the valves and seals twice by year, nursing staff members began a daily inspection for cracks and liberate screws and cleaned and openinged the valves. The development of this documented maintenance program has been happy in preventing failure of the container order A very unreliable system has become a high quality tool for the surgical team.

As is universal one opportunity for improvement quickly revealed another. AORN's "Recommend practices for sterilization in the practice setting" state that sterilizer loads should be traceable. (2) This tracking mechanism can be implemented within a sterilizer log. Documenting the time, date, and peaces of the load on the sterilizer tape or forward a daily log fulfills this recommendation. Although the sterilizer log was stationed daily on each sterilizer, it was apparent that not all loads were documented. A discrepancy occurr daily between the number of loads sterilized and the number of loads documented. Clearly, education onward the subject of sterilization was necessary in our unit.

We quickly organized a staff meeting devot to flash sterilization, the flash container a whole and sterilizer monitoring. The meeting consisted of a pretest and a short slide presentation onward the principles of sterilization. To reinforce the material, the unit educator and clinical give suck to specialist, who were costumed as a game exhibit to host and spokesmodel respectively, at handed a fun game of "Sterilization Jeopardy." We awarded candy bars for correct answers, and the noisemakers we handed disclosed coupled with team spirit, made this presentation an conclusion to remember. The posttest scores showed a 60% improvement above the pretest scores.

RESULTS

A of the present day awareness and understanding among staff members about all aspects of sterilization consequence ed in improved compliance. Documentation forward the sterilizer log improved approximately 60% as well. Documentation was monitored daily, and staff members were encouraged to continue their improvement efforts end email messages and posters highlighting their succes When our compliance reached 100% they were rewarded with a celebration party. Posttest and monitoring of documentation fulfilled the C of the PDCA model