This series of self-study lessons on Central Service topics was developed by the International Association of Healthcare Central Service Materiel Management (IAHCSMM). The lessons are administered by Purdue University’s Continuing Education Division.
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Many Central Service professionals have been confronted by physicians who have made unreasonable or impossible requests, such as, “Please process the instrument loaner set within the hour so it will be ready for the next surgical procedure.” Physicians are rightfully concerned about their patients, and they can become easily frustrated when sterile instrumentation and supplies are unavailable for use when needed. The issues that upset customers—including physicians—are often unrelated to Central Service, but personnel in this department often bear the brunt of customer frustrations when surgical procedures are delayed. Therefore, it is essential for physicians to know about the services performed by Central Service personnel, and the time and other limitations which affect their output. They must understand exactly what the Central Service department does and the protocols required to assure that instrumentation is sterilized, case carts are complete, and surgical devices are in proper working order (among numerous other responsibilities). As this occurs, physicians will recognize that Central Service staff are important members of the healthcare team, not obstacles that impede the delivery of critical patient services. This self-study lesson provides information that can help “tell the Central Service story” to physicians.
Physicians must learn (if they do not already know) about the important role of Central Service in the provision of high quality healthcare. They are likely aware of the basic activities required to prepare instrumentation for re-use and, rightfully, expect the correct instruments, in proper working condition, to be consistently available when needed. In fact, the error rate for Central Service products is very commendable in most facilities. Achieving “zero defects” (no errors at any time), however, is very unlikely in a labor-intensive setting such as healthcare in general, and Central Service, in particular. Unfortunately, problems, while rare, do occur, and they frequently arise at the worst possible times.
Most physicians will be more understanding about case delays caused by instrument turnover and other problems when they know how Central Service cleaning and sterilization processes work. Many physicians will begin to schedule cases using realistic time schedules that sequence non-related cases or office time in between cases requiring instruments that have limited availability. The strategy of educating physicians about Central Service challenges is much more effective than explaining reasons for problems after they occur, especially if they could have been prevented in the first place.
Educated physicians will more likely want to be involved in decisions about instrument selection, scheduling, and use than their less-informed counterparts. With their involvement in these decisions, they will have a vested interest in the success of the revised processes that are implemented. Also, when physicians understand instrument processing realities, they can be great allies to Central Service personnel when budgets for additional staff or processing equipment are being developed and evaluated by facility administrators. For example, physicians may support the purchase of additional instrument sets when it is obvious that there is insufficient instrumentation to meet their needs.
Effective Central Service managers invest the time necessary for developing peoples’ skills. They know that quality time is needed to develop the knowledge of their customers—including physicians—as well as the knowledge and skills of their Central Service staff.
As technology has advanced, so have requirements for proper cleaning and sterilization, and the regulations that govern these procedures. Increasingly complex and difficult-to-process instrumentation also increase the difficulty of delivering safe-to-use devices for the surgeons’ use. Many healthcare providers—including those performing surgical procedures—are unaware of the changes that have occurred and how they affect the services provided by Central Service employees.
First, consider the regulations and standards of the U.S. Food and Drug Administration (FDA).1 The FDA has developed a medical device classification system, based upon potential risks to patients, which impacts sterile processing standards. Reporting requirements under the FDA’s Safe Medical Devices Act require the monitoring and reporting of medical device-related serious injuries and deaths. Also, its MedWatch program provides for the voluntary reporting of device-related problems, which allows the FDA to collect information about specific problems so that, after identification, they can be resolved.
These requirements provide examples of ways, perhaps unknown to physicians, that Central Service personnel help to assure that surgical instrumentation will be safe for patient use. Central Service personnel are also affected by FDA regulations for sterilizing single-use items and monitoring processing cycles, which also help assure that physicians have safe instrumentation available for use.
Loaner instrumentation (instruments or sets borrowed from a vendor for emergency or scheduled surgical procedures) provides another example of the efforts undertaken by Central Service staff to assist surgeons with their special needs. Detailed procedures for loaner instrumentation receipt and inventory, decontamination, inspection and assembly, and handling and storage are implemented before items reach surgical suites for physician use.
While physicians certainly know about and demand increasingly complex surgical instrumentation, they may be less aware of the increased difficulty in cleaning, decontaminating, and sterilizing these devices.2 Those who engineer and manufacture surgical instruments are aware that these products will be hazardous if they cannot be sterilized adequately for the surgeons’ use. At the same time, Central Service personnel are challenged as they learn how to proficiently clean, disinfect, and sterilize this new generation of very costly surgical instruments. They are also aware of the need to fulfill their important responsibilities to physicians and their patients, and to their facilities.
Central Service professionals are well aware of the numerous regulatory and processing challenges that affect their work activities. Physicians are less likely, however, to know about or realize the impact of these issues. Communication and education activities undertaken to review these issues can provide a foundation to justify the processing procedures used by Central Service, not to provide excuses for delayed deliveries, or other quality problems. This information should be integral to any physician education programs that are planned.
Prior to developing and implementing a physician education program, it is important that the best possible resources be identified. Fortunately, every healthcare facility has resources that can assist in the education effort. Some are obvious, such as requesting assistance from physicians and operating room staff to determine important issues.
Central Service staff members must have an on-going cooperative relationship with operating room personnel. To do so, they must possess the knowledge and skills required for their jobs, and they must maintain the proper attitude and respect for their co-workers. With open communication and an understanding of different work-related perceptions, Central Service staff can first begin to educate operating room personnel about device processing and the need for advance notice of required instruments. When Central Service personnel are competent, when their efforts are directed toward successful performance, and when available resources are used effectively, they will likely have operating room advocates who can be very helpful in influencing and educating physicians about the Central Service department.3 Operating room personnel are in the room when a surgeon is waiting for an instrument and can share information about what occurs as instruments are being processed.
Personnel in the medical library, medical staff office, risk management, and infection control and prevention departments are also great resources because they interact with physicians regularly, and they often hear complaints that can be addressed successfully in a physician education program. The engineering and biomedical department staff are also a valuable resource because they are frequently called upon to fix equipment (even if it is not broken) or to modify instrumentation. Another resource that often goes unused is the physicians’ dining room staff. This staff may overhear physicians’ conversations and can share information with Central Service personnel. If asked, they may place information on tables and circulate educational flyers. Product vendors will likely know about physicians’ concerns regarding planned education activities and can serve as another valuable resource.
After appropriate personnel have been identified, several tools can be used to help determine the subjects and priorities for inclusion in the educational program. Surveys to more precisely identify training needs can be developed, but it is important to be creative, because physicians will not want to spend time completing a detailed survey. Several surveys over a scheduled time period are usually better than one all-inclusive survey.
Use short questions with directed answers. For example, instead of asking, “Are your instrument trays assembled correctly,” ask if specific instruments, such as osteotome and Kerrison rongeurs, are sharp. Then provide options for answers such as, “sometimes, occasionally, and usually.” Also be creative about how surveys are implemented. It may be more effective to have someone ask the questions rather than to expect a “pen and paper” survey to be completed. Allow for open-ended comments on surveys and remember that need-to-know, not nice-to-know information is best.
Personal contact is also an effective tool to yield helpful information for planning the content of educational activities. This can occur during conversations with physicians at the scrub sink and before or after committee meetings. Remember that brief and to-the- point information gathering is always best.
After content of the training program has been identified, it must be delivered while keeping the target audience (physicians) in mind. Remember that, if the physicians do not participate, they will not learn, and the efforts expended to develop the program will be wasted. Key points to remember when considering how to best implement the program include:
To keep the program focused, list the specific topics to be covered and the reasons you want to teach the topics. Remember the program’s goals (to educate physicians about Central Service) and be creative. While a classroom setting for an hour or so may be ideal, this is not usually practical. Alternatively, you may sometimes want to use simple quizzes of a few questions, or contests and guessing games. Perhaps Central Service can be included as an agenda item in key committee meetings or a “Central Service Update” could be circulated in physicians’ on-site mail boxes.
Remember that the information must be basic, interesting, and informative, but should not be defensive. Warm-up activities can help market the program and heighten the interest of the target audience. Programs that involve the participants as much as possible are generally more successful than programs that do not. Posing questions to begin the educational process and to generate interest can be useful starters; for example: “What percentage of hospital-acquired infections can be traced to improper sterilization? Improper instrument cleaning? Dull instruments?”
Deliver the information in small sections to capture and maintain the physicians’ interest, and to challenge them. For example, when introducing the topic of processing loaner instrumentation, ask how long it takes to correctly process total hip instruments. The answer may surprise the physicians, and it will help them to understand the challenges that may be avoided if surgery schedules are adjusted accordingly.
Plan a variety of approaches to distributing educational information. Consider providing educational information:
Another suggestion is to invite surgeons to visit the Central Service department for a quick walk-through to see what happens as instruments are reprocessed. Staff can create a short “tour book” that explains processing steps, and act as tour guides. Signage on equipment that provides important information, such as washer cycle times, can be helpful. Also, Central Service managers can “invite themselves” to visit surgeons’ meetings to spend a few minutes addressing processing concerns. A handout and brief overview about “A Day in the Life of an Instrument Set” can also be useful. This activity could detail the process that instruments go through from pre-cleaning after one use to their next use. This would involve a discussion about processing steps, storage and transport, and a review of procedures necessary when devices are broken or missing.
Monitoring physician education programs is essential to determine their success and to assist in the development of future programs. One of the best indicators of success is fewer complaints from both operating room staff and physicians. Data should be collected before the start of the program and, using the same methods, at pre-determined intervals after the program is completed. For example, satisfaction surveys and defect count data can be tallied and compared. Measurable feedback on before-and-after conduct of the educational activities can be helpful. Monitoring also identifies which delivery methods are effective and methods that may need modification or replacement.
Today’s busy healthcare schedules require Central Service managers to be creative when developing and implementing physician (and any other) education and training programs. One effective way to educate physicians is to use questions and short PowerPoint programs, and to participate in committee sessions. Several methods may be used in different areas of the facility at the same time. Monitor the program closely to determine if changes are needed. Share educational successes and understand that it is unlikely that one hundred percent of the physicians will participate. Those who do participate, however, will be among the best advocates to help market future educational sessions.
Davis, CMRP, CRCST, CHMMC
Susan Klacik, ACE, CHL, CRCST, FCS
Patti Koncur, CRCST, CHMMC, ACE
Natalie Lind, CRCST, CHL
David Narance, RN, CRCST
Petro, CRCST, RN, BSN