Educating OR Staff

September 1, 2005

Educating OR Staff

By Kathy Dix

Defining what education is necessary for operating room (OR)
staff is a more difficult task than determining what is necessary for the
sterile processing department (SPD). The SPD has one defined task to
sterilize and disinfect instruments and trays to make them suitable for use.
However, the OR staff have a wider range of duties and thus a greater range of
education needs.

Barbara Trattler, RN, NPA, CNOR, CAN,
administrative director of perioperative services at Monmouth Medical Center,
Long Branch, N.J., part of the St. Barnabas Healthcare System, believes that the
main deficits in OR staff education is limited knowledge in sterilization.

The deficits are continuing education in the growing field
of technology, sterilization requirements and resistant organisms, she says.
The focus in orientation of OR personnel during orientation is becoming
familiar with the surgical procedure and instrumentation. The expectation is
that sterilization and aseptic practices and technique are taught during the
education experience. The knowledge bases that perioperative staff RNs and techs
need are about surgical procedures, anatomy, physiology, what to plan for and
what to anticipate. This knowledge assists the RN in performing her assessment of
the surgical patient and identifying a plan of care. What they dont know are
the specific sterilization modalities and the parameters that SPD uses to
monitor sterilization along with the manufacturers recommendation for the sterilization of any
device or instrument. More knowledge and confidence in the area of sterilization
for the perioperative staff would be helpful in questioning and challenging the
sterilization modalities available for use. Over time, this is improving with
the evolution of alternatives for gas sterilization.

Trattler adds, Most perioperative staff has great
confidence in SPDs producing a sterile item for the procedure. The important
issue for both the OR and SPD is that they keep the lines of communication open.
It is imperative that the OR inform SPD when new equipment is purchased so the
SPD can obtain the manufacturers recommendation for sterilization to meet the
expectations of the OR in using the new instrument or set. The other area where
I would say OR staff needs more education is microorganisms and the growing
concern about antibiotic resistant organisms.

Old-fashioned video is still good for a large inservice,
Trattler says when asked how to educate OR staff. The staff enjoys video
presentations, and they are easy to do during a typical OR inservice period,
Trattler explains. The Web is also available for selected training modules,
particularly related to automation in the OR with supplies and documentation. We use Health Stream, which is helpful in fulfilling annual
mandatory education requirements. The staff can access Health Stream on a
computer and complete the required education online.

However, nothing can substitute for hands-on experience. Often,
the vendor will offer this level of education through a skills lab in which the
staff can learn how to assemble new technology and how it is used, she adds.
This is extremely valuable for the staff to do prior to beginning new
programs like robotics, which require a different approach and orientation to
the surgical field.

Vendors often offer off-site workshops for continuing
education credit for nurses and other staff members who have certification
requirements to fulfill. The nursing division and hospital system schedule
many inservices and programs with continuing education credits, free of charge,
to assist the staff in obtaining CEUs to satisfy certification requirements. We
support and encourage staff to attend conferences and seminars throughout the
year, she says.

Linda Clement, BSM, CRCST, consulting service manager at
STERIS and Mike Russell, RN, BSN, MSN, clinical education specialist, weighed in
on the offerings available from vendors.

When asked about deficits in current knowledge among OR
practitioners, Russell replies, Industry recommended practice standards for
ORs and SPDs, such as those from the Association for the Advancement of Medical
Instrumentation (AAMI) and the Association of periOperative Registered Nurses
(AORN), are not often directly available to OR and SPD staff, nor are they
consistently used in many facilities.

If they are available, there appears to be a disconnect
between written policies and procedures and real-world practice. These are the
basics of good work practices, and yet OR and SPD staffs are often not
well-versed in these guidelines and recommended practices because the facilities
are shortstaffed and daily work volumes dont leave much time for scheduling
adequate education programs, or because budget constraints often take their toll
on available funding for education.

Education should be tailored to the size, topic and needs of
the group, says Clement. Not all programs must be instructor-led in a classroom, for
example. They can consist of CD programs, video programs, or a series of
self-study modules that comprise a complete education program. Games based on
television game shows may be used that are geared toward healthcare-related
topics. There is no one-size-fits-all approach to providing effective
education programs to healthcare professionals.

Some newer means of education include online offerings,
conferences, workshops and inservices. However, time is of the essence. Teleconferences, especially over the lunch period, called
brown bag luncheons, are very effective, Russell points out. I also
see a growth in professional organization memberships, which can provide an
economical means to obtain valuable perspectives on clinical topics and a useful
avenue for professional networking. Small group sessions are still the most
effective way to provide detailed information, especially when assessing staff
competencies regarding the operation of specific equipment.

STERIS has developed several new presentations available as
regional one-day seminars. By providing regional seminars, we are able to take
education programs closer to our customers, to make education more accessible
and help reduce program and travel costs for attendees, Russell says. STERIS
also sponsors Webcast educational events with timely presentations by
researchers and other experts. These Webcasts are convenient for staff to access, and the
Webcast remains available for a period of time for ongoing review by
participants and new visitors. A recent Webcast, for example, discussed current
research and data about a new patient-empowering hand hygiene compliance program
from the University of Pennsylvania called Partners in Your CareSM. This Webcast
drew over 800 participants. (For more information about the program, visit

STERIS offers courses relevant to
current issues in healthcare, including infection prevention, hepatitis,
Creutzfeldt-Jakob disease (CJD), and antimicrobial resistance. We also
believe in providing education for educators both our STERIS educators and
our customers educators, adds Russell. Webcasts are a great means of
disseminating information to large numbers of people. The Association for
Professionals in Infection Control and Epidemiology (APIC) recently offered a
Webcast on MRSA, and the American Society for Healthcare Central Service
Professionals (ASHCSP) is offering an education session addressing the impact of
bioterrorism on the hospital (including a roundtable session addressing CJD)
during the upcoming fall seminar. AORN is also active in providing education regarding current
issues with resistant organisms in their international, national, and local
chapter education meetings, with such topics as combating bioterrorism, emerging
infectious diseases, and hepatitis.

Education which is essential to meet their membership
requirements is also a priority for industry associations. Adverse events,
for example, have been an essential topic for the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO).

Whitney Berta, PhD, is a member of the faculty of medicine,
University of Toronto and a consulting staff member for Leading and Learning,
Inc., a management consulting firm that works with executives and staff on
organizational change, leadership, and personal and professional effectiveness.

Regulatory agencies and other organizations in the U.S.
have been quick to respond to the gap between current practices and new
approaches that would improve patient safety, says Berta. JCAHO has
updated accreditation requirements, emphasizing organizational responsibilities
for patient safety. JCAHO sets patient safety-related accreditation standards
for its members around medication use, infection control, surgery and
anesthesia, transfusions, restraint and seclusion, staffing and staff
competence, fire safety, medical equipment, emergency management, and security.
In July 2001, additional JCAHO patient-safety standards went into effect for
hospitals. These standards address a number of significant patient-safety
issues, including the responsibility of organization leadership to create a
culture of safety; the implementation of patient-safety programs; the response
to adverse events when they occur; the prevention of accidental harm through the
prospective analysis and re-design of vulnerable patient systems (e.g., the
ordering, preparation and dispensing of medications); and the hospitals
responsibility to tell a patient about the outcomes of the care provided to the
patient whether good or bad.

Meeting or exceeding these standards makes education a
necessity, motivating hospitals to train their staff members, and maintain those
employees competencies for the unannounced surveys JCAHO now performs.

Other associations have also become involved in requiring
competency for adverse events, Berta says.

She explains that Leapfrog Group, founded by a national
association of Fortune 500 companies who constitute some of the larger employers
and healthcare purchasers in the U.S., has identified three practices that
hospitals must employ in order to qualify them to provide care for its members

  1. The adoption of computerized physician order entry (CPOE)
    systems to reduce medication errors
  2. The staffing of intensive care units
    (ICUs) by full time intensivists
  3. Volume standards for five selected high risk
    procedures and neonatal intensive care.

Berta also says that the Agency for Healthcare Research and
Quality (AHRQ) has published a review of 79 practices that reduce the risk of
adverse events in patient care.