By Kathy Dix
Defining what education is necessary for operating room (OR)staff is a more difficult task than determining what is necessary for thesterile processing department (SPD). The SPD has one defined task tosterilize 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 ofeducation 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 themain deficits in OR staff education is limited knowledge in sterilization.
The deficits are continuing education in the growing fieldof technology, sterilization requirements and resistant organisms, she says.The focus in orientation of OR personnel during orientation is becomingfamiliar with the surgical procedure and instrumentation. The expectation isthat sterilization and aseptic practices and technique are taught during theeducation experience. The knowledge bases that perioperative staff RNs and techsneed are about surgical procedures, anatomy, physiology, what to plan for andwhat to anticipate. This knowledge assists the RN in performing her assessment ofthe surgical patient and identifying a plan of care. What they dont know arethe specific sterilization modalities and the parameters that SPD uses tomonitor sterilization along with the manufacturers recommendation for the sterilization of anydevice or instrument. More knowledge and confidence in the area of sterilizationfor the perioperative staff would be helpful in questioning and challenging thesterilization modalities available for use. Over time, this is improving withthe evolution of alternatives for gas sterilization.
Trattler adds, Most perioperative staff has greatconfidence in SPDs producing a sterile item for the procedure. The importantissue 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 theSPD can obtain the manufacturers recommendation for sterilization to meet theexpectations of the OR in using the new instrument or set. The other area whereI would say OR staff needs more education is microorganisms and the growingconcern 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 videopresentations, 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 annualmandatory education requirements. The staff can access Health Stream on acomputer 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 thestaff 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 newprograms like robotics, which require a different approach and orientation tothe surgical field.
Vendors often offer off-site workshops for continuingeducation credit for nurses and other staff members who have certificationrequirements to fulfill. The nursing division and hospital system schedulemany inservices and programs with continuing education credits, free of charge,to assist the staff in obtaining CEUs to satisfy certification requirements. Wesupport and encourage staff to attend conferences and seminars throughout theyear, she says.
Linda Clement, BSM, CRCST, consulting service manager atSTERIS and Mike Russell, RN, BSN, MSN, clinical education specialist, weighed inon the offerings available from vendors.
When asked about deficits in current knowledge among ORpractitioners, Russell replies, Industry recommended practice standards forORs and SPDs, such as those from the Association for the Advancement of MedicalInstrumentation (AAMI) and the Association of periOperative Registered Nurses(AORN), are not often directly available to OR and SPD staff, nor are theyconsistently used in many facilities.
If they are available, there appears to be a disconnectbetween written policies and procedures and real-world practice. These are thebasics of good work practices, and yet OR and SPD staffs are often notwell-versed in these guidelines and recommended practices because the facilitiesare shortstaffed and daily work volumes dont leave much time for schedulingadequate education programs, or because budget constraints often take their tollon available funding for education.
Education should be tailored to the size, topic and needs ofthe group, says Clement. Not all programs must be instructor-led in a classroom, forexample. They can consist of CD programs, video programs, or a series ofself-study modules that comprise a complete education program. Games based ontelevision game shows may be used that are geared toward healthcare-relatedtopics. There is no one-size-fits-all approach to providing effectiveeducation 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, calledbrown bag luncheons, are very effective, Russell points out. I alsosee a growth in professional organization memberships, which can provide aneconomical means to obtain valuable perspectives on clinical topics and a usefulavenue for professional networking. Small group sessions are still the mosteffective way to provide detailed information, especially when assessing staffcompetencies regarding the operation of specific equipment.
STERIS has developed several new presentations available asregional one-day seminars. By providing regional seminars, we are able to takeeducation programs closer to our customers, to make education more accessibleand help reduce program and travel costs for attendees, Russell says. STERISalso sponsors Webcast educational events with timely presentations byresearchers and other experts. These Webcasts are convenient for staff to access, and theWebcast remains available for a period of time for ongoing review byparticipants and new visitors. A recent Webcast, for example, discussed currentresearch and data about a new patient-empowering hand hygiene compliance programfrom the University of Pennsylvania called Partners in Your CareSM. This Webcastdrew over 800 participants. (For more information about the program, visitwww.med.upenn.edu/mcguckin/handwashing.)
STERIS offers courses relevant tocurrent issues in healthcare, including infection prevention, hepatitis,Creutzfeldt-Jakob disease (CJD), and antimicrobial resistance. We alsobelieve in providing education for educators both our STERIS educators andour customers educators, adds Russell. Webcasts are a great means ofdisseminating information to large numbers of people. The Association forProfessionals in Infection Control and Epidemiology (APIC) recently offered aWebcast on MRSA, and the American Society for Healthcare Central ServiceProfessionals (ASHCSP) is offering an education session addressing the impact ofbioterrorism on the hospital (including a roundtable session addressing CJD)during the upcoming fall seminar. AORN is also active in providing education regarding currentissues with resistant organisms in their international, national, and localchapter education meetings, with such topics as combating bioterrorism, emerginginfectious diseases, and hepatitis.
Education which is essential to meet their membershiprequirements is also a priority for industry associations. Adverse events,for example, have been an essential topic for the Joint Commission onAccreditation 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 onorganizational 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 newapproaches that would improve patient safety, says Berta. JCAHO hasupdated accreditation requirements, emphasizing organizational responsibilitiesfor patient safety. JCAHO sets patient safety-related accreditation standardsfor its members around medication use, infection control, surgery andanesthesia, transfusions, restraint and seclusion, staffing and staffcompetence, fire safety, medical equipment, emergency management, and security.In July 2001, additional JCAHO patient-safety standards went into effect forhospitals. These standards address a number of significant patient-safetyissues, including the responsibility of organization leadership to create aculture of safety; the implementation of patient-safety programs; the responseto adverse events when they occur; the prevention of accidental harm through theprospective analysis and re-design of vulnerable patient systems (e.g., theordering, preparation and dispensing of medications); and the hospitalsresponsibility to tell a patient about the outcomes of the care provided to thepatient whether good or bad.
Meeting or exceeding these standards makes education anecessity, motivating hospitals to train their staff members, and maintain thoseemployees competencies for the unannounced surveys JCAHO now performs.
Other associations have also become involved in requiringcompetency for adverse events, Berta says.
She explains that Leapfrog Group, founded by a nationalassociation of Fortune 500 companies who constitute some of the larger employersand healthcare purchasers in the U.S., has identified three practices thathospitals must employ in order to qualify them to provide care for its membersemployees:
Berta also says that the Agency for Healthcare Research andQuality (AHRQ) has published a review of 79 practices that reduce the risk ofadverse events in patient care.