Finding Common Ground

The operating room (OR) calls the sterile processing department (SPD) and says, Where is the doctors ortho tray? The SPD replies, We sent it up in the case cart. The OR then says, We cant find it, no you didnt. The SPD insists, Well, its up there, we just sent it up, look for it.

How many times has this dialogue occurred between the OR and SPD at your hospital? The OR is angry, running and frustrated. The SPD is angry, running and frustrated. The question is, if both departments are trying to accomplish the same thing for the same purpose, why cant we all get along? Many common issues within both departments are failure to communicate, failure to prioritize, failure to take ownership and failure to become educated. Both departments feel the need to always be right. Placing the blame is much easier than taking ownership. For starters, a tray is lost in the OR, instruments are not sent back to the SPD, cases are delayed, and whos really to blame? Is it the people? Is it the process?

Too often processes have been cast in stone. People will remark, Its always done that way. Or weve done it like this for the past 40 years. My answer to that remark is you can either be an active participant as a change agent, or you can continue to run, be angry, and place blame and waste valuable time. I love the saying, If you are not part of the solution, you are part of the problem. Lets discuss some solutions for some of these issues.

It is very important for both departments to have monthly inservices. Incorporating these in-services by combining both areas may open the lines of communication. This gives opportunities to discuss the certain levels of frustration and why certain issues arise. This is a great time for compromise. You can finally place the face to the name on the other end of the phone you know, the one you always scream at. Know who your colleagues are. You are in the same institution for the very same reason, the patient. To facilitate this dialogue, the Association of periOperative Nurses (AORN) has a position statement on patient safety. Maybe calling down to the SPD after a case will help in the OR turn-over process. Not opening trays unnecessarily is another step. Perhaps set a par level of certain instruments to be peel-pouched. Many repair vendors specifically color-code dip these instruments a certain color which dictates peel-pouching only. Lines of communication should flow effectively up and down and throughout the organization. Proper telephone etiquette should be utilized at all times; dont scream at the person on the other end of the line. It wont help you; it will only hinder the process. Perhaps have one head-set phone designated for the OR. This will help alleviate the issue of the OR calling and SPD not answering fast enough.

Having the SPD manager work closely with the OR manager and the OR nurses is also important. Discuss each departments priorities the day before the scheduled surgeries. What needs to be turned over quickly? How many Stryker camera heads will be needed? How many trays are actually on hand in the SPD? This will help with the turn-over process as well, insuring that doctors will have what they need. This will also help eliminate flash sterilization. The SPD needs to communicate to the OR any issues with the sterilizers, washers, instruments or other needed items. If a tray will not be ready, call the OR and tell them why. Offer a solution to the issue. The patient trusts your facility for the very best services, and they pay for it dearly, possibly with their life. You are the patients advocate. Are the instruments sharp enough, is the count sheet accurate, do we need to add or remove items from a specific tray? These issues can and should be communicated, perhaps at the meetings. Communication needs to be done daily. Perhaps get a logbook, even a communication book so important information can be documented and left for the next shift.

Another issue in many institutions is the ORs lack of knowledge and education within the SPD department and vice versa. They are not techs in SPD, so many do not realize how the turn-over process really does work. The SPD is responsible for more than cleaning instruments; it is responsible for case carts, par levels, supply carts, decontamination, assembling, sterilization, equipment plus many other tasks. Although the OR is the primary customer, the SPD must provide services for all end users. Suggesting that the OR techs and nurses spend time in the SPD may help the OR to better understand the functions of the SPD and how the flow works. They need to understand the correct terminology of instruments names, how sterilization works and the amount of time it actually takes to re-process one tray. Perhaps invite surgeons to the SPD for a tour; this can be the perfect opportunity for a mini in-service.

A guarantee of quality in reprocessing is essential to achieve a great product and service. Proper sterilization of all patient-care equipment and devices cannot be substituted. SPD techs should spend a few hours daily in the OR, which can be very beneficial for both units. The SPD tech can better understand the OR processes, realizing that the fast-paced OR faces time pressures and constraints they may be short staffed, they are fatigued and they must multitask. Both departments are under a significant amount of stress, however, trust, communication, prioritization and teamwork will alleviate these common issues.

Misplaced trays and supplies in the OR can be easily tracked, either manually or through a computer-based tracking system. Some facilities utilize a manual OR elevator log sheet, in which all items sent to the OR are documented with the date, time, doctor and case number. OR professionals should be encouraged to document on a log sheet of their own, when they receive the item. If there are any discrepancies, share the information with their colleagues in the SPD. Although the process can be time-consuming, it all works out in the long run. This is where ownership comes in; OR staff should take the initiative to help make things flow effectively. Making statements such as, Im too busy and I dont have time is not acceptable and should be addressed immediately. We must make time, as we are patients advocates. We are responsible for ensuring that we have the necessary resources for good patient outcomes. Both departments must trust each other. A hands-on OR and SPD manager is likely to be a much more effective manager. Many times, the manager only hears of issues when it is out of the employees control. This can be avoided with continued communication and teamwork. Both departments need to realize that they go hand in hand. Its like a finely tuned car; you cant drive your car without the gasoline. The bottom line is that the OR is the car and the SPD is the fuel that keeps the OR running. 

Kristina Pirollo, CRCST, is director of central sterile services and OR materials management at Trinitas Hospital in Elizabeth, N.J.