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The grand opening of the new Stafford Hospital Center in Stafford, Va. was held on Feb. 27, 2009. What a great feeling this accomplishment gave everyone involved, as it provided us with a brand-new sterile processing department (SPD).
New sterilizers, new tables, new instruments, and new cart washers, new everything ... but wait -- all of these new things are good but what if the “old” ways follow? What if the same old thought process of “this is the way it’s always been done” follows? No worries, it won’t. This is a new facility, and it gives us the chance to do it the right way from the very start. Typically, managers are hired after the facility has been set up, so how important and how amazing is this for me to have been involved in the process months before we opened. What a once-in-a-lifetime opportunity this was for me to take my experience and apply it to setting up an SPD the correct way from scratch. No chasing tails here at Stafford!
Being in the mindset of “this is how we always do it” never works and will certainly not be practiced in the Stafford SPD. The goal that will be met and kept is to exceed all manufacturers’ recommendations as well as standards of the Association of periOperative Registered Nurses (AORN) and the Association for the Advancement of Medical Instrumentation (AAMI) from the very beginning. The relationship between the SPD, periop and all units will grow and flourish from the beginning. And because the SPD is considered to be perioperative services, this allows all teams to meet in the middle.
The new design is perfect. The SPD is across the hall from the operating room (OR), which makes it extremely convenient to communicate and to be visible to each other. Tours and in-services regarding each other’s departments have moved full-speed ahead. The doctors have walked through this fabulous SPD and they love it. It makes a significant difference having the SPD so close to the OR. Typically, the SPD is located in the basement next to the loading area. How can anyone have a relationship or meet the needs of perioperative services if they are in the basement? How can any type of relationship be formed? Having both areas side by side saves time and money and helps to eliminate confusion. Communications are improved and surgeons can get exactly what they need quickly.
When we talk about exceeding standards, what comes to mind? Patient safety of course, but what about flash sterilization? After all, aren’t we trying to stay away from it? What can we do to reduce and eventually eliminate the need to flash? Options are available; turning options into action plans and following through are the beginning steps.
Let’s discuss certain items that are flashed: forceps, needle holders, scissors and yes, sometimes full trays. What can be done to help eliminate this process? AORN states that flash sterilization should not be used because of a lack of instrumentation. Here are some things to consider:
• Ensure that each facility has more than two of the same tray.
• Do not book back-to-back cases
• Can instruments ordered be used in a processor such as the Sterrad NX for a shorter cycle?
• Can the vendor bring in trays to help facilitate turn-over times?
Here is what Stafford Hospital did:
• We ordered more than two of the same tray
• We do not book back-to-back cases
• We utilize the Sterrad NX for certain items
• We have vendors bring in instrumentation, along with recommendations
For us, the best part of reducing the use of flash sterilization is our great big wall! The wall is constructed of louvered panels and bins. Each bin has its place on the wall. Instruments were ordered, peel-packed and sterilized. These instruments were then placed on a wall and labeled from A to Z. The wall is not only alphabetized but numbered according to instrument. If an Adson is dropped, there is no need to flash... it’s already sterile on the wall located in bin No. 6. If someone can’t locate the item needed, they can refer to our laminated booklet and find the instrument or device grouped in order with the bin number for easier access. Looking for trays? Not a problem. All of our shelves are located by service and are numbered. For example: General cart A-1; Shelf 1: Lapchole, basic lap, pediatric lap; Shelf 2: Hysterectomy, etc. What a great convenience for our personnel, and it eliminates worry in the OR.
The set-up of this new SPD is so finely tuned and organized that everyone who walks in from perioperative services knows exactly where to locate anything they need. Even the surgeons have complimented us on how accessible the items are.
Finally, let’s add a goal that is often overlooked and yet, very attainable: buildings and maintaining relationships. It takes more than an organized department to make relationships work. Here at Stafford Hospital, our motto is “always.” It’s what we live by and we practice it every day in our communications with each other.
• Respect one another
• Assist each other
• Listen to each other’ opinions
• Strive to give one thousand percent to each other and to our patients
• Engage in “star” behavior every day
After all, accepting each other’s values and differences is what makes us work so well here at Stafford Hospital.
Kristina L Pirollo, CRCST, CHL, is manager of sterile processing at Stafford Hospital Center.