October 8, 2024
Jhmeid Billingslea CRCST, CIS, CER, CHL, CST, CMRP, HACP-IC
Once a Year is NOT Enough! Developing an SPD Education Program that speaks to the REAL Dragons that speaks to the Real Dragons in your Surgical Services Dungeon
If you have ever played a newly released computer game that you used to be good at with a younger family member, you quickly realize that if you did not stay up to date, they smoked you! Whether you are a new Sterile Processing team member or a grizzled veteran of the Sterile Processing industry, you know that annually you must perform competencies. But if you are honest, you know that every important basic skill is not in that assessment, and you also know that once a year is not enough for some more complex skills.
Annual competencies typically include a demonstration of the ability to generally function in each area in the department. But what about the most difficult skills? Are they incorporated, and if we only evaluate them once a year, how certain are you that these tasks can be performed independently on an off-shift or when the Team Lead is on vacation? This is a core question that gets to the heart of the bulk of our customers’ service disruptions.
One of the best ways to improve a process is to use ideas that have proven successful. When I was a Surgical Assistant and Technologist, we had a great Operating Room (O.R.) Educator who always had our Annual Competencies done before President’s Day. Having everyone’s competencies signed off was great on paper, but several of us had to stand an additional service specialty call for complex cases, because the physicians were uncertain about some team members’ ability to perform during more difficult cases. The extra call for complex cases got old quickly and caused staff dissatisfaction among the best Technologists, First Assistants, and O.R. Nurses. We formed an Interdisciplinary Team that identified and called out the REAL reasons that we struggled during unfamiliar cases. We then produced quarterly training specific to the reasons we were called in, such as assembling and priming the Midas Rex™ drill, draping the Neurosurgery microscope, assembling fracture tables, preparing the suture for Cardiac cases, etc. It was a raging success that increased retention and gave our surgeons assurance in the ability of any call team to help provide the best standard of care.
I always say, “True Competency = Confidence + the Ability to perform the task under pressure.” We often interpret the Advancement of Medical Instrumentation (AAMI) recommendation to “conduct competency assessments at least annually” AAMI ST79:2017 (AAMI, 2017) to mean “at max annually.” We leave out the other part in which AAMI tells us that “healthcare facilities should establish a formal, ongoing training program for Sterile Processing personnel.” AAMI also specifically reminds us that “for those complex, high-risk tasks, training should be more frequent”—think quarterly or even monthly (AAMI, 2017).
It is not just AAMI; the Association of periOperative Registered Nurses (AORN) guidelines also suggest that ongoing education and competency validation should be tailored to the complexity of the tasks (AORN, 2024). The Centers for Disease Control and Prevention (CDC), emphasizes the importance of regular training to maintain exacting standards of sterilization and high-level disinfection (CDC, 2008, 2016, 2024). Finally, the Centers for Medicare & Medicaid Services (CMS) requires that healthcare facilities demonstrate ongoing staff competency, especially for tasks that impact patient safety (CMS, 2021).
So, what does that mean to those of us struggling to even get our Annual Competencies done with the operational challenges that we face? It means that we must reconsider our current plan and develop a new, better, and more compliant to industry standards educational plan that addresses our real problems in real-time. Remember that most of the fires you are struggling to put out are because you did not take time to provide repeatable training to avoid those issues.
Here are some suggested steps to a better SPD Education Plan:
- Survey your customers: Which trays or tasks do they think that you are struggling with?
- Perform a Root Cause Analysis of the trays and tasks from the survey with the entire SPD leadership team to identify which steps or barriers are tripping your team up.
- Develop training using training material from Vendors, feedback from experienced team members, and industry standards and guidelines
- Ensure the training is repeatable and use the complexity of the tray/task to develop a schedule and frequency that verifies that all shifts receive training and, more importantly, prove their competency via testing and/or return demonstration versus self-checkoffs.
- Document this training and share its completion with your SPD Team and Customers.
- Work together to complete Quality Audits on the tray/task and report progress to your SPD Team and your Customers.
For those of us in the trenches, this means rolling up our sleeves and diving into training sessions regularly. A single Educator cannot do this on their own: this is a project for the combined efforts of the entire SPD Leadership team. Think of it as your workout routine—consistency is key to staying fit and infection-free. In short, training in Sterile Processing is like a never-ending journey of discovery in an online game. Keep the quest going, earn more points, powers, and special abilities, and your department will hold the “High Score” in the delivery of the instrumentation for patient care! Happy training, SPD Warriors!
References
AAMI. (2017). Comprehensive guide to steam sterilization and sterility assurance in health care facilities (ANSI/AAMI ST79:2017). Arlington, VA (Veteran Affairs): AAMI.
AORN. (2024). Guidelines for perioperative practice. Denver, CO: AORN.
CDC. (2008, 2016, 2024). Guideline for disinfection and sterilization in healthcare facilities, 2008. Atlanta, GA: Centers for Disease Control and Prevention.
CMS. (2021). State operations manual. Baltimore, MD: Centers for Medicare & Medicaid Services.
