By Tony Thurmond, CRCST, CIS, CHL, FCS
Competency is a term that relates to performance improvement, and professionals are expected to attain and cultivate it through experience and a desire to learn, grow and advance in their knowledge and skillsets. In the sterile processing (SP) environment, it’s important to examine how competencies are valued and applied. Are they viewed as a necessary evil or do SP professionals embrace the opportunities competencies can provide?
ANSI/AAMI ST79, Section 4.2.2, states that “the responsibility of sterile processing should be assigned to qualified individuals who have demonstrated competence in all aspects of sterile processing.” Qualifications for SP professionals include demonstrated knowledge of and documented competencies in the tasks they perform, and a working knowledge of the work environment. Documentation is critical because there must be evidence that proper training and demonstration of that training took place. Surveyors will ask to see employees’ orientation checklists and the documented competencies for each employee.
Tap power of checklists
Thorough competency checklists must be created and maintained for each of the following areas of the SP department (SPD):
- Decontamination: Competency must be shown in instrument sorting, disassembly/reassembly, manual and mechanical cleaning methods, microbicidal processes, equipment operation, standard- and transmission-based precautions, and engineering and work practice controls.
- Instrumentation: SP professionals must know the names and descriptions of instruments in the organization’s inventory as well as the demonstrated inspection points of each device. Other competencies include proper preparation and packaging methods for sterilization.
- Sterilization/High-level Disinfection (HLD): Competencies should cover all sterilization practices and principles, including steam, low-temperature, ethylene oxide and HLD processes.
- Worker Safety and Environmental Safety: SP professionals should understand and be able to demonstrate how to properly handle emergent situations, environmental hazards and other patient safety situations.
More competencies can be developed for specific equipment and instrumentation (to include proper cleaning techniques, sterilization and maintenance of each). Note: A completed competency does not ensure a technician is competent, much the same way that holding certification does not ensure an individual’s competency. The proper skills learned and used effectively in day-to-day operations are what make for a competent technician. Some technicians can demonstrate the correct way of performing a task during a competency review, but then return to their bad habits after the review. Still, a competency checklist can benefit the department and facility in numerous ways, as the following paragraphs will demonstrate.
When developing a competency checklist, equipment and departmental design will dictate the processes and workflow necessary to be completed. First, an orientation checklist must be developed and implemented for new SP employees. New team members should work with a competent technician who is willing to train and has the skills required to properly onboard the new employee. This orientation checklist is typically completed after 90 days of employment to verify the skills learned and the likelihood of the department continuing with the individual’s employment.
If the new employee demonstrates they have retained the training information provided and have the desire to continue to learn and broaden their skills, this growth should be documented by the SP leadership during the 90 days. If areas of weakness surface or it is determined certain information was not retained, the supervisor must review the training process and its effectiveness. The supervisor may need to review the preceptor or trainer to determine whether the proper information was given and whether certain aspects of the training process could be improved.
If no improvement is needed in the training process and the preceptor is providing proper, effective training, it must then be determined whether the new hire can be successfully trained and prepared for their role. Everyone learns at their own pace; however, the individual must demonstrate the desire to learn and do their best if they are to move past their 90-day review and continue to grow into a strong, proficient SP professional. It is recommended that new employees both verbalize and demonstrate the task(s) being evaluated.
Competency checklists must be written in the proper order of the process or workflow for the desired knowledge and skills being reviewed − and each item to be reviewed must be thoroughly understood and/or demonstrated. The checklist should indicate whether the demonstration is verbal or demonstrated, and it must be marked as “satisfactory” or “unsatisfactory” by the SP supervisor or manager. Each task/line item must be initialed by the person reviewing it to document that a thorough review was performed. Checklists should also include an area for comments (which can include suggested training or positive comments for technicians who demonstrated success and aptitude with a particular task).
The checklists must be reviewed at least once every six months to determine areas in need of improvement. Managers should ensure the checklist is current, taking into consideration any changes to equipment or internal processes, and whether any standards updates occurred that could require a change to current practices. If more errors have been identified in certain areas or for certain processes, an impromptu competency review may be necessary. Competency reviews for each technician must be reviewed by a competent technician, educator or manager who has also demonstrated working knowledge and expertise of the area being reviewed/assessed. The checklist must be signed by both the evaluator and the individual being evaluated, and the competency should be placed in the employee’s file.
Conclusion
Competency checklists are considered a requirement in the SPD and other health care departments because they allow departmental leaders to assess areas in need of improvement and gauge employees’ consistent adherence to best practices. Checklists can also lead to more standardization regarding how tasks and processes are performed, which can further lead to performance improvement and error reduction.
– Tony Thurmond, CRCST, CIS, CHL, FCS, serves as central service manager for Dayton Children’s Hospital. He is an HSPA past-president who currently serves as a director on the HSPA Board of Directors. He earned his HSPA Fellowship in 2021.
