By Tony Thurmond, CRCST, CIS, CHL, FCS
Sterile processing (SP) professionals must work toward excellence with every action and interaction they undertake. Unfortunately, significant time and attention go toward addressing challenges and disruptions, so the successes of the department aren’t always prioritized, shared or celebrated. The challenges SP professionals face each day can range from instrumentation and information technology (IT) to mechanical challenges and difficult personal interactions. Regardless of the challenge, the resolution must be swift and appropriate.
The key to tackling SP-related challenges lies in effective troubleshooting and assessment. This practice involves searching for the source of the problem and correcting it to make a process or practice whole or functional again. A wise question SP leaders can ask is: “What tools are being given to technicians to become better at troubleshooting?” Many times, SP leaders may face a challenging issue that technicians do not know how to address. Perhaps they did not know where or how to look for the answer, or instead of reporting it, maybe they simply assumed that the next person would address it. Does your staff make the initial call for equipment repairs with the vendor or the facility’s biomedical engineering team, or do they report it to leadership?
Troubleshooting can be effective for addressing mechanical issues, departmental processes, and even personal interactions. Often, SP team members aren’t comfortable troubleshooting. Perhaps they believe they do not have the authority to troubleshoot, or that it is only the leader’s responsibility. That assumption can be detrimental to the department’s success. SP leaders should encourage every team member to speak up and bring their ideas and concerns to the forefront immediately.
There are several key troubleshooting steps that will have all team members identify problems and become part of the solution. Utilizing these tools will not immediately guarantee success, but continuing to work with them will help develop a clear path to success and problem mitigation.
Pinpoint the problem. The first step in problem solving is knowing a particular problem exists and determining its root cause. Some things occur that can just be a fluke, not a root cause. Start by asking questions about the problem and seeking answers to those questions. Once the questions uncover specific problems, address each problem before moving to the next. An example would be soiled instruments coming through the washer-disinfector. Are the soiled devices the result of poor manual cleaning, inadequate point-of-use treatment, a defect with the washer, or a combination of all these factors?
Consider this scenario: The technician in decontamination sees an instrument tray came from the operating room (OR). It was sprayed at the point of use and organized. The technician bypassed the manual cleaning and goes straight to the washer. The technician fails to realize that the conveyor taking the rack to the washer is jammed. The rack does not go immediately into the washer and is delayed for more than two hours before he notices it. And on this day, the washer has a blocked spray arm that is not producing the appropriate flow of water. We can also add that there was no hand-off communication to identify that this one-of-a-kind tray is needed for another case. The tray comes through the washer, and it is visibly unclean. As one can see, the answer is not always an obvious one.
Establish probable cause. The next step is creating a list of the probable causes or concerns. Break out the causes into various categories and reflect on each separately and in the order of the process, listing them from the highest concern to the lowest. It is prudent to have several people involved in all processes to gain perspective and capture all opportunities. Seek out the advice of someone who is doing the task routinely, even if they are less experienced. Often, leaders have years of experience but may no longer be experiencing the issues personally.
Again, using the previous scenario, consider the following: The technician makes the decision to skip manual cleaning. There was the fact that the conveyor did not activate as it should, and the washer spray arm was blocked. Additionally, the department did not know the tray would be needed for a later case. It is necessary to break down each challenge and troubleshoot each step.
Determine the action plan. Be sure to include all individuals necessary to help determine the plan of action. If it is necessary to include an outside vendor or an in-house IT or BME colleague, invite them to participate. Do not overlook others who can bring vital information to the team. Identify any specialty equipment or supplies to help achieve the desired outcome. Evaluate and rule out all possibilities that may be creating the challenges.
As we now know, the example scenario is truly multiple challenges wrapped into one. Breaking it into steps and reviewing each from the beginning is crucial to determine the best solution(s). Some may mistakenly stop at the point of the technician’s error with manual cleaning. It is advised, however, to follow the process to identify other outliers that could be contributing factors for the process failure.
Implement the plan. When determining the plan of action, one may find there are several options. The key is to implement one plan at a time. Implementing multiple changes at once could prove detrimental to the plan and outcomes. Successfully implementing a plan requires that each step be taken one at a time. If a failure still exists, reverse the steps to find the culprit. There may need to be an adjustment to a single step.
In continuing with the scenario example, it can be easy to immediately assumed the problem is limited to the technician not performing a critical step, but there are numerous other contributing challenges – the conveyor failure, the spray arm blockage and the communication oversight. If the leader stops at the technician’s mistake, they will never fully address the other challenges that be less obvious but no less egregious.
Document and share the findings. Once the problem, action plan and implementation strategy are identified and determined, it is vital to document the challenges, proposed solutions and findings. That information should then be shared with staff and others as needed (e.g., customers, infection preventionists, biomedical staff, executives). Establish an effective way to communicate the steps associated with troubleshooting the challenge. Consider laminating and posting the material in the department, or distributing it in an email for all stakeholders to access.
In our scenario, the leader found that the technician did skip a step and that they can be easily coached or reviewed with a competency to assure the technician is aware of the oversight and understands the correct process. The conveyor and spray arm can be addressed by the service technician coming in to review the equipment and perform preventive maintenance. Again, the technician will be reminded of his responsibility for ensuring the conveyor is activated and working properly and that the spray arms inside the washer have movement and clear flow. Additionally, the issue of the tray not being identified as being needed later should be captured with possible updates to preference cards (review the interface of the preference card and the instrument tracking system if used). Another solution is to identify one-of-a-kind trays with a distinct color label. This serves as a visual reminder for all staff to prioritize those trays.
Conclusion
Learning troubleshooting techniques and practices is beneficial to the entire SP team, regardless of their position and experience level. The goal is to work as a team to identify problems earlier, proactively find the most effective solutions and document the process and results. Doing so helps contribute to greater outcomes for the patients as well as the SPD and the customers its serves.
