By Tony Thurmond, CRCST, CIS, CHL, FCS
Sterile processing (SP) professionals are responsible for providing excellent service every day on the job. Still, SP managers and technicians often spend more time addressing challenges and disruptions than enjoying the day’s successes. The challenges faced each day may range from instrumentation and information technology (IT) issues to mechanical malfunctions, personal interactions with fellow departmental teammates and customers the sterile processing department (SPD) serves, and more – and resolving such challenges requires focused assessment, troubleshooting and resolution tactics.
Troubleshooting is a form of targeted problem solving that is critical for well-functioning SPDs. In simplest terms, it’s an attempt to search for the source of the problem and correct it to make it whole or functional again. SP professionals actively troubleshoot equipment, processes and interactions over the course of each shift, but how are leaders ensuring that their teams have the necessary skills to troubleshoot most effectively? A concrete plan of action is prudent as opposed to simply diving into an issue head-on without proper thought, planning and preparation. Often, SP technicians are unsure how best to address certain challenging circumstances. Perhaps they do not know where or how to look for the answer, or instead of reporting the incident, they overlook it because they expect another team member will handle it. It is imperative that SP leaders give their technicians guidance to troubleshoot issues effectively and promptly. The following are essential steps for successful troubleshooting and problem resolution:
Clearly identify the problem – Some issues happen that are simply a fluke, not a root cause; therefore, it’s imperative to first ask questions about the problem and seek answers to those questions. Some questions will create more queries, and this is acceptable because you are actively exploring all opportunities for improvement at this point. Once the questions identify specific problems, address them one at a time. One example could be soiled instruments coming through the washer-disinfector. Are the devices soiled due to poor manual cleaning practices, inadequate point-of-use treatment, an operational defect with the washer or a mix of all these factors?
Consider this scenario: The technician in the decontamination area identifies an instrument tray that came from the operating room (OR). The devices were sprayed at the point of use and organized, so the technician bypasses manual cleaning and places the instruments directly into the washer. As the technician turns to other work, he fails to realize that the conveyor is jammed, causing the rack not to go immediately into the washer and delaying the process for more than two hours before the technician notices it. Also on this day, the washer has a blocked spray arm that is impeding water flow. Further, there was no hand-off communication to identify that this one-of-a-kind tray was needed for another case that day. The tray was noticeably unclean when it came through the water, and we can see with this example that multiple factors contributed to that outcome.
Pinpoint the probable cause – It is important to break out the possible causes of the problem into various categories and reflect on each separately. Prioritize the list of problems, tackling each according to their level of concern, it is prudent to have several people involved to gain different perspective and capture all opportunities and ideas for improvement. Another helpful approach is to seek advice from technicians who perform certain tasks routinely, even if they are less experienced. Often, SP leaders have years of experience but may no longer be the ones performing the work and experiencing the issues firsthand. Soliciting advice from all frontline technicians demonstrates that the leader appreciates their knowledge and skill sets and views all teammates as valuable contributors to quality improvement initiatives.
Reusing the example above, one can see several possible causes of a problematic outcome (dirty instruments). First, there was the technician who chose to skip the manual cleaning process. Secondly, the conveyor malfunctioned, and there was a blocked spray arm. Finally, the department did not know the tray would be needed for a later case. Again, it is essential to individually explore each challenge and troubleshoot each step.
Draft the action plan – Determining a plan of action is vital to the SPD’s success. Be sure to include all necessary individuals who can effectively put the plan into action, including vendor representatives or in-house facilities, information technology or biomedical professionals. Also, do not overlook others who can bring vital information and perspective to the team, and identify any specialty equipment or supplies that can help achieve the desired outcome.
Put the plan into action – Sometimes, there are several options for putting a plan into action. Whatever options are taken, the key is to implement one plan at a time. Implementing multiple changes at once can prove detrimental to a plan of action. Successfully implementing a plan requires that each step be taken one at a time; then, if failure is still present, the steps can be reversed to pinpoint the problem’s cause.
Document the outcomes – Once the plan of action has been established and implemented, the findings must be carefully documented and shared with staff and other stakeholders. It is important to not only share the troubleshooting process with technicians, but also each step involved in the new plan of action/course of correction. This documentation can be laminated and posted in the department or distributed more widely in an email (whatever the approach, the goal should be easy access to the information).
In the previous scenario, the leader learned that the technician skipped a step – a mistake that could be addressed by a competency review. Additionally, the conveyor and spray arm could be addressed by the service technician coming in to review the equipment and perform preventive maintenance. The technician should be reminded of their responsibility in ensuring the conveyor is activated and working properly and that the spray arms inside the washer move and flow well. The issue of not identifying the tray as needed for a subsequent case could be addressed with possible updates to preference cards (review the interface of the preference card and the instrument tracking system if such technology is used by one’s facility) or an improvement in hand-off communication. Another solution is to identify one-of-a-kind trays with a distinct color label as a visual reminder for all staff to prioritize those trays.
Conclusion
Troubleshooting is important for addressing mechanical issues, departmental processes and personal interactions. Often, SP team members believe they do not have the authority to troubleshoot on their own, or that it is not their responsibility; however, such is not the case. Leaders should empower every technician, from the most seasoned veteran to the newest team member, to speak about issues and bring concerns to the forefront immediately.
Learning and implementing troubleshooting techniques and practices is beneficial to the entire SP team, regardless of their position and experience level, and leads to better outcomes for SP customers and patients.
– Tony Thurmond, CRCST, CHL, CIS, FCS, serves as sterile processing manager for Dayton Children’s Hospital in Dayton, Ohio. He is an HSPA past-president and former director on the HSPA Board of Directors.
