Department Plays Role in Transforming 21 st Century Sterile Processing

Transcription

1 Healthcare Technology Management Department Plays Role in Transforming 21 st Century Sterile Processing Jennifer DeFrancesco About the Author Jennifer DeFrancesco is chief of biomedical engineering at Richard L. Roudebush VA Medical Center in Indianapolis. There is a tremendous need and opportunity for HTM personnel to collaborate with sterile processing professionals in order to enhance outcomes for patients throughout the country. As healthcare technology management (HTM) continues to evolve, many organizations are quickly realizing that the growing need for technology consultation is placing different expectations on staff and forcing biomedical engineering professionals into new roles. Some of these new roles come more naturally than others. Sterile processing technology implementation and consultation, within most organizations, can be considered a duty that may not be fully embraced by HTM professionals. However, there is a tremendous need and opportunity for HTM personnel to collaborate with sterile processing professionals in order to enhance outcomes for patients throughout the country. Where Are We Now With Sterile Processing Equipment? Sterile processing equipment historically has been thought of as workhorse types of equipment that can last long past its lifespan. The fact that this equipment can last well past its prime contributes to the current state of technology within the sterile processing realm. In the past, the transition to new technology for sterilization equipment has been slower than the rest of the medical field; it was not until recently that a wider range of sterilization equipment produced has been network capable. Additionally, there are several contributing factors within the healthcare industry that pose unique challenges to sterile processing departments and their implementation of new equipment. Many sterile processing departments are now facing the challenge of providing for 21 st Century healthcare services while being confined to outdated areas whose designs create innate inefficiencies in their workflow. Inconsistent and burdensome cleaning instructions from device manufacturers only add to the frustration that the sterile processing leadership within facilities face. Add to this the fact that we are experiencing an era of immense (and sometimes disparate) regulatory oversight and a healthcare industry that is challenging staff to do more with less, and it is no wonder why technology implementation and replacement falls by the wayside in this area. Changing Needs And the Call for HTM Expertise With multiple agencies tackling different facets of sterile processing updates, keeping up with regulations and/or suggested best practices from organizations such as AAMI, the Association of perioperative Registered Nurses (AORN), and the Society of Gastroenterology Nurses and Associates (SGNA) can be extremely difficult. To address this, a variety of compliance tools have been developed or enhanced in order to aid organizations in their ability to adapt to these standards, including ISO 9001 tools, ISO tools, electronic SOPs. All of these difficulties require a healthcare 186 Biomedical Instrumentation & Technology May/June 2014

2 professional who is skilled in solving multifaceted problems to aptly address them in a cohesive manner; this is where HTM is being called to action within organizations. The complex challenges that face sterile processing may make the role as a technology consultant for the department uncomfortable for some, but those challenges are a good reason why HTM professionals should become immense assets to their sterile processing leadership and organization as a whole. As a support service, sterile processing has always faced the challenge of competing for resources against clinical services in the big picture of an organization. Often, this equipment is a low priority within an organization because the return on investment (ROI) is not as straightforward as direct patient care equipment. HTM staff has the opportunity and ability to become fervent advocates for sterilization equipment to the organization s capital asset planners, equipment committees, and executive leadership. HTM is being called to action to aid sterile processing departments throughout the country transform and adapt to the needs of the current healthcare industry through technology consultation, systems integration and strategic management of sterilization equipment. Primary Areas Where HTM Can Impact Sterile Processing There are four primary paradigms within sterile processing where HTM professionals can take the lead or take a more active role sterilization equipment management and standardization, systems integration, construction and redesign, and new technology implementation. Focusing on these four areas during a gap analysis can ensure that your technical expertise is focused on areas of sterile processing where the greatest impact can be made. Sterilization Equipment Management Strategically managing sterilization equipment and the potential for standardizing equipment is a simple means for HTM professionals to provide their organizations with meaningful data to make equipment funding decisions; this is a role that HTM professionals are very comfortable with, and this strategy can mimic that of the organization s overall equipment HTM staff has the opportunity procurement strategy. Start simply and ability to become fervent by understanding the type of advocates for sterilization equipment within your organization. These data can be utilized to equipment to the organization s identify modalities that can be capital asset planners, standardized; for example, going equipment committees, and from three different types of executive leadership. endoscope reprocessors to one model that has the ability to be networked and provide utility reporting. Vulnerabilities also can be identified with these data. It is important to objectively evaluate the data and the current equipment inventory with respect to system redundancy, contingency planning, and translation of potential service interruptions into patient care outcomes through a risk assessment of these vulnerabilities. For example, one region of hospitals found that about 22% of their sterilization equipment portfolio was past its usable lifespan. After tracking downtime for each piece of equipment, the outdated units had a 97% uptime in comparison to a 99.7% uptime for equipment within its expected lifespan. This translates into an average of less than 30 minutes of downtime per week per machine for equipment that was being managed appropriately in comparison to Strategically managing approximately six hours of downtime per sterilization equipment week per machine for equipment past its and the potential lifespan. While this may not seem to be a for standardizing significant difference, the organization cannot perform or must delay some procedures if instruments cannot be sterilized, means for HTM equipment is a simple which costs the facility in terms of employee professionals to provide salary costs, utilities costs, and potentially fee their organizations basis costs depending upon the criticality of with meaningful data the patient s need. to make equipment System Integration and Validation Systems integration also is a role that HTM professionals are very comfortable with, as the position necessitates the ability to successfully integrate systems and facilitate their implementation. Instrument tracking systems (ITS), real time locating systems (RTLS), electronic SOP systems, and other new software- and hardware-based technologies are becoming more pervasive throughout the healthcare industry and more essential to efficiencies within sterile processing. These systems also lend themselves to funding decisions. Biomedical Instrumentation & Technology May/June

3 Facility #1 SPS Strategic Equipment Management Plan SPS Equipment Network Preparedness Equipment with Networking Capability 20.59% Percentage Networked 28.57% Life Cycle Management 66.67% Remove ALL Standalone Aerators Plan for Steam Sterilizer Replacements (Networking Capable) Remove/Replace IUSS units Assess Need to Replace Ultrasonic Washers, Procure Additional for Eye Instruments/Sets Plan for abator implementation for remaining EtO sterilizers by FY 14 Plan for Hydrogen Peroxide Sterilizer Upgrades in FY 13 Plan for EtO to Hydrogen Peroxide in FY 13 Goal to have 25% of SPS Equipment with Networking Capability Goal to have 35% of Networkable Equipment on Network Plan for AER Upgrade in FY 15 Assess Need to Replace Ultrasonic Washers in FY 15 Goal to have 35% of SPS Equipment with Networking Capability Goal to have 50% of Networkable Equipment on Network **Replace Equipment with Network Ready Equipment when available SPS Systems ITS Preparedness 75.00% RTLS Preparedness 90.00% IVN Preparedness 75.00% ISO 9001 Conformance 0.00% Procure VISN-wide Instrument Tracking System under RTLS PMO Implement RTLS Solutions VISN-wide Complete Database of SOPs for IVN system Begin ISO 9001 Quality Management Conformance Process Plan for Upgrade of ITS System Complete ISO 9001 Conformance Process Evaluate additional needs for RTLS and ITS systems (training, equipment, etc.) Techonology Implementation Construction Preparedness 87.50% Complete SPS Design Begin SPS Construction Project Complete SPS Construction Project Set aside an annual Engineering or NRM budget for SPS needs including ventilation Strategic Equipment Planning Strategy SPS Involvement % Early Adoption/Technology Implementation 66.67% Plan to minimize use of EtO sterilization Perform Gap Analysis for facility instrumentation that cannot be sterilized via Hydrogen Peroxide if currently sterilized in EtO No EtO Sterilization at facility in FY 13 Table 1. Sample of a Balanced Scorecard Utilized by a Facility Continue to Evaluate new SPS Sterilization Equipment Technologies 188 Biomedical Instrumentation & Technology May/June 2014

4 ISO 9001 or ISO conformance. While many facilities are not quality management certified, and do not plan to pursue it, many healthcare organizations are adopting a conformance to these systems to ensure regulatory compliance, systems reliability, and reproducibility of processes. Our Biomedical Engineering Department has many of the support processes in place for quality management conformance, as we maintain records for preventive and corrective maintenance and equipment planning due to regulatory oversight. Sterile processing s changing climate will ensure that other software and hardware technologies are going to be continuing to come into healthcare facilities. HTM has a choice to be a consultant, facilitator, or not involved. Construction and Redesign Construction and redesign has been another issue within many organizations sterile processing areas. Depending upon the role of HTM within your organization, this may be an area where clinical engineering is highly involved. Either way, HTM professionals can add their expertise to implementing and installing new equipment that enhances workflow within the sterile processing department. HTM also can provide critical technical input in design and construction of new areas with the capability of housing sterilization equipment for today s requirements as well as the future s. An interesting way to frame a complete redesign of a sterile processing department is to consider how you would design a sterile processing department from scratch for today s healthcare model, including automation considerations. HTM has an opportunity to aid an organization by translating clinical needs into the appropriate sterilization equipment and area design from technical specifications with a keen eye toward right sizing equipment and areas based upon current needs while planning for future expansion. New Technology Implementation Finally, the implementation of new technology is another realm in which clinical engineers are seasoned professionals. HTM must ensure that sterile processing has adequate representation on capital Sterile processing s changing climate will ensure that other software and hardware technologies are going to be continuing to come into healthcare facilities. HTM has a choice to be a consultant, facilitator, or not involved. investment committees and integrated product teams (IPTs) for equipment as appropriate; including critical, semicritical and noncritical equipment. Additionally, it is important that as technology consultants within this realm, we are moving toward new equipment modalities and away from old technology. To be effective at this, HTM must garner a thorough understanding of the portfolio of critical and semicritical RME and its implications for cleaning, workload and throughput. For example, many hospitals are moving away from ethylene oxide (EtO) sterilization when possible. If removing EtO gas for patient and staff safety considerations is a priority in your organization, HTM professionals can aid the process by completing an analysis of the organization s scope inventory, particularly identifying what can be sterilized via other means and what can only be sterilized through EtO. Given this, provide your executive leadership with a summary of what it would cost the organization to completely remove EtO from the facility. These implementations also may lend themselves to green initiatives and reduction in utility usage. Where to Begin Stepping into a new role with your sterile processing department is not always easy. Transforming the way your organization views sterile processing and its needs can prove to be even more difficult. So where do you start? Beginning with a gap analysis is the easiest way to determine your best course of action. First, define your organization s end goal. Engage your key stakeholders and their customers and utilize these conversations to create a framework for your goals. Does your organization want compliance, or innovation or both? What are your organization s mission/vision and strategic goals? Make sure that your end goal is aligned with the organization s overall priorities. Discuss this initiative with executive managers to ensure their buy-in and take into Beginning with a gap analysis is the easiest way to determine your best course of action. Biomedical Instrumentation & Technology May/June

5 consideration any other organizational needs or goals that they may bring up. Next, determine the best way to collect data within your organization that will allow you to present the best overall picture of sterile processing in your organization this can be quantitative or qualitative and may also involve staff surveys, focus groups, and data mining. After the data are collected, you will be able to formulate a comprehensive current state of sterile processing equipment within your organization. If there seems to be gaps in the data you ve collected that are important to the overall outcome of your project, re-engage your stakeholders to find a way to evaluate these within your organization. After the current state is fully understood, look at the data with your sterile processing staff and discuss what the future of the department looks like and how it will need to change to meet organizational needs. Regardless of the organization s For example, a single facility size or complexity, HTM organization may recognize the need to revamp its sterile professionals have an processing equipment, but opportunity to impact significant may not necessarily want to change in the management of invest in all new equipment. sterilization equipment, resulting This organization may consider prioritizing equipment in improved efficiency, enhanced upgrades where possible and patient safety, and reduced investing strategically in a few organizational liability. new pieces of equipment that would lend toward ISO 9001 or ISO compliance and digital verification/validation of such. To accomplish this, the biomedical engineering staff can work collaboratively with sterile processing leadership to utilize the facility s inventory to evaluate the age and suitability to the environment of the sterile processing equipment (vendors may need to be consulted, as well). The leadership of this organization also is keenly aware of the cost of ownership of this equipment over its lifetime and may want to evaluate contract costs versus in-house support costs of potential new buys. They also may prioritize features that will be useful in the future (such as networkability, and vendor VPN access) for new equipment purchases and consider the uptime percentage of current equipment. Equipment that could be upgraded would be determined by the inventory and discussions with sterile processing and original equipment manufacturer (OEM) staff. The equipment then could be prioritized based upon criticality to operations, and the available funds for sterilization equipment could be utilized in that order. This approach provides a conservative and cohesive approach to ensure that the most critical equipment is being replaced expeditiously, while garnering executive leadership support for equipment requests in the upcoming fiscal years. Moving Forward Creating tools for the organization to set goals, and establishing metrics and key milestones will be imperative to sustain sterile processing initiatives. A simple tool is establishing a balanced scorecard approach that can be provided as an executive summary to your organization s leadership. Within the four paradigms discussed above, establish the goals for your facility within each area. Many organizations find a stoplight coloring system an easy visual indicator to designate areas where goals are being fully met, somewhat met, and not met. Table 1 shows a sample of a balanced scorecard utilized by a facility. This executive summary also establishes short- and long-term goals for each of the areas and can serve as a comprehensive plan for the organization s development of the sterile processing area and a quick measure as to whether the organization is meeting its goals. Regardless of the organization s size or complexity, HTM professionals have an opportunity to foster significant change in the management of sterilization equipment, resulting in improved efficiency, enhanced patient safety, and reduced organizational liability. With the current competencies and evolving roles of HTM professionals, this expanded role within sterile processing is intuitive and has the potential to yield significant gains for the organization as a whole. Through providing technical and professional consultation, HTM professionals can choose to play a significant role in the impending and inevitable rapid technological advancement of technology within this realm. 190 Biomedical Instrumentation & Technology May/June 2014