Author: Hank Balch | Beyond Clean
- Learn the definition of sterile processing competencies.
- Understand the importance of competency reinforcement throughout the year.
- Identify creative strategies to enforce competencies and expand technician knowledge.
Few words strike fear into the hearts of new technicians like “competency,” and few words cause more looks of exhaustion and elicit more groans from department leaders than “annual competencies.” And yet, these are some of the most important pieces of documentation that a department can have in preparation for their required accreditation visits from organizations such as The Joint Commission, DNV, etc. Perhaps that is part of the reason that competency documentation seems so daunting, because we have the importance of these checklists drilled into us from the earliest days of training and onboarding in our Sterile Processing careers. Even though the importance of competencies for regulatory compliance is fairly well understood, many still haven’t found a way to crack the code between this experience being comprised of hours of grueling, stress-filled questions and answers, and something that technicians and leaders can actually start to look forward to. In the sections below, we’ll discuss some creative approaches to consider that will not only take the pain out of the process but may also help pull competencies out of the shadows of a filing cabinet and into the daily duties of our frontline Sterile Processing heroes.
Required vs. Real Life
According to Wikipedia, “Competence is the set of demonstrable characteristics and skills that enable and improve the efficiency or performance of a job.” While there are only four states in the US which currently require certification for Sterile Processing technicians working in the hospital setting, all 50 states require documented competencies for individuals involved in the cleaning and reprocessing of medical devices. The full scope of what is exactly required to be included in these mandatory competencies is sometimes up for debate. Certain activities which are clearly traced from federal law or regulatory oversight are straightforward – such as OSHA (Occupational Safety and Health Administration) requirements to provide a safe working environment for employees, and CMS (Centers for Medicare and Medicaid Services) requirements to follow the FDA (Food & Drug Administration) approved manufacturer’s instructions for use (IFUs) for reprocessed medical devices. The farther away you move from clear regulatory guidance, the closer you get to the real life situations that average Sterile Processing technicians confront on a regular basis in which they still need high levels of competence to adequately fulfill their department duties.
While regulatory surveyors may not be delving into the nuances of this real life experience of frontline technicians, these activities are critical for hardwiring technician excellence in your department. Here are just a few examples of what I mean:
- What is the appropriate way to find and replace a missing instrument in your inventory?
- How do you ensure you properly replace and reload chemistries for automated washers?
- If there is a non-toxic spill on the clean side, how do you notify Environmental Services?
- What is the standard documentation process for a loaner?
Again, most of these don’t rise to the level of a CMS finding, but without a baseline level of competency around these activities your department will be unprepared to excellently navigate the real life experiences of day-to-day workflow in Sterile Processing. In short, we want to ensure our frontline technicians have every little bit of practical knowledge they need to safely and effectively do their jobs, regardless of whether anyone with a clipboard will ever ask to see it.
Check Off Before Your Check In
We did mention this new vision for competencies would be creative, right? Well, one of the biggest misconceptions with our traditional approach to competencies is that they must happen all at once, and only once a year (or even less often). Is this really the only way to do competencies within the Sterile Processing department? No. It’s just the way we’ve always done it. And, if you ask me, that sounds like a phrase we might want to run away from.
One example of reducing the stress of the mountain of annual competencies looming before us each year is to take small bites out of the proverbial elephant — each and every time an employee logs into work. Accounting for two weeks of vacation a year, the average Sterile Processing technician will log into their department tracking systems 250 times per year. That means we have 250 opportunities to engage them with a small, bite-size slice of competency information that can actually be stored in a retrievable, digital format. Not only that, but we can leverage the settings & modules of our instrument tracking systems to target specific competency check off, quizzes, and reviews for the specific area of the department our technicians are logging into.
For instance, if Johnny is logging into the Prep/Pack assembly area, he may be asked to answer a multiple choice question on the functionality testing required for a Gelpi Retractor. However, when Suzy logs into her shift for Decontamination, she may be asked to identify the missing portion of PPE from a graphic on the screen. Not only are these questions helpful for queuing up applicable knowledge prior to a technician’s shift, but we get to engage with them while they are still fresh for the day – instead of at the end of a three hour session of policy & procedure reviews once a year.
Featured Competency of the Week
While the example above keys in on the ability for technology to assist us with competency delivery and documentation, that’s not the only way you can add much-needed diversity in how and even by whom your competencies are presented as a department. In many departments, it is common for competency discussions to be led almost exclusively by the department manager, supervisor, or educator. However, there is a tremendous upside to engaging your entire staff in the competency delivery itself. A great example of this would be developing a “Featured Competency of the Week,” where every week a different competency theme from your department is highlighted during daily shift huddles and weekly staff meetings.
For instance, one featured competency theme may be “Chemical Indicators & Integrators.” That week you would print out copies of that section of competencies and put them in the break room and employee mailboxes (or email them if it’s easier). During your staff meeting you would ask a particular staff member to highlight key aspects of the competency and discuss any common misconceptions or regulatory risks around your current process. Then you could ask (or volun-tell) different staff members during your daily huddles to give mini in-services or competency demonstrations regarding things such as determining chemical indicator pass/fails and proper chemical integrator placement within the surgical tray. While not every staff member may be excited about public speaking, and teaching like this, it’s been well proven that being able to explain concepts to others is a key marker that we understand the concept ourselves. So this model is as much for the staff member doing the demonstration, as it is for the rest of the staff who may be listening.
A side benefit to engaging your frontline technicians in competency demonstration and discussions like this is that you are likely to surface areas of competency gaps and non-standardized practice that can then be addressed with additional feedback and education. Learning about those gaps on a regular basis throughout the year is a much better scenario than having it come up 11 months after that practice has already taken hold in your workflow.
One final idea to add into this creative competency mix is actually one of the high points of my Sterile Processing leadership career – hosting a department Olympics event. The idea is fairly straight-forward (though quite a bit of work to implement within a large-scale department). Instead of simply sitting down for a verbal competency review each year, or even observing technicians during their daily workflows on a standardized checklist, Sterile Processing Olympic events can be developed to measure the exact same thing, but with a fun, competitive flair. Here are a few examples of “events” that provide for this unique blend of creative competence review:
- Battery Wrap Race: Time technicians in *compliantly* wrapping 5 surgical power batteries – including indicators, wrap, and packaging tape. (This measures competency in wrapping techniques, indicator placement, and tape utilization)
- Nit-Picking Needle Holders: Gather 10 – 12 surgical needle holders with different levels of functional damage (chipped inserts, cracked box locks, faulty ratchets, etc.). Lay them out on a numbered grid and time technicians for how quickly and correctly they can identify the specific damage on each device. (This measures competency around instrument identification, functionality testing, and quality assurance).
- Eagle Eyes Documentation Check: This event would involve printing screen shots from your electronic tracking system (such as sterilization loads, temperature & humidity checks, etc) with a handful of intentional errors and omissions within it. The goal would be to see if technicians can identify all documentation issues within a given time frame (This measures competency around documentation requirements for various aspects of the department).
Regardless of what you do differently from the traditional model of the “annual competency avalanche” in Sterile Processing, the key is to step out of the office and make those bullet points come alive for your technicians. You don’t have to be a natural event planner or compliance guru yourself, but you do have to set the paper down and dream a little. Just make sure you pull in your technicians to do a little competency dreaming with you. You might be surprised what kind of creative competency strategies your team comes up with!