A Work Systems Analysis of Sterile Processing: Sterilization and Case Cart Preparation.
Systems Engineering Initiative for Patient Safety
Work systems analysis
case carts preparation
instrument reprocessing
sterile processing
sterilization
Journal
Advances in health care management
ISSN: 1474-8231
Titre abrégé: Adv Health Care Manag
Pays: Netherlands
ID NLM: 101090746
Informations de publication
Date de publication:
24 Oct 2019
24 Oct 2019
Historique:
entrez:
21
2
2020
pubmed:
23
2
2020
medline:
25
2
2020
Statut:
ppublish
Résumé
Achieving reliable instrument reprocessing requires finding the right balance among cost, productivity, and safety. However, there have been few attempts to comprehensively examine sterile processing department (SPD) work systems. We considered an SPD as an example of a socio-technical system - where people, tools, technologies, the work environment, and the organization mutually interact - and applied work systems analysis (WSA) to provide a framework for future intervention and improvement. The study was conducted at two SPD facilities at a 700-bed academic medical center servicing 56 onsite clinics, 31 operating rooms (ORs), and nine ambulatory centers. Process maps, task analyses, abstraction hierarchies, and variance matrices were developed through direct observations of reprocessing work and staff interviews and iteratively refined based on feedback from an expert group composed of eight staff from SPD, infection control, performance improvement, quality and safety, and perioperative services. Performance sampling conducted focused on specific challenges observed, interruptions during case cart preparation, and analysis of tray defect data from administrative databases. Across five main sterilization tasks (prepare load, perform double-checks, run sterilizers, place trays in cooling, and test the biological indicator), variance analysis identified 16 failures created by 21 performance shaping factors (PSFs), leading to nine different outcome variations. Case cart preparation involved three main tasks: storing trays, picking cases, and prioritizing trays. Variance analysis for case cart preparation identified 11 different failures, 16 different PSFs, and seven different outcomes. Approximately 1% of cases had a tray with a sterilization or case cart preparation defect and 13.5 interruptions per hour were noted during case cart preparation. While highly dependent upon the individual skills of the sterile processing technicians, making the sterilization process less complex and more visible, managing interruptions during case cart preparation, improving communication with the OR, and improving workspace and technology design could enhance performance in instrument reprocessing.
Identifiants
pubmed: 32077655
doi: 10.1108/S1474-823120190000018008
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : AHRQ HHS
ID : R03 HS025538
Pays : United States
Informations de copyright
Copyright © 2019 Emerald Publishing Limited.
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