3 innovative quality improvement project ideas for ASCs
Immediate use sterilization overhaul uncovers QI feedback loop
"Immediate-use sterilization was a huge challenge for our surgery center. Our center had continued with outdated [sterilization] practices until about 2012," says Angie Blankinship, RN, BSN, CASC, administrator of Longmont (Colo.) Surgery Center. Staff members hadn't attended industry events with updated practices, and it showed. Once the center started a campaign to improve immediate-use sterilization processes, staff was able to revise the process and improve the practice.
However, revision was more involved than a simple educational change. Longmont Surgery Center's case mix is nearly half ophthalmology, and the improved immediate-use sterilization protocols revealed an important detail: "We found we were 'flashing' to make up for the fact we didn't have the inventory we needed," says Ms. Blankinship.
Surgery center staff quickly made rebuilding inventory a priority, calculating the number of necessary instruments and executing the supply purchase to reach compliance. The correct number of equipment sets also improved their immediate-use sterilization rates dramatically. Longmont Surgery Center now monitors sterilization practices; only eligible manufacturer-approved instruments are sterilized by immediate-use sterilization, and they have the equipment necessary to do their jobs, according to Ms. Blankenship.
Documenting variances to practice
Baxter, Minn.-based Brainerd Lakes Surgery Center has a program to document what they term "variances to practice." If a practice is performed in a way that differs from documented policy, whether or not that alteration is adverse, it is recorded. "We feel that it is important to document all of these [changes to the routine]," says Sandy Berreth, RN, MS, CASC, administrator of the center, of the practice, which allows her to keep track of compliance issues and the evolution of center routine.
Infected? Ask the patient
Also at Brainerd Lakes Surgery Center, they have initiated an extra protocol to identify and track potential infections. "At one month, we call the patient to determine if [he or she] has been seen for any infections, not only at the surgical site, but anywhere," says Ms. Berreth. Implant patients receive an additional call at 90 days to check for infections, which is a proactive way, compared to most infection control standards, of screening for potential infection control issues.
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