Chapter 20 quality

Chapter 20

Define “quality” in the context of Central Service operations, and tell how to identify it

Describe components in a quality Central Service program

Discuss quality control indicators:

◦ Administrative indicators◦ Customer satisfaction indicators◦ Technical indicators

Explain the basics of Failure Mode and Effects Analysis and Root Cause Analysis

Discuss common quality programs:◦ Quality assurance and process

improvement◦ Continuous quality improvement◦ Total quality management◦ Other quality programs and standards

Review quality procedures in the Central Service Department

Physicians, Nurses and professional personnel served by Central Service staff members

To be successful, Central Service Technicians must look at what they do from their customers’ perspectives

The degree or grade of excellence of a product or service The consistent delivery of products and services according

to established standards Quality is not a Quick-Fix Achieving World-Class Quality requires a multi-year plan. Top Level Administrators must emphasize and support

Quality Quality requires effort from everyone in the facility

EmpowermentLeadershipStandard DataPlanning Tools and Procedures

Staff MembersProcess Management

The act of granting authority (power) to employees to make decisions within their areas of responsibility

Decisions that may have been made by managers in the past are made by front line employees and supervisors. In other words, those most familiar with the details of the process

Define standards to be attained

Help:◦ Manage Data◦ Plan Opportunities◦ Establish Priorities◦ Empower People

Help create and maintain standards Ensure that coaching occurs daily for all

employees Set Priorities Undertake problem-solving and quality planning Be responsible for error-proofing Address three types of error:

◦ Inadvertent◦ Intentional◦ incompetence

Department Leaders, Shift Supervisors, Lead Technicians should be first line “Guardians” of the quality program

All employees should adhere to standards are priorities set by managers

Should help their teammates follow established guidelines

Financial Data Organizational Data (i.e. Turnover

Data) Patient and Employee Satisfaction

Levels Number of Defects Cycle Times

Collect

Compile for Analysis

Reduces Existing Problems

Prevents Potential Problems

Identify Factors that are important to customers

Study the competition

Do everything better than (or at least equal to) the competition

Remember that the process (not people) is the cause of most problems

Think about how to improve

1. Identify needs and requests of the department’s customers

2. Identify an ideal process to consistently address each need/request

3. Compare actual steps and outcomes for each process to the ideal outcome. (for example, 100% error free trays)

4. Plan process control activities to improve the system

5. Measure Defects. With a good process the defects should decrease

Define traits of successful employees

Provide employees with knowledge, skills and tools

Empower employees to participate in solutions

Patient Focus

Process Management

Continuous Quality Improvement

Fact-based Decisions

Senior leaders must be involved in process management

Studying processes is critical

Process problems cause defects

Reducing defects increases quality and helps meet quality standards

Administrative Indicators

Customer Satisfaction Indicators

Technical Indicators

What do we do?

How are we doing it?

Response time for STAT requests No outdates Sterilization Quality Assurance Monitors Correct and Complete Instrument Sets Customer Satisfaction Levels Availability of Patient Items Logging and Documentation Flash protocols are followed Case Cart contents are correct

Regulated by policies, procedures and other administrative actions to assure safe and efficient departmental operations:

◦ Management Control Monitors◦ Inspection Control Monitors◦ Facility Meeting Information

Department Management

Policies & Procedures

Training and Education System

PoliciesProceduresWork Assignment Lists (with expected timelines and outcomes)

Written documentation helps assure consistency

A technical, statistical sampling method that measures the quality of production.

Technical, statistical sampling which measures the quality of production

“Checks your work”

MeasurablePerformed Regularly

“Relates to an outcome of patient care or employee safety”

Inspection of a sample from a larger lot to decide whether the lot should be accepted

A table of numbers generated in an unpredictable, hap-hazardous sequence that is used to create a random sample

Safety Inspections

Regulatory Inspections

Accreditation Surveys

Committee Minutes

Safety Committee Information

Infection Control Committee Information

Staff Meeting Minutes

SpeedAccuracy

Customer Surveys

Incident Reports

Tray Cards

Customer Complaints

Staff Complaints

Process control measures utilized to assure that planned technical conditions within sterilizers and aerators are met

Should be used in all areas that perform sterile processing, including sterilization activities that occur outside of Central Service

Mechanical Indicators Chemical Indicators Biological Indicators

FMEAFailure Mode and Effect Analysis

A process designed to predict the adverse outcomes of various human and machine failures to prevent adverse outcomes

RCARoot Cause Analysis

A process that “looks backwards” at an event to help prevent its future

occurrence

A comprehensive and measured effort to provide total quality. Also a technical, statistical sampling method that measures production quality

The strategy of finding solutions to eliminate the root causes of process performance problems

The concept of measuring the current output of a process or procedure, and then modifying it to increase the output, increase efficiency, and/or increase effectiveness

Input Throughput Output Outcome

Recognizes that improvement can occur with individuals, teams, organizational units (departments) and the organization itself

A quality process which applies statistical methods to improve work processes.

CQI Audits:◦ assist in assessment and identification of

problems◦ promote communication

A quality process that focuses on delivering near-perfect products and services

Six Sigma Goal: Deliver high performance, reliability, and value to the end customer

DefineMeasureAnalyzeDesign Verify

DefineMeasureAnalyzeImproveControl

Industry-Driven Organization

Ensures standards are set, monitored, and maintained

Routine or unannounced inspections (called surveys) are used to monitor a healthcare facility’s performance

Award given by the American Nurses Credentialing Center to hospitals that satisfy factors that measure the strength and quality of nursing care

International Standards Organization

An international standard used by participating organizations to help assure that they consistently deliver quality products and services

Always wear PPE Disassemble all items that are meant to

be disassembled Measure Chemicals properly Load and operate washers properly Follow procedures Clean as you were trained to Check equipment before using to insure

it is working

Check for holes and lint when using linen

Check for holes in all disposable wrappers and filters

Never use a wrapper, filter, or instrument that has fallen on the floor

Always follow count sheets Check instruments for functionality,

cleanliness, alignment, proper assembly and sharpness

Always load sterilizer carts as trained

Always verify mechanical and chemical indicators after each sterilization cycle

Do not touch sterilized items until cool

Properly complete all documentation

Always follow established pick sheets

Check product packaging for holes, expiration dating, and appropriate color changes

Carefully load items on shelves, carts, and other storage units to ensure they stay intact

Pay attention to what you are doing. Avoid distractions like excessive talking, loud music, etc.

Don’t do anything that you haven’t been trained to do If you are unsure about a completed project, ask someone to check

your work If you get distracted, check the entire project to ensure it was done

correctly If you can’t perform at 100%, don’t do the project. Don’t start

projects that you can’t finish Re-check all work Remember, neatness counts! Always help other staff members, even if they don’t think they need

help If you think something is wrong, speak up Report inoperative or damaged equipment

Attend all the educational in-services, seminars, infection control, service technician, and vendor-sponsored programs that you can. The more education you can obtain, the better Central Service Technician you will become

Always follow the rules Question anything about which you are

unsure