AORN JOURNAL APRIL IOY?, VOL 55. NO 4

Take Charge GETTING THE TECHNICAL INFORMATION YOU NEED

Marimargaret Reichert, RN

imple instrumentation that required mini- mal instruction (Fig 1) has been replaced S by complex devices and systems that

require instructions for setup, use, disassembly, cleaning, inspection, reassembly, and steriliza- tion (Figs 2 and 3). Procedures such as standard cholecystectomies are no longer routine and familiar to the perioperative nurse. These now are very specialized procedures performed through fiberoptic endoscopes with videotape and laser support.

This changing technology has created vol- umes of information perioperative nurses must

Marimargaret Reichert, RN, MA, is president of Reichert and Associates Consulting Firm, Concord, Ohio. She earned her nursing diplo- ma at Blockley School of Nursing, Philadelphia General Hospital. She earned her bachelor of science degree in business administration at St Joseph’s College, North Windnm, Maine, and her master of arts degree in technical educa- tion at the University of Akron (Ohio).

know. Few nurses are expected to be familiar with the technical equipment and devices used in every department of the hospital; yet periop- erdtive nurses are expected to be familiar with the technical equipment, products, and instru- mentation used in all surgical specialties. How often does one staff nurse seek help from anoth- er? How often is a procedure delayed until someone who can help set up the equipment is found? How often do nurses say there is not enough time to keep up with the changes’?

Because of the current explosion of new technology and its accompanying products, equipment, and instrumentation, perioperative nurses need educational resources and producl- use instructions that are concise, convenient, and easy to follow. These tools will help change nurses’ feelings of anxiety and frustra- tion to feelings of confidence and competence.

This article illustrates the resources needed to promote perioperative nurses’ feelings of competence and identifies ways to influence manufacturers to provide these necessary instructional tools.

Resources

erioperative nurses need methods and tools to quickly ass imi la te product P instructions to

correctly use a product, reduce the number of problems associated

minimize the resources needed to trou- with misuse of the product, and

bleshoot and solve problems.

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Information in a self-teaching format is most effective. Optimally, the program should be no longer than 10 minutes; longer topics should be broken down into short segments. Instructions should mini- mize the use of text. Vocabulary must be in the clinical context. Directions support- ed with technically correct illustrations will increase the probability of correct interpretation. Additional support tools such as training videotapes and abbreviat- ed reference sheets often are needed.

Product-use instructions. Instructions for product use should be written by some- one who is familiar with both the product and the clinical environment in which the product will be used. Instructions should be technically correct, appropriate for the clinical environment, and supported by recommended professional practices. I

Reusable devices should have directions for cleaning, preparation, and disinfection or sterilization. These procedures should be tested by the device manufacturer to ensure that they will produce the desired results.2 Directions for reusable devices should include

Fig I . Traditional major laparotomy instrument sets were relatively simple.

0 disassembly instructions; 0 type of cleaning products to be used; 0 warnings; 0 preparation instructions, including

Fig 2. Total joint implant instrumentation is more complex.

lubrication (ie, type of lubricant and quantity), reassembly (ie, how to check for correct assembly), checking of gaskets or seals, and measurable inspection criteria; and sterilization instructions, including type (eg, steam, ethylene oxide, liq- uid chemical), method (eg, gravity displacement, prevacuum, pulsating vacuum), wrapping guidelines, and exposure time and temperature.

The complex medical devices and instrument sets introduced during the past few years have created an additional need for sterilization validation testing. Sterilizing complex instruments using the gravity displacement method generally

Fig 3. Nurses require knowledge to properly assemble expensive, complex rigid endoscopic instrumentation.

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APRIL 1992, VOL 5.5. NO 3 AOHN .IOURNAI,

requires extended exposure times for the steam to mix with the air trapped in the numerous crevices in the instruments. For example, the irrigating instruments now used in laparoscopic cholecystectomies require removal of the cap and may need distilled water placed in the channels.3 Complex devices may need to be disassembled for flash sterilization in the OR. Instructions for reusable devices should be sup- ported with a testing information report. The information needed in this report is listed in Table 1.

Videotapes. Many manufacturers provide videotapes with their products. These video- tapes provide an overview of the advantages of a product, instructions for the use of the prod- uct, or instructions about the care and handling of the product.

A videotape used as a sales tool provides an overview of the advantages of the device and is intended to sell the product. After the product is purchased, users need an instructional video- tape that contains the necessary information to use the product correctly.

Some manufacturers combine sales promo- tions and user instructions in the same video- tape. This mixture of information usually falls short of providing adequate user instructions. Just as with written instructions, the informa- tion in the videotape should be technically cor- rect. The credibility of information is ques- tioned when videotapes portray inappropriate practices or technical errors.

Quick reference sheets. A quick reference sheet is a resource located at the point of use and is used by employees who have been trained but need a quick review to perform the task correctly (Fig 4). These sheets are helpful because all the information presented at in-ser- vice programs is not always retained. Most sur- gical staffing patterns cannot accommodate a repetitive learning process for each staff mem- ber.J The quick reference sheet facilitates quick review of the key points needed to perform the task correctly.

Wall-mounted reference tools are of little use when they are rolled up and stuffed in a book- shelf or behind a desk because there is no wall

Table 1 Data for Medical

Device Testing Report

Date issued: Report issued by: Name of device: Series or model number:

Objectives: This section should con- tain the ob.jectives of the study or why the study was done. The primary reason is usually to prove something (eg, materials compatibility, microbiocidal effectiveness of a recommended pro- cess, removal of toxic chemical residues). Another reason may be to provide additional information or to update an existing study.

Materials and methods: This section should include the materials used for the study such as

the type of medical device, the type and brand name of the

0 the type and brand of equipment, the type and number of organisms

the type of innoculation, 0 how the test was performed, and

recovery process used.

disinfectant/sterilant,

used for the test,

Illustrations: Illustrations are valuable in demonstrating how the device was innoculated or placed in the equipment.

Results: Results of the testing should be presented with tables, graphs, or illustrations.

Conclusions: What does this mean to the user? Does this study support cur- rent practices'? Should practices be changed based on the results of this study?

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Fig 4 . Laminated quick reference sheets with operating instructions can be attached to equipment and are an accessible reminder.

Fig 6. Support products for one type of joint implant.

Fig 5. Two laser units show the differ- ences in similar pieces of equipment.

Fig 7. One of five trays for a total joint implant.

APRIL 1992. VOL 5 5 . NO 4 A O R N J O U R N A L

space or because there are no walls at the point of use. Printing the key operational steps on the equipment or designing small laminated refer- ence sheets with a holder are acceptable alter- natives.

How to Get What You Need

t is time to take charge of your anxiety-pro- ducing environment by developing strate- I gies to control it. Nothing will change if

you only listen to staff members express their feelings of “new technology frustration.” It is time to empower yourself by taking action.

Current products. Start by reviewing current products, systems, or equipment that continue to create problems. Staff members should review instructions, opera tors ’ manuals , instructional videotapes, and quick reference sheets to identify problems.

The format and presentation of product information is as varied as the devices (Figs 5 , 6, and 7). A crucial piece of information may be overlooked because of the varied instruction formats used by different manufacturers. For example, warnings may be highlighted in red, printed in bold text, or indicated by a symbol.

Differences between similar products should be identified. It is common for one facility to have products from several manufacturers of total joint replacement systems. The differences are subtle, but they may create problems for nurses who must know what product to select and how to use it. These problems should be identified to determine the specific instructional and training resources that are necessary to establish competence when using the product, system, or equipment.

Put it in writing. Write to the manufacturer and express your needs. Send your letter to the product manager, and send a copy to the presi- dent of the company. Always personalize the letter and suggest possible solutions. If possi- ble, provide examples of resources that are effective. If the problem can be illustrated (eg, packaging that is difficult to open), take a pic- ture and send it with the letter.

Table 2 Some Questions to

Ask Before Purchasing

1. Does the manufacturer of the device recommend any specific cleaning process, agents, or equipment?

2 . Can the recommended process be per- formed in your department?

3 . Can the device be totally disassem- bled? Are there small pieces that can get lost? Will set screws loosen dur- ing processing?

4. Can small pieces be ordered? Are any special tools needed to repair in- house? Will the device have to be sent out for repair? How much will it cost? How long will it take?

5. Can the device be immersed?

6. Does the device have difficult-to-clean parts? Are special brushes, cleaning tools, or cleaning agents available?

7. Will any cleaning agents or processes harm the device?

8. What are the potential contaminants (eg, blood and body fluids)?

9. Can the device be subjected to an appropr ia te biocidal process in decontaminat ion to pro tec t the employee and the patient?

10. How long will i t take to correctly clean and decontaminate the device?

1 1 . Are the processing instructions tech- nically correct? What kind of educa- tional training tools are available (eg, videotape, manual, reference sheet)?

A O K N JOURNAL APRIL 1992, VOL. 5 5 , N O 3

Network. Talk to your colleagues in the community to determine if the training tools that you are requesting from the manufacturer are reasonable. If you are the only one experi- encing problems, find out what your colleagues are doing differently. If they also are experienc- ing problems, write to the manufacturer as a group.

Group influence carries more weight than one person’s request. Resources are not allocat- ed to appease one person. Network within your local AORN chapter. Professional support and chapter endorsement of the request is a power- ful tool, even if a form letter is sent by all the members.

A letter complimenting the manufacturer for an effective instructional training resource will encourage the manufacturer to continue provid- ing this type of resource. Members of your local AORN chapter also could develop a com- plimentary form letter.

New products. A prepurchase evaluation is an excellent way to methodically review a product and identify the resources needed to effectively and efficiently use this product. Whether the prepurchase evaluation is a formal process in which each request is reviewed by several key people or simply a request initiated by the surgeon and reviewed by the director of surgical services, a list of questions should be developed and answered before purchase (Table 2 ) .

When a product is not methodically reviewed, assumptions about the product can be made. This probably is the most critical prob- lem because a patient may be compromised, a product could be damaged, an employee may be hurt, or the environment could be compro- mised if a product is not used properly.

Summary

frustration and anxiety with new technology will never change unless you take charge and communicate your needs to manufacturers. Tell them what you like about a product and, just as important, how to make i t better. Tell them what resources are needed to minimize the anx- iety and frustration associated with using their products. ri Notes

I . M Reichert, T Schlotterback, J Young, ”ln- Hospital Processing of Reusable Medical Devices,” .lournu1 of Hrulthcure Materiel Mtrnugenient 4 (March/April 1986) 29-46: AORN S[atrilulds und Reccrmtrrended Pruc~tic~es f h r Perioperutiw Nur.siny (Denver: Association of Operating Room Nurses, Inc, I99 I ); AAMl Stundards und Ki~c~onrnretrtlcil Prui.tices 2 (Arlington, Va: Association f o r thc Advancement of Medical Instrumentation, 1990).

2. E A Reed, P M Schne ide r , R Kralovic , “Powered surgical instruments,” AORN J~~rmraI 4 I (January 1985) 250-268.

3 . J J Perkins , P r i n c ~ i p l r s irnd Mrthorls of Strril izution i n Heirltk Sc , icnces . second ed (Springfield, 111: Charles C Thomas, 1969) 107-1 I I .

4. M Reichert, R Blackwood, “Sell talk training: Inservicing new products and procedures more effec- tively,” Journal ($ Hrulthcore Materiel Mutiugemeni 4 (September/October 1986) 1 1 1 - 1 14.

Correction In the article, “NOLF Meeting,” which appears in the February 1992 issue of the Journul, the two women in the photograph on page 600 are identified incorrectly. The caption should read, “Newly elected NOLF officers Vickey Bradley (left), member-at-large, and Marianne Chulay, vice chairperson.” The .lour-nu/ regrets the error.

emember that manufacturers want your business. Manufacturers want to pro- R vide what you need to use a product

correctly. They believe they are meeting that need.

I t is up to you to decide your future. Your

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