The change challenge experienced by the Sterile Processing unit was a change to the processing of Intraocular instruments.

1. There was a sense of urgency once it was discovered that enzymatic cleaners were still being used to clean the cataract sets.  The risk of patient injury/blindness is documented with the occurrence of TASS (Toxic Anterior Segment Syndrome) if instruments aren’t properly processed.  Outside perspective came from the numerous position statements from the Ophthalmology specialties as well as memorandums/directives internal to the Veteran’s Administration. Previous management had not made the necessary changes to practice.

2. I was able to obtain the support of the OR Nurse Manager, the Infection Control Preventionist, and Patient Safety Manager as well as my Nurse Executive.  The change difficulties came from a couple of staff members who doubted the validity of my research.  They were assured that this change was required and the research information posted and shared with the entire staff. The benefit to our department and surgery is best practice for patient care.

3. The key reason for change was to eliminate the danger of serious ocular damage to patients.  The merit of enzymatic detergent use is far outweighed by dangers if instruments aren’t  rinsed properly and thoroughly.  Knowing I had to institute the change as quickly as possible required setting up the mechanical aspects of the change (having a new eye wash cycle and pump installed  on our washer/disinfector and ordering the appropriate detergent were the easy actions).  Asking the staff to be flexible, patient, and open to the necessity of changing their practice was more difficult. There was a period of time where instruments had to be hand washed and rinsed and questions about exactly which instruments needed to be kept out of enzymatic detergent repeatedly came up.

4. Communication was essential throughout the process.  From identifying the concern initially  to applying the changes physically to the equipment.  Then to  teaching the staff the required change in practice, with a strong educational component.

5. The leader from the OR is well known to the SPS employees and had more credibility with the staff since I had only been in my position for 2 months when I found that change was needed.  It was an autocratic type of change, necessitated for patient safety.  I had to empower myself to believe that I was correct in my knowledge once I found out the practice being followed was incorrect (in the face of the challenges from the staff that they have always “done it this way”).

6. The transition wasn’t seamless, but did proceed quickly and we have total compliance at this time. There are still areas to work on with our eye instrument processing.

7. Now that we have targeted the cleaning and disinfecting portion, we have an ultrasonic washer that will be the next step.  And we will continue to evaluate and cement our new processes.

8. We had a successful transition.  I have more confidence in myself, the staff learned new best practice.  They are always open to doing the best they can for the Veteran’s they take care of.  Once they realize it’s not about them, it’s about  the patients, things progress more smoothly!