Reduce Repairs and Cross Contamination

1. In an effort to provide information in a concise and eco-friendly format Please print these slides as a companion to the presentation

2. Reduce Repairs and Cross Contamination For Flexible Endoscopes

3. The Joint Commission • PI 1.10 The hospital collects data to monitor its performance. • PI 2.10 Data are systematically aggregated and analyzed. • PI 2.20 Undesirable patterns or trends in performance are analyzed. • PI 2.30 Processes for identifying and managing sentinel events are defined and implemented. • PI 3.10 Information from data analysis is used to make changes that improved performance and patient safety and reduce the risk of sentinel events. • PI 3.20 An ongoing, proactive program for identifying and reducing unanticipated adverse events and safety risks to patients is defined and implemented. • EC 6.10 The hospital manages it medical equipment risks. • EC 6.20 Medical equipment is maintained, tested, and inspected.

4. TJC - Orientation • HR.2.10.2 The organization orients staff to the identified key elements prior to the provision of care, treatment, and services. • HR.2.10.5 As appropriate, staff orientation addresses organization wide polices and procedures (including safety and infection control) and relevant service or program specific policies and procedures. • HR.2.20.2 Staff can demonstrate actions to eliminate, minimize, or report risks. • HR2.20.4 Staff can describe or demonstrate reporting processes for common problems, failures, and user errors.

5. Objective Specific Measurable Comprehensive Clinically Valid Relevant Efficient Indicator Qualities

6. Steps for Process Improvement

7. Process Improvement Using the Nursing Process Applied to Endoscopes Assessment Understand Inventory & Utilization Proactive Inspections Diagnosis Departmental Evaluation Repair Histories Outcomes ID Goals Setting Planning Tailoring Educational Needs Modification of Processes/Staffing Infrastructure Modifications Implementation Targeted Education Competency Validations Evaluation Quarterly/Annual Reviews Evidence Basis for Practice Changes

8. Process Improvement • Inventory • Proactive Maintenance Inspection • Departmental Evaluation • Process, People, Infrastructure • Tailored Education • Cause, Effect, Prevention • Competency Validations • Quarterly Trend Analysis • Annual Review and Goals Setting

9. Data Collection/Assessment Understanding Inventory & Utilization • How many of what type of scopes? • How many of what type of procedures? • Too many? • Too few? • Favorites?

10. Utilization Calculations

11. Utilization Calculations

12. Data Collection/Assessment Understanding Inventory & Utilization • How many AER bays? • Asynchronous operation? • Type of chemical? • Chemical exposure period? • Staffing mix

13. Data Collection/Assessment Proactive Maintenance Inspections • Endoscopy Team • Pre-procedure function checks • Leak tests • Equipment Repair Provider • Performance standards

14. Tabulate Data/Diagnosis Repair Histories • Cost per procedure associated with repairs • 3 most expensive repairs • 3 most frequent repairs • Changeable – quick, simple, inexpensive

15. Expense Fluid Tube Replacements CCD Chips Frequency Efficiency Angulation Channels Tubes Fluid Tabulate Data/Diagnosis Repair Histories

16. Expense Fluid Tube Replacements CCD Chips Frequency Efficiency Angulation Channels Tubes Fluid Tabulate Data/Diagnosis Repair Histories

17. Leak testing Cleaning Disinfecting Drying Tabulate Data/Diagnosis Departmental EvaluationProcesses People Infrastructure • Storage • Transportation • Set-up • Utilization • Pre-cleaning

18. Storage • Cabinets that are tall enough for scopes to hang freely • Made of easily cleaned materials • Hangers that support the control body • Water resistant caps off • EtO Venting caps on • All function valves stored separately • Angulation and stiffness in neutral

19. Transport & Room Set Up • Carried in large loops • Support and protect • Covered containers • Minimal stacking • Pre-function checks • Ergonomical tower set up • Pre-cleaning

20. Leak Testing • Same rules as transport apply to sinks • Pressurize before submersion • Full submersion is key • Stress angulation knobs, buttons, & bending section • Remove from water • Depressurize

21. Manual Cleaning • Concentration of enzymatic solution • Enzymatic soak time • Appropriate brush sizes • Appropriate adapters and attachments • Check condition of all equipment

22. Reprocessing & Drying • Proper placement in tubs • Thorough rinse • Prompt removal upon completion • Flush with alcohol • Flush with air carefully • Hang to dry

23. Cause Effect Prevention Risks Benefits Alternatives Consequences Damage & Cross Contamination

24. Implementation • Make modifications in infrastructure • Revise policies &/or procedures • Inservice staff as to cause, effect, and prevention of repeating repair issues • Validate competencies of staff

25. Lessons From a Physicist • “We cannot solve our problems with the same thinking we used in creating them.” • “Insanity is doing the same thing over and over and expecting a different result.”

26. Indicators • Repair costs per case • Reduction in number of repairs by type • Episodes of procedure delays based on functional scope lack of availability

27. Outcomes Identification • Set goals with the end in mind • Where would you like to be at the end of the process?

28. Episodic Monthly Quarterly Annual Staff Equipment Training Budget Evaluation

29. Your Questions Thank You!