Personal care assistants in the operating room are workers who assist the room in getting items to the room that are necessary for the next case, as well as running cultures and helping clean up the rooms. Having a motivated worker with you for the day can really help ease the pressures off the entire room. This day I have been destined to end up in ortho. Ortho is like being in a marathon, where only the surgeon and reps are the winners. The music is usually excessively loud, always banging, and typically everyone is in a great mood.
OR 12, I have a personal care assistant named Tara who has been in shoulders as a PCA for 5 years. What I found odd about this assignment is they have resorted to having the PCA’s scrub in to hold retractors as well as open the rooms. These skills are usually kept to a scrub technologist, who has been through a two year program at a college to teach and train sterile techniques, and the requirements to maintain that for a sterile, safe environment. To make matters worse, when I inquired about the training of the PCA’s I was told they were given “a couple weeks training”. The casualness of that statement hit me totally wrong.
Tara is working hard, trying to get the room cleaned and turned over to impress the surgeon. When I stumble upon an instrument pain that didn’t have locks on the outside of it, which is a no go. If the instrument pan doesn’t have locks, there is no way I can ensure it has been sterilized. I tell Tara that I need to send the shoulder retractor down, as it isn’t locked, and she takes it to the elevator while I get on the phone with sterile processing. Sterile processing answers and immediately deflects responsibility wondering if someone in the room had taken locks off, if, we are sure? Annoyed, I tell them it is coming down and will need another one. The fight between the OR and SPD is universal amongst all OR’s.
Continuing to setup the room and open all the pans we are getting ready for our total shoulder replacement. In walks Tara with a new shoulder retractor pan from SPD, I happen to walk over to her and ask her “why haven’t the locks changed colors?”. She looks at me, like I’m speaking in Greek, with the puzzled look on her face I lift the lock and show her that it is solid orange. She still doesn’t engage, that’s when I tell her…… Ya know when they put the locks on they send them through the sterilizer and the solid lock gets a blue dot on it….. She said she did not know that. I sit in shock, and try to hide it.
Holding on to my shock with Tara, I call SPD and ask for the supervisor. He gets on the phone and I instruct him on what had happened. I had a potentially contaminated pan come to my room, with no locks, sent it back, and instead of properly addressing it, they sent it back up with locks that hadn’t turned. Essentially just put locks on the pan. Was this a test from SPD? Did they think we are that dumb, (apparently some), but I said I would be writing this up and got proper names.
Getting the case started eventually, I sit and think through the response of Tara. The PCA of five years, the person that is tasked to help open instrument pans didn’t even know the basics of making sure the pan was sterile. The very first step of verifying the pans are okay to be opened, she is completely unaware of. Trusting these staff in the room with a scrub tech alone to increase efficiency, and this girl doesn’t even know the basics of the job after five years in one specialty. I decided to casually approach another PCA that just finished his training and inquire if he was educated on the process. This particular guy responded “nobody showed me that” as well.
I decided to approach the nurse in charge and inform her that this was an issue. Explaining what had happened and seeing the look on her face, um okay, information filed in I don’t give a shit please go back to work. Places are pushing boundaries of job roles to get bodies in those roles. Which I am all about growth and development, but the education and seriousness of the job must match. Surgery isn’t casual, these are people’s lives, and if you want PCA’s to scrub in, and open sterile rooms the education must match.
Within two months that room had a contamination issue, where a non-processed (dirty) pan landed on the field for the entire duration of a shoulder replacement. Nobody looking for the indicators, paying attention to their role until the end when someone noticed a wrapper in the trash had tape that hadn’t turned. This resulted in a patient potentially having an infected joint, as well as six-week antibiotic therapy just to try to ensure it wouldn’t happen. Imagine coming out of your shoulder and hearing this? Although in the medical world fault will be fluffed, responsibility of fault will be vague, the hospital will pay for the antibiotic therapy all the while never revealing it was their fault. Maybe with proper training this would have been prevented, proactive versus reactive approach is a lost theory in my field.