As a traveler you get accustomed to listening to every facilities “normal” behaviors and processes that seem quite abnormal to anyone else. As with anything in life, what you have experienced and seen has a drastic impact on what moral code you encompass as well as what you believe is morally acceptable. Spending time in the first few weeks just to learn the methods of each facility is very typical.
Arriving at the board and seeing lots of ortho and plastics. I am assigned to do breaks, and so my morning begins. Arriving to each room realizing that the same struggles are unfolding, disgruntled surgeons from long turn overs, disgruntled staff with contaminated instrumentation, and sterile processing hiding in the basement avoiding all the madness. Each room has wet pans, no filters, or bone left on instrumentation. There seems to be no real accountability for sterile processing, so instead of fixing the problem downstairs, it is placed upon the circulator to “flash” instruments in our autoclaves upstairs.
Flashing is something that has been phased out of most operating rooms, even as far as removing the physical machines so we have no access to them. This involves a rapid steam cycle in a pan to rapidly sterilize that instrumentation. This is a much quicker way to get an instrument sterilized, but is not considered standard of care, and has much higher risk of infections post op from this approach. Yet this facility is using this as a standard turnover for total joint instruments. Instead of buying more instrumentation to be able to properly sterilize it, utilizing the flashpaks all day long. My mind was blown, inquiring gently to the staff to see if this is in fact their normal, and it was validated.
I arrive in a plastic surgeons’ room, Dr H, and he is complaining about turnovers, I expressed to him the issue with the instrumentation being contaminated. I express to him that sterile processing is turning it over, but they are trying to flash it as well, but I add in “that is not standard of care”. To which he inquires about my statement, and I explain to him the issue with flashing instruments, and the risk of infection and that it is not standard of care for patients. Dr. H immediately gets hot, walk straight into the director’s office, and begins inquiring to her about my statement. Uh oh, I started some shit I thought.
Dr. H returns to the room to let me know that “the director said it’s okay”. I laughed, and just told him “These are your patients and your outcomes you are responsible for”. At that point my phone rings, it’s the director, she lets me know to go ahead and get the patient, and use whatever instrument pan came up first, the flashpak one or sterile processing pan. I do as I am told and get the patient and get the case started, the entire time knowing that what I said is in fact correct, but the culture here is speed over safety, cost containment over appropriate instrument purchases, until something bad happens.
The very next week I arrive at the board, with chaos ensuing. Charge nurses are standing at the board, director is as well, that’s when you know it’s real serious for them to leave their desks. I whisper around to try to find out what the problem is, when I catch just an issue with Dr. H’s room. Charge makes eye contact and asks me to go to Dr H’s room and lend a hand in any way possible. I sigh, while I want to know what’s going on, the second I step foot in that room, I know my name will now be logged into the chart, and I may be caught up in a lawsuit.
I arrive at the room, feeling an immediate heaviness in the air, I make eye contact with the scrub who is one of my good friends, her eyes are wide. I ponder my approach in the room, do I remain quiet until someone speaks, do I speak and break the ice? I approach my friend and ask her “what can I do for you?”. When Dr. H, begins his tirade from across the room “what you can do for me is let the director know she gets to go tell the family that these lipo cannulas were used that had bioburden (old blood and tissue) from the last use!”. I was immediately mortified, this patient had come in for an elective surgery, to do something for themselves and was essentially injected with another patient’s gunk. What would be the recoil from this?
Dr. H breaks scrub and takes off out of the room. I quickly gathered any information from the room, who all looked defeated. It appeared that sterile processing had not flushed the cannulas after the last use. So the first couple of passes Dr H made on the fat, black/red gunk came out instead of yellow fat. Dr. H was out at the board demanding answers, answers that won’t change the situation. Answers to the complete lack of accountability and responsibility of a department that has now failed a patient and a surgeon. That’s when the game of pass the buck begins, the room should have flushed them as well, the room should have pre-flushed them prior to use. All of these get us nowhere and still leave us with the problem of no accountability, as well as the casualness of mistakes that can change a person’s life.
While at that facility I observed so many egregious errors in instrumentation and seen not one change to take accountability for the potential danger the patients have experienced. At the end of the day, every mistake has a cost, every sloppy choice comes with a consequence, I hope no patients were hurt in these sloppy cheap choices, although I know there are some out there.