Creation of an Annual Competency for Preoperative Patient Skin Antisepsis

Annual competencies are an opportunity for the perioperative educator to demonstrate best practices and to regularly assess the knowledge and evaluate the technique of staff to ensure that policies are followed and best patient care is provided. To do all of this in a streamlined and reproducible manner, so that each staff member is assessed equally, takes proper preparation by the perioperative educator. This article provides an example of how an annual competency for preoperative patient skin antisepsis was created and proctored in a series of steps.

Step One 

The first step was to identify the competency and how it would be evaluated; in this case, preoperative patient skin antisepsis using an alcohol-based prep solution and a povidone-iodine prep solution was chosen. This is a critical function in surgical procedures and is performed on a regular basis, making it necessary to ensure that organizational policies are followed to reduce the incidence of surgical site infections.

Following the established policy on preoperative patient skin antisepsis, an evaluation tool was created, with each step of the process being used as a checkpoint (ie, “performs appropriately” or “does not perform”). To create the evaluation tool, the organizational policy was referenced to properly identify and isolate each step as it pertained to the skill of preoperative patient skin antisepsis. The evaluation tool followed the proper order of steps in obtaining the required supplies, exposing the site to be prepped, establishing a field for prepping (including placing towels to soak up any pooling prep solution), donning appropriate personal protective equipment, scrubbing the expected incision site and surrounding areas, using closed-loop communication for the required dry-time for alcohol-based prep solutions, and disposing of prep supplies according to policy.

Step Two

The second step was to identify the staff members who would need to take part in the competency training. For our training, the staff members who typically perform preoperative patient skin antisepsis, the registered nurses (RNs) in the OR, needed to be evaluated. We created teams of two, comprised of one RN and one surgical technologist (ST). Their roles were divided so that the RN was the “prepper” and the ST was the “watcher.” As the prepper, the RN was tasked with obtaining the required supplies and performing preoperative patient skin antisepsis per policy. The watcher assumed the role of being a second pair of eyes to ensure that the surgical site and surrounding skin/tissue was prepped in its entirety, with the expectation that, if something was missed or contaminated during the prepping process, closed-loop communication would be used to bring attention to the miss. This helped to reinforce a team approach for preoperative patient skin antisepsis and encourage closed-loop communication among the team members for calling out dry time for the alcohol-based prep solution. 

Step Three

The third step was to choose a space and provide the necessary supplies (Table 1) to perform the tasks as needed. An empty OR was identified to allow for enough space for staff to perform or observe the tasks. The supplies were saved throughout the year; wasted clean supplies were continually collected by the education team if a sterile setup had to be torn down for a cancellation or any other reason.

Table 1. Supplies Needed for an Annual Competency for Preoperative Patient Skin Antisepsis

The Perioperative Department has dedicated staff inservice/education time every week for 1 hour, and this time is utilized once a year to complete annual competencies. Due to the nature of the staffing model, two separate times were scheduled (once at the start of the day before any scheduled surgical procedures and once in the afternoon for the staff who are scheduled for later shifts) to allow for all staff members to attend one session and be evaluated for competence.

Challenges

The barriers that were identified after the competency event were that not all staff members were able to attend the one-day session, and subsequent sessions had to be scheduled on an individual basis. Another barrier was time. There were approximately 40 staff members who participated, and with only 1 hour to complete the evaluation, there was less time available to perform preoperative patient skin antisepsis. Because of this, upcoming annual competency sessions will be scheduled over multiple weeks to ensure that the majority of staff are able to attend without the need for individualized evaluations.

Conclusion

The first step in creating a valuable annual competency training course for our staff was to identify what competencies needed to be evaluated and how they could be evaluated on an equitable scale. It also was important to take some time to answer questions regarding who, what, where, and how, to help identify all the components needed to make the competency training go smoothly. 

AORN Resources

Open access:

• Shift Your Competency Mindset | AORN Blog
• Ready to Build Your Competency in Research? | AORN Blog

AORN members can access:

• Strategies to Implement a Competency Assessment Verification Program - AORN Journal

If your facility has a subscription to eGuidelines+, you can access:

• Competency Verification Tool—Patient Skin Antisepsis | AORN eGuidelines+