Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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ing and — with the help of instru- ment tracking software — deter- mines where the set was last used and who last used it, then calls the OR supervisor. Often the missing piece is found misplaced with an implant set or in a tray for a different instrument set. Depending on the model, tracking software employs barcodes, RFID tags and etched markings to help staff locate specific tools in minutes. They're also helpful in monitoring wear and tear on instru- ments and can help improve the accuracy of case- costing analyses. At Johns Hopkins, all instrument sets are scanned before being used in the OR, when they arrive at CSP for reprocessing and again at the decontamination area. "If something is missing, we can go back to the assembly person, frontline clini- cal staff or reprocessing tech at the decontamina- tion area to ascertain the instrument's location, or what happened to it," says Ms. Gentry. Meanwhile, the OR staff determined that the best way to prevent the loss of items on their end was to count the items in each power set before and after they were used in each case. At first, there was pushback, but it was quickly allayed, because the counts take only a minute or two. "The reality is that most drill sets have four or eight parts — the one we have with the most com- ponents has 21 parts, so while the idea of the counts seemed onerous when suggested, it really wasn't a big deal," says Ms. Gentry. 5. Conduct ongoing monitoring Drift can occur from newly implemented practices, so be sure to monitor your staff's compliance with updated instrument care protocols. Leadership at Johns Hopkins audited the counts and contents of the power tool sets to make sure the new protocols were being followed, but the oversight effort was discontinued shortly after it started as compliance was high almost immediately. Ms. Nack attributes the high level of compliance to not only the better organized instrument containers, but to the higher level of communication and collaboration between the ORs and CSP. The two departments continually meet to foster a climate of cooperation and trust. Understanding what pressures the other department faces each day helps. In addition to the instrument committee meetings, new SPD employees visit the ORs as part of their orientation process. "We send the new CSP techs to the ORs to understand the complexity of what the OR staff faces, from sharing the power tools among all the ORs to simply seeing the enormity of the tasks they face each and every day," Ms. Gentry says. The ongoing interaction helps CSP understand how cleanups during and after cases are never-end- ing issues for OR staff. The rush to turn rooms over quickly can result in mistakes such as losing a part to a power tool kit. They can be left on mayo stands and wind up in the linen or the trash at the end of the case, meaning they're lost forever. CSP, meanwhile, is charged with following increasingly meticulous, complex and time-con- suming IFUs from manufacturers in order to deliv- er sterile instruments to ORs to ensure safe patient care. In addition to being told to take their time and get it right, they're also told to hurry up from anxious OR staff who want their cases to begin on schedule. On the same page Implementing these steps at Johns Hopkins signifi- cantly improved the hospital's instrument repro- cessing \practices — only three power tool pieces went missing in the first six months after the new protocols were put in place. When surgical team members and central sterile techs began to under- stand the other department's perspectives, they worked together to dive into the causes of the miss- ing parts and were open to brainstorming solutions together. OSM 6 8 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 2 0 Our successes started when we began to communicate and collaborate. — Carol Gentry, MSN, RN, CNOR