2Presented by SPSmedical Largest sterilizer testing Lab in North America with over 50 sterilizersDevelop and market sterility assurance products that offer advanced technologiesProvide full day sterilization Seminars and on-site Facility audits for compliance with best practicesCorporate member: CSA and AAMI, serving on numerous sterilization working groups
3Objectives At the end of this program, participants will be able to… create an OR and SPD committee to address case cart concernswrite a plan for implementation of a case cart systemcollect data outlining your facilities specific needs as well as site visits to other facilities with a system already in placeoutline traffic patterns for this new systemselection of proper case carts designs
4How To Get The Most Out of Your Case Cart System Write a Plan Collect data Define the Benefits Define The Implementation Process
5Establish A Joint CS and OR “Case Cart Committee”Take MinutesProvide InputGet Involved
6Writing A Plan Keep it simple: Include the OR in the planning process Determine the when (time frame)Write down what you want to doWrite down why you want to implement a Case Cart systemWrite down how you want to accomplish the task
7Collecting Data Create a bench-marking tool View other facilities that have case carts (CS and OR)Inventory current instrument and tray inventoriesInventory Operating Room supplies
8Collecting Data (continued) Determine the number of surgical procedures a week, month and per year,Define your service areas: OR, Ambulatory Surgery, Endoscopy, OBS, or off-site locationsEstablish distribution polices & procedures
9Benchmarking Tool Site Visited: Number of Hospital Beds: Number of Patient days:Specialty Services:Numbers and types of sterilizers:(ask, do they have enough?)SteamETOSTERRADSTERIS System INumber of Case Carts:Regular carts:Specialty:Stand-by carts (in OR / CS):Number of cases per day, week, & year:Per dayPer weekPer yearNumber of FTE’s (Full time employees):(ask do they have enough?)How many shifts:Supervisors:Lead Technicians:TechniciansService Areas:ORAmbulatory SurgeryEndoscopyOBSERNursing ServiceICU / SCURTOTOther (Do you manage Portable Biomedical Equipment?)
10Defining the Benefits What will you get? Rapid turn-a-round time = $$$ (Operating Room Time)Improved Primary care for the Patient!Reduces Mechanical NursingInventory reduction – ORProduct controlMonitor returnsImproving Infection ControlConstant update of Surgeons Preference Cards
11The Implementation Process Make sure you have measured your space.Define the cart route.Establish dedicated elevator/slide use.Establish communication devices between clean area in CS/SPD and clean area in OR and soiled area etc.Determine numbers and sizes of case carts based on service areas in the OR, i.e., Open Heart, Ortho Minor, Ortho Major, General Surgery or Minor Surgery, or GYN.
12The Implementation Process Determine how many “Stand-By” emergency carts you will need. These will not be used everyday.Establish your inventory for the case carts. Initially there may be some duplication of products, this is normal, until the Operating Room’s confidence level is assured.Move instrument inventories to CS/SPD.Several weeks prior to the implementation, rotate OR Surgical Techs through CS/SPD to work with staff on assembling of the OR trays.Make sure you have tray listings complete and accurate.
13Instrument Count Sheets Should accompany every tray however, they should not be placed inside wrapped trays or rigid containers AORN
14The Implementation Process Design what a complete case cart looks like.Establish locations for every item that is placed on the case cart. No surprises for the OR will earn you their respect.Have policies and procedures written in advance on the OR’s responsibilities in care and handling of instruments and basins.Develop a Case Cart Surgical Procedure form. A form used to communicate between the person who assembled the cart and the person that is utilizing the cart in the OR.
15Case Cart Surgical Procedure Form General Hospital Case Cart Tracking FormDate: 2/6/ Block/Room: Case: Time:Doctor: Dr. Socola DOW: Procedure: Lap Chole? BunionectomyPreference Card Available?: Y / N If No Use:Special Instructions: Dr. Moore will do BunionectomyInstrument Extras: Add Ortho ExtrasName of Person who assembled Cart: ChuckCS Add these Supplies:OR Add these supplies:OR Feed Back: Cart Complete , Good Job!!!Attach to Each Case Cart11:00 AM
16Use the Form to Communicate Information between Departments: For OR:OR add aneurysm trayNeeds 2 packages of hemostatsFor CS:Cart missing Basic Lap Pack Case Cart slips should be routed to CS/SPD Supervisor/Manager
35Case Cart DesignsOpen Cart SystemClosed Cart System
36Case Cart Design Design considerations: Is cart easy to load and unload?Do the doors stay open during loading & unloading?Is the cart the right height and width? It has to fit through all doors.Is the handle well positioned?Do the carts move easily when fully loaded?
37Case Cart Design Construction considerations: Locks and door handles should be flush to prevent doors from opening unexpectedly or catching on doorframesStainless steel shelf edges should be smooth to prevent injury to people and productMake sure there are no metal barbs and that the welds are smooth on the inside and outside of the carts (Both open wire and closed carts)
38Case Cart Design Other Considerations: Cart should be constructed of all stainless steel or plastic componentsSelect a style with drawers to contain small itemsKnow the terms of your warranty, carts wear rapidly if not maintainedMake sure there are at least two breaking wheels
39Open Multi -Tier Cart Large Orthopedic Cases Laparoscopy Cart or Special Procedures cartLow Open Case Cart available with sides and back
40CART TIPS Don’t get them so large, no one can move them.. Medium Upright Closed CartDon’t get them so large, no one can move them..
43The Complete Case CartWe are obligated by the nature of our business and common sense to make the Case Cart Process & System as predictable as possible.Take the guess work out product locations.Take the guess work out of product descriptions.Start picking your cases a day in advance.Make each shift responsible for double and triple checking.All first and second cases must be complete by start time.
44Standardize Your Product Locations Put solutions on the bottom shelf in case of spillage.Place basins and larger like items on the bottom shelf.Place heavy trays, regular trays and containers on the middle or waist high shelf to reduce bending and lifting. (Reduces dragging also)Provide plastic washable bins for placement of small sterile items. Place the bin on the top shelf so you can see the contents.Place linens and surgical packs on the top shelf to facilitate checking and viewing of products.
48Computerized Case Cart Systems… Combine trays, kits, sets, equipment, pharmaceuticals, reusables and stock inventory into a single procedure case cart.The computerized system generates the necessary pick lists for each stocking areaRecords documentation for each cart and provides a case-completion function for charging patients for products used and returning unused items to inventory.
49Case Carts…Case carts control the over-supplying of multiple procedure cases using predetermined preference card settings that identify which supplies are needed on a procedure-by-procedure basis, and which supplies are needed on a case basis.These procedures are also Physician specific. This avoids over supplying redundant items, such as sterile drapes, during multiple procedure cases.
50Equipment ConflictsComputerized systems help ensure: efficient scheduling of valuable, critical hospital equipment by providing conflict reports, which can include any needed clean-up/sterilization time. For equipment that is needed at multiple facilities, a system provides the ability to share the equipment, check conflicts across facilities, and account for transportation time.
51Tray & Equipment Locator Maintains the locations of all of your trays in…REAL TIME!By utilizing Bar Code labels & scanners, you can locate and communicate the location of most all your trays and equipment immediately. Productivity Measurement Tool
52Surgeon’s Preference Cards Requisitions and Pick Lists
53Surgeon's Preference Card Service: Plastic Surgery Orthopedic Surgery General SurgerySurgeon: ______________________________________________________________Glove Size: ____________________________________________________________Procedure(s): __________________________________________________________Position: ______________________________________________________________Prep: _________________________________________________________________Supplies: ____________________________________________________________________________________________________________________________________Instruments: ___________________________________________________________Suture: (include needle sizes) _____________________________________________Medications/Irrigations: ___________________________________________________Dressings: _____________________________________________________________Equipment: ____________________________________________________________Special Preference(s): ____________________________________________________
54Lost Preference CardsThe Surgery preference card function makes it easy to:create generic and physician-specific cards for all types of procedures.promote standardization across physicians and across multiple facilities
55CASE CART REQUISITION Patient:______________________ Procedure Date: 02/02/2002Surgeon: LAZIO, HAWKEYE Procedure Date: 02/02/2002 Case #:2nd Surgeon: Start Time: Room: 25Patient: SMITH, JOHN Radio Station: WLUV Gloves: 8 regMR #: Room Temp: 68FDate of Birth: 10/05/50 Age: 39 Sex: MPROCEDURE(S):INSERTION PACEMAKER TRANSVENOUS; Location: Comments:From Card: Hospital Pacemaker ImplantPREP: Betadine Sol. Comments: Preps before scrubbingPOSITION: Supine Comments:DRAPES: Drape Sheet, Towels X 4INSTRUCTIONS: MEDICATIONS0.5% Lidocaine plain in 10cc syringe with 25ga 1 ½” needle1 ea NACL 1000ccCOMMENTS:Have image availableCrash Cart in roomno Bovie or suction (have available in room)Does not like 4X8s, likes lap spongesHe will prep, inject, then scrubSuture on pacemaker cart18 ga Spinal Needle BD # Pink tip X 2)CORDIS AVANTI #504-60**5FR FEM-ARTERIAL LINE INTRODUCER (available)*********************FOR RE-DOS ADD CULTURE TUBE***************************ADDITIONAL NEEDS:DESCRIPTI ON INITIALS DESCRIPTION INITIALS:______________________ _________ ________________________ _______________________________ _________ ________________________ _________PICKED LOC CODE CDM REF # ITEM QTY HLD QTY COSTDrape CSD L BASIC PACK SET-UP CSD N DRAPE C-ARM
56What Does The Future Hold? Case Cart Locators – Tiny micro chips that indicate every case cart location within a facility.Instrument Tray Locators – Tiny heat resistant micro chips that indicate the location of trays no matter where they are, all in real time.When picking supplies for a surgical procedure, once the surgeon’s preference card is selected, tiny green lights indicate which products to select off the shelf.When products are removed from the shelf, scanners automatically relieve inventory, reorder, and charge thespecific patient.Optical lithograph printers print package and tray contents by passing through a conveyor.
58Purchasing AAMI Standards If your organization is not a member of AAMI, you may purchase the Standards directly from SPSmedical at our member discount. The member discount saves you 40-50% depending on the document.For example:ORDER CODE: AAMI ST:79List Price: $220Member Price: $110
59References & Resources Association for the Advancement of Medical Instrumentation1110 North Glebe Road, Suite 220, Arlington, VAFax:Association of periOperative Registered Nurses2170 South Parker Road, Suite 300 Denver, COCanadian Standards Association5060 Spectrum Way Mississauga, Ontario L4W 5N6 CANADAFax: (416)Certification Board for Sterile Processing & Distribution2 Industrial Park, Suite 3 Alpha, NJ 08865International Assoc. of Healthcare Central Service Materiel Management213 W. Institute Place, Suite Chicago, IL 60610Fax: