Case Cart Systems

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Objectives At the end of this program, participants will be able to… create an OR and SPD committee to address case cart concerns write a plan for implementation of a case cart system collect data outlining your facilities specific needs as well as site visits to other facilities with a system already in place outline traffic patterns for this new system selection of proper case carts designs

How To Get The Most Out of Your Case Cart System  Write a Plan  Collect data  Define the Benefits  Define The Implementation Process

Establish A Joint CS and OR “Case Cart Committee” Take Minutes Provide Input Get Involved

Writing A Plan Keep it simple: Include the OR in the planning process Determine the when (time frame) Write down what you want to do Write down why you want to implement a Case Cart system Write down how you want to accomplish the task

Collecting Data Create a bench-marking tool View other facilities that have case carts (CS and OR) Inventory current instrument and tray inventories Inventory Operating Room supplies

Collecting 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 locations Establish distribution polices & procedures

Benchmarking Tool Site Visited: Number of Hospital Beds: Number of Patient days: Specialty Services: Numbers and types of sterilizers: (ask, do they have enough?) Steam ETO STERRAD STERIS System I Number of Case Carts: Regular carts: Specialty: Stand-by carts (in OR / CS): Number of cases per day, week, & year: Per day Per week Per year   Number of FTE’s (Full time employees): (ask do they have enough?) How many shifts: Supervisors: Lead Technicians: Technicians Service Areas: OR Ambulatory Surgery Endoscopy OBS ER Nursing Service ICU / SCU RT OT Other (Do you manage Portable Biomedical Equipment?)

Defining the Benefits What will you get? Rapid turn-a-round time = $$$ (Operating Room Time) Improved Primary care for the Patient! Reduces Mechanical Nursing Inventory reduction – OR Product control Monitor returns Improving Infection Control Constant update of Surgeons Preference Cards

The 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.

The 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.

Instrument Count Sheets Should accompany every tray however, they should not be placed inside wrapped trays or rigid containers. - 2009 AORN

The 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.

Case Cart Surgical Procedure Form General Hospital Case Cart Tracking Form Date: 2/6/2009 Block/Room: 2 Case: 3 Time: Doctor: Dr. Socola DOW: Procedure: Lap Chole? Bunionectomy Preference Card Available?: Y / N If No Use: Special Instructions: Dr. Moore will do Bunionectomy Instrument Extras: Add Ortho Extras Name of Person who assembled Cart: Chuck CS Add these Supplies: OR Add these supplies: OR Feed Back: Cart Complete , Good Job!!! Attach to Each Case Cart 11:00 AM

Use the Form to Communicate Information between Departments: For OR: OR add aneurysm tray Needs 2 packages of hemostats For CS: Cart missing Basic Lap Pack Case Cart slips should be routed to CS/SPD Supervisor/Manager

The KEY To Success Is Commitment

Good Communication

These Are Your Customers

System Design Considerations ? ? ? ?

Functional Work Areas of A Sterile Processing Department Work Flow Pattern

Decontamination Washer / Decontaminators Pass-Thru Window

Decontamination Cart Washer Air

Enzymatic solutions, forced air & siphon Brushes Air Enzymatic Solution

Soiled Case Cart Water Soak Bagged Trash

Simplified Decontamination Area

Package, Preparation, & Sterilization Access to Bulk Stores Lockers S O R T I N G P

Sterile Storage/Clean Hold

Sterile Storage

Sterile Storage

Sterile Storage

Case Cart Holding

Simplified Case Cart System

More Complex System

Case Cart Designs Open Cart System Closed Cart System

Case 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?

Case Cart Design Construction considerations: Locks and door handles should be flush to prevent doors from opening unexpectedly or catching on doorframes Stainless steel shelf edges should be smooth to prevent injury to people and product Make 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)

Case Cart Design Other Considerations: Cart should be constructed of all stainless steel or plastic components Select a style with drawers to contain small items Know the terms of your warranty, carts wear rapidly if not maintained Make sure there are at least two breaking wheels

Open Multi -Tier Cart Large Orthopedic Cases Laparoscopy Cart or Special Procedures cart Low Open Case Cart available with sides and back

CART TIPS Don’t get them so large, no one can move them.. Medium Upright Closed Cart Don’t get them so large, no one can move them..

Plan For Regular Preventative Maintenance Inventory Replacement Parts: Extra wheels Bumper guards Shelving clamps Doors Clean & Oil Wheels Regularly

Consider An Automated Cart Washer

The Complete Case Cart We 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.

Standardize 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.

Linens Bin for Small items Packs/Drapes Trays Basins Solutions

Automate Your System Computerized Supply Acquisition Computerized Materials Handling Computerized Case Cart System Surgical Supply System Equipment Management

Tracking Your Instruments

Computerized 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 area Records documentation for each cart and provides a case-completion function for charging patients for products used and returning unused items to inventory.

Case 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.

Equipment Conflicts Computerized 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.

Tray & 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

Surgeon’s Preference Cards Requisitions and Pick Lists

Surgeon's Preference Card Service:         Plastic Surgery     Orthopedic Surgery     General Surgery Surgeon: ______________________________________________________________ Glove Size: ____________________________________________________________ Procedure(s): __________________________________________________________ Position: ______________________________________________________________ Prep: _________________________________________________________________ Supplies: ______________________________________________________________ ______________________________________________________________________ Instruments: ___________________________________________________________ Suture: (include needle sizes) _____________________________________________ Medications/Irrigations: ___________________________________________________ Dressings: _____________________________________________________________ Equipment: ____________________________________________________________ Special Preference(s): ____________________________________________________

Lost Preference Cards The 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

CASE CART REQUISITION Patient:______________________ Procedure Date: 02/02/2002   Surgeon: LAZIO, HAWKEYE Procedure Date: 02/02/2002 Case #: 243535 2nd Surgeon: Start Time: 0800 Room: 25 Patient: SMITH, JOHN Radio Station: WLUV Gloves: 8 reg MR #: 45367 Room Temp: 68F Date of Birth: 10/05/50 Age: 39 Sex: M PROCEDURE(S): INSERTION PACEMAKER TRANSVENOUS; Location: Comments: From Card: Hospital Pacemaker Implant PREP: Betadine Sol. Comments: Preps before scrubbing POSITION: Supine Comments: DRAPES: Drape Sheet, Towels X 4 INSTRUCTIONS: MEDICATIONS 0.5% Lidocaine plain in 10cc syringe with 25ga 1 ½” needle 1 ea NACL 1000cc COMMENTS: Have image available Crash Cart in room no Bovie or suction (have available in room) Does not like 4X8s, likes lap sponges He will prep, inject, then scrub Suture on pacemaker cart 18 ga Spinal Needle BD # 405184 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 COST Drape  CSD011 64738200 L32374 BASIC PACK SET-UP  CSD011 8746598N 6615 DRAPE C-ARM

What 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 the specific patient. Optical lithograph printers print package and tray contents by passing through a conveyor.

THANK YOU! SPSmedical Supply Corp. Sterilization Products & Services 6789 W. Henrietta Road Rush, NY 14543 USA Fax: (585) 359-0167 Ph: (800) 722-1529 Website: www.spsmedical.com © SPSmedical Supply Corp. Case Cart Systems Certificate is available after viewing by calling SPSmedical or e-mailing education@spsmedical.com

Purchasing 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:79 List Price: $220 Member Price: $110

References & Resources Association for the Advancement of Medical Instrumentation 1110 North Glebe Road, Suite 220, Arlington, VA 22201-4795 703-525-4890 Fax: 703-276-0793 www.aami.org Association of periOperative Registered Nurses 2170 South Parker Road, Suite 300 Denver, CO 80231-5711 800-755-2676 www.aorn.org Canadian Standards Association 5060 Spectrum Way Mississauga, Ontario L4W 5N6 CANADA 800-463-6727 Fax: (416) 747-2510 www.csa.ca Certification Board for Sterile Processing & Distribution 2 Industrial Park, Suite 3 Alpha, NJ 08865 908-454-9555 www.sterileprocessing.org International Assoc. of Healthcare Central Service Materiel Management 213 W. Institute Place, Suite 307 Chicago, IL 60610 312-440-0078 Fax: 312-440-9474 www.iahcsmm.org