1. Case Cart Systems

2. Presented by SPSmedical
Largest sterilizer testing Lab in North America with over 50 sterilizers
Develop and market sterility assurance products that offer advanced technologies
Provide full day sterilization Seminars and on-site Facility audits for compliance with best practices
Corporate member: CSA and AAMI, serving on numerous sterilization working groups

3. 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

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

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

6. 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

7. 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

8. 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

9. 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?)

10. 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

11. 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.

12. 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.

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

14. 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.

15. Case Cart Surgical Procedure Form
General Hospital Case Cart Tracking Form
Date: 2/6/ Block/Room: Case: 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

16. 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

17. The KEY To Success Is Commitment

18. Good Communication

19. These Are Your Customers

20. System Design Considerations? ? ? ?

21. Functional Work Areas of A Sterile Processing Department
Work Flow Pattern

22. Decontamination
Washer / Decontaminators
Pass-Thru Window

23. Decontamination
Cart Washer
Air

24. Enzymatic solutions, forced air & siphon
Brushes
Air
Enzymatic
Solution

25. Soiled Case Cart
Water Soak
Bagged
Trash

26. Simplified Decontamination Area

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

28. Sterile Storage/Clean Hold

29. Sterile Storage

30. Sterile Storage

31. Sterile Storage

32. Case Cart Holding

33. Simplified Case Cart System

34. More Complex System

35. Case Cart Designs
Open Cart System
Closed Cart System

36. 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?

37. 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)

38. 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

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

40. 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..

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

42. Consider An Automated Cart Washer

43. 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.

44. 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.

45. Linens
Bin for
Small items
Packs/Drapes
Trays
Basins
Solutions

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

47. Tracking Your Instruments

48. 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.

49. 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.

50. 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.

51. 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

52. Surgeon’s Preference Cards
Requisitions and Pick Lists

53. 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): ____________________________________________________

54. 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

55. CASE CART REQUISITION Patient:______________________
Procedure Date: 02/02/2002
Surgeon: LAZIO, HAWKEYE Procedure Date: 02/02/2002 Case #:
2nd Surgeon: Start Time: Room: 25
Patient: SMITH, JOHN Radio Station: WLUV Gloves: 8 reg
MR #: 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 # 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
 CSD L BASIC PACK SET-UP
 CSD N DRAPE C-ARM

56. 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.

57. THANK YOU! SPSmedical Supply Corp. Sterilization Products & Services
6789 W. Henrietta Road
Rush, NY USA
Fax: (585)
Ph: (800)
Website:
© SPSmedical Supply Corp.
Case Cart Systems
Certificate is available after viewing by calling SPSmedical or ing

58. 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

59. References & Resources
Association for the Advancement of Medical Instrumentation
1110 North Glebe Road, Suite 220, Arlington, VA
Fax:
Association of periOperative Registered Nurses
2170 South Parker Road, Suite 300 Denver, CO
Canadian Standards Association
5060 Spectrum Way Mississauga, Ontario L4W 5N6 CANADA
Fax: (416)
Certification Board for Sterile Processing & Distribution
2 Industrial Park, Suite 3 Alpha, NJ 08865
International Assoc. of Healthcare Central Service Materiel Management
213 W. Institute Place, Suite Chicago, IL 60610
Fax: