Traditionally, sterile storage area designs are influenced by patient-specific instrumentation, whereas instruments of like procedures are grouped. Grouping instruments allow staff to locate the specific needs fast. Color coding the areas also helps staff find instrumentation more quickly; red for cardiac, yellow for urology, pink for Gyn, etc. However, there is still the need to locate the instrument sets that you want. How do we design more efficient ways to locate and deploy instrumentation for emergencies, urgent needs, and case development? First, one fit for all situations is not the answer. Dividing up the severity of need can help you create a better design.
Case Cart Design
Since Evolved Sterile Processing Consulting is positioned to improve sterile processing departments, we will start with case cart design. Depending upon whether or not you are using an instrument tracking system can define your starting point. If you are using an instrument tracking system, our first recommendation is to evaluate your software to ensure your instrument storage locations are up to date. A second step would be to ensure your OR management system is synced to your instrument tracking system to provide correct data on your OR preference sheets. Whether or not you are using an instrument tracking system, a good starting point would be to evaluate which instruments sets have high and low utilization points. Without an instrument tracking system, you can still pull the information from your OR management system. Your high to medium utilized sets should be closest to the access points of your storage system. The instruments should be placed in a primary eyesight position for ease of visibility. Think about your local grocery store. Items placed in the mid-point of the shelves are the items that they want you to purchase first. Lesser purchased items either go on the top or bottom shelves. Instruments that are used most should be in the middle of your shelves. Another deployment model would be to design end caps for your sets with the highest use. End caps eliminate the need for staff to go down an aisle, saving time. Your lowest utilized instrument sets should be placed furthest from the access points of your storage system and in either a high position or low position. The one caveat is to place heavy items on the middle shelves whether or not they have high or low utilization. Doing so will lessen the chance of back injuries. If possible, design your storage system with access points from both ends to allow continuous movement without backtracking while pulling instrumentation for OR cases.
Preference cards are the recipe cards for the case carts system. Lack of information or incorrect information creates wasted time. Preference cards should be built to include the correct name of the instrument sets. We often find the OR and SPD using different set identifiers in the OR management and instrument tracking systems. Decide on one set name and train staff. Communication is the most critical aspect of quality control—poor communication; poor quality outcomes. Finally, adding locations to your preference cards and aligning the cards to printout storage locations in a sequenced order reduces redundant movement while picking instruments.
Urgent Needs
Urgently needed items are items that have demand because of an issue within the case cart process. Instrument demands would be from missing items, problems with container systems ( e.g., holes in wrappers), or something being contaminated. To reduce delays in the surgical case the item is needed immediately. This storage area is where redundancy can save time. Splitting up some of your high-end utilized sets and placing them closer to the surgical suite can help save time in deploying the instruments. Minimal storage is the key. You don't want to lose time managing a par-level instrument storage system. This area is a key place to store individual wrapped instrumentation. Grouping instrument by procedural use in this storage area makes more sense. This area should have low utilization, understanding there is a sound quality assurance system in sterile processing and your management systems are up to date. The staff utilizing this area will more than likely be OR staff. They will be more familiar with procedural needs; thus, aligning instruments' storage with procedural areas saves time. With low utilization, the staff will be less knowledgeable about storage locations. Color-coding this area is a great organizational tool. The one drawback to a secondary area is that most OR management systems that we have utilized do not list secondary instrument locations on OR preference cards. As in all storage locations, signage is crucial and should be well defined.
Emergent Needs
We are defining emergent instrument needs as instruments needed in the case of an emergency. Trauma cases come to mind. Pulling instruments in volume where the standard case cart process would take too long to assemble the needed instruments requires a different strategy. Stand-alone storage systems best fit this need. Preparing a case cart (opened or closed) ahead of time will be the quickest possible way to meet the needs of the OR and your patient. Keeping these storage systems in a controlled environment, usually Sterile Processing, is the best process. Otherwise, instruments can be removed from the storage area unknowingly. Regular inventory inspection is required.
In Conclusion
Better-designed sterile storage systems offer many benefits—quicker access to the instruments needed, better quality control, and physician and patient satisfaction. Delays in the deployment of instrumentation can have undesirable consequences. Utilizing lean principles and good signage can improve the efficiency of your processes. Think outside of the box when designing your storage areas. Evaluate your data and design to usage. Removing redundancies in your operations will increase satisfaction for your staff. Whether or not the sterile processing department or OR picks the surgical case matters not. The principles described above will work for both units. Lastly, get staff input when designing your storage area. The end-users often know best.
At Evolved Sterile Processing, our consultants have a greater focus on sterile processing. With our decades of experience, we will help you develop better processes and educational resources for your staff.
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