case cart systems. presented by spsmedical largest sterilizer testing lab in north america with over...
TRANSCRIPT
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Case Cart Systems
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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
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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
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Write a Plan
Collect data
Define the Benefits
Define The Implementation Process
How To Get The Most Out of Your Case Cart System
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Establish A Joint CS and OR
“Case Cart Committee”
Take MinutesProvide InputGet Involved
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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
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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
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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
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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?)
Benchmarking Tool
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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
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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.
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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.
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Instrument Count Sheets
Should accompany every tray however, they should not be placed inside wrapped trays or rigid containers. - 2009 AORN
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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.
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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
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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
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The KEY To Success Is
Commitment
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Good Communication
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These Are Your Customers
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System Design Considerations
?
??
?
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Functional Work Areas of A Sterile Processing Department
E qu ipm e n t S to ra ge D is tribu tio n
S te rile S to ra ge
C a s e C a rt S e t-up
C a rt & E qu ipm e nt H o ld ing
S te ril iza tio n
P a c k a g ing L ine n
I ns trum e n t S to ra ge & A s s e m b ly
De c o n ta m ina tio n
S o ile d R e c e iving
C a rt W a s h ing
C le a n -up
Work Flow Pattern
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Decontamination
Washer / Decontaminators
Pass-Thru Window
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Decontamination
Cart Washer
Air
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Enzymatic solutions, forced air & siphon
Air
EnzymaticSolution
Brushes
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Soiled Case Cart
Bagged
Trash
Water Soak
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Simplified Decontamination Area
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Package, Preparation, & Sterilization
Lockers
Access to Bulk Stores
S
O
R
T
I
N
G
I
N
S
P
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Sterile Storage/Clean Hold
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Sterile Storage
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Sterile Storage
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Sterile Storage
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Case Cart Holding
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Simplified Case Cart System
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More Complex System
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Case Cart Designs
Open Cart System Closed Cart System
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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
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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
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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
Case Cart Design
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Open Multi -Tier Cart
Large Orthopedic Cases
Laparoscopy Cart or Special Procedures cart
Low Open Case Cart available with sides and back
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Medium Upright Closed Cart
Don’t get them so large, no one can move them..
CART TIPS
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Plan For Regular Preventative Maintenance
Inventory Replacement Parts:
• Extra wheels
• Bumper guards
• Shelving clamps
• Doors
• Clean & Oil Wheels Regularly
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Consider An Automated Cart Washer
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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.
The Complete Case Cart
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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.
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Solutions
Basins
Trays
Bin forSmall items
Packs/DrapesLinens
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Automate Your System
• Computerized Supply Acquisition
• Computerized Materials Handling
• Computerized Case Cart System
• Surgical Supply System
• Equipment Management
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Tracking Your Instruments
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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.
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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.
Case Carts…
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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.
Equipment Conflicts
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Tray & Equipment Locator
Maintains the locations of all of your trays in…
REAL TIME!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
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Surgeon’s Preference Cards
Requisitions and Pick Lists
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Surgeon's Preference CardSurgeon'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): ____________________________________________________
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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
Lost Preference Cards
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CASE CART REQUISITION Patient:______________________
Procedure Date: 02/02/2002 Surgeon: LAZIO, HAWKEYE Procedure Date: 02/02/2002 Case #: 2435352nd Surgeon: Start Time: 0800 Room: 25Patient: SMITH, JOHN Radio Station: WLUV Gloves: 8 regMR #: 45367 Room Temp: 68FDate of Birth: 10/05/50 Age: 39 Sex: MPROCEDURE(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” 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 # 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 COSTDrape
CSD011 64738200 L32374 BASIC PACK SET-UP CSD011 8746598N 6615 DRAPE C-ARM
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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.
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THANK YOU!!
SPSmedical Supply Corp.
Sterilization Products & Services6789 W. Henrietta RoadRush, NY 14543 USAFax: (585) 359-0167Ph: (800) 722-1529
Website: www.spsmedical.com
© SPSmedical Supply Corp.
Certificate is available after viewing by calling SPSmedical
or e-mailing [email protected]
Case Cart Systems
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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:79List Price: $220 Member Price: $110
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References & Resources
Association for the Advancement of Medical Instrumentation 1110 North Glebe Road, Suite 220, Arlington, VA 22201-4795703-525-4890 Fax: 703-276-0793 www.aami.org
Association of periOperative Registered Nurses 2170 South Parker Road, Suite 300 Denver, CO 80231-5711800-755-2676 www.aorn.org
Canadian Standards Association5060 Spectrum Way Mississauga, Ontario L4W 5N6 CANADA800-463-6727 Fax: (416) 747-2510 www.csa.ca
Certification Board for Sterile Processing & Distribution2 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 60610312-440-0078 Fax: 312-440-9474 www.iahcsmm.org