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Archive November 2020 XXI, No. 11

5 Steps to Improved Instrument Care

Reorganized trays, team togetherness and real-time tracking are the keys to success.

Adam Taylor

BIO

DOUBLE CHECK
Johns Hopkins Hospital
DOUBLE CHECK The OR staff at Johns Hopkins ensures they ship complete sets to central sterile processing.

Components of some power tool sets used in the OR suites at The Johns Hopkins Hospital in Baltimore were going missing — and it was costing the facility nearly $150,000 a year to replace them. Something had to be done to limit the losses and preserve the occasionally tenuous relationship between the ORs and central sterile processing (CSP). The hospital's leadership decided to implement a series of steps aimed at improving how the departments communicate and coordinate their handling of the costly tools.

In the first six months after changes were made, the bills for replacement parts plummeted to around $5,000. Two years later, the average annual cost of replacement parts was just $3,500. The process improvements they implemented to achieve those incredible results can serve as a blueprint for flowing instruments through your facility in ways that will save money and avoid unnecessary headaches.

1. Identify issues

The first thing that has to end is the OR and CSP pointing fingers in the other's direction when an instrument goes missing, according to Brenda Nack, MSN, RN, CNOR, CSSM, CRCST, director of sterile processing at Johns Hopkins. "We created an instrument committee to get to the bottom of the issue and focus on solutions," says Ms. Nack. "Our successes started when we began to communicate and collaborate, and departments stopped blaming each other."

As it turns out, how the components of the 10 different power tool sets used by surgical teams at Johns Hopkins were organized in the instrument trays was a big part of the problem. It was very disorganized — sometimes the sets were transported to CSP in a single layer, other times they arrived double- or triple-stacked. Some were labeled; some were not.

"We had a really good blame game going on," says Carol Gentry, MSN, RN, CNOR, nurse manager in the pediatric OR at Johns Hopkins.

After the committee met, both sides realized they had culpability in the problem. Improvements were made when each side realized how expensive instruments are — a missing handpiece could cost $15,000 to replace. Also, they needed to understand that replacement parts could take several months to arrive because the hospital first had to approve the expense, and the manufacturer didn't always immediately have the needed item in stock.

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