Steps in the Management of Surgical Instrumentation

Step 6:

Get full control of flash sterilization; this means that you need to staff someone on both shifts in the OR to manage the process. Instrument coordinators who have full control over flash, System-1, and scope management will save your hospital thousands of dollars. By having someone in the OR managing the daily instrument needs, you will also be able to pinpoint where additional sets are needed and address repairs much more accurately. If you are relying on flash sterilization to turn over instruments, then you do not have enough inventory to support a standard of care. Budget and purchase more.

Address one-of-a-kind instrument sets, if you are flashing them between cases, then purchase additional sets. The excuse that we only have one set or that we cannot afford an additional set does not support a standard of care. Flash sterilization adds time to the daily OR schedule and can directly affect room turnover, which costs the hospital money and reduces surgeon satisfaction. Too often short cuts are taken with the washing of instruments in preparation for flash sterilization, for which the Association of periOperative Registered Nurses (AORN) has noted in its standards.

Special note: Do not allow your consignment orthopedic vendors the ability to wash and flash-sterilize their instrument sets. If at all possible, add all consignment sets to your count sheet system with pictures kept on file in SP and in the OR.

Step 7:

Have an on-demand instrument needs-list report printed from the OR scheduling system. The information is available in the OR scheduling system by requesting the cases for the day and the corresponding preference card equipment database. The report needs to be reviewed three times daily. Review before the first case of the day at the OR shift report, the second during the SP shift change, and again at the end of the day. We are not talking about hour-long reviews — the morning review is completed during the OR shift report to look for add-on cases; the second review is 15 minutes during the SP shift change; the third is completed by the night shift instrument coordinator before leaving for the day and posted for the morning shift to close out. Understand that communication between shifts is crucial to attend to instrument problems and addressing consignment instrument utilization.

Special note: Knowing what consignment or loaner sets are coming or going is critical to ensuring that they are handled in the same manner as any other set before being used on a patient.