Surgical instrument availability

AORN Journal,  May, 2005  by LuAnn Prephan

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The article "Surgical instrument availability" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education. Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is May 31, 2008.

Complete the examination answer sheet and learner evaluation found on pages 1027-1028 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on surgical instrument availability, nurses will be able to

1. compare the FOCUS-PDCA and FACETS analysis models used as the basis for this quality improvement project,

2. define the problems that were identified during the preproject data collection,

3. discuss the actions taken to rectify the identified problems, and

4. describe the improvement in surgical instrument availability after implementation of project initiatives.

Ensuring availability of instruments was a daily struggle for the surgery department at the Toledo Hospital, Toledo, Ohio, just as it is for many ORs. The surgery department includes 22 OR suites, one cystoscopy suite, and one procedure room. An average of 70 to 80 procedures are performed each day, including open heart procedures. Instruments are purchased, decontaminated, sterilized, set up, damaged, and lost. Searching for items shortly before a procedure was a common occurrence. Staff members and surgeons became frustrated by this perpetual struggle, and ultimately, a few, very vocal surgeons demanded that someone fix the problem.

Finding a significant solution to instrument availability problems was a daunting proposition. Many people might believe that a surgical services system with 1,400 instrument sets and thousands of single items was functioning as well as it ever would. Medical staff members, however, challenged surgical services team members to improve the system, thus beginning a three-year project to improve instrument availability throughout surgical services.

Ensuring efficient completion of the surgical schedule in a timely fashion is impossible without appropriate instrumentation. This project was a concentrated effort to dramatically change the inefficient way in which instruments were processed, prepared, and delivered on a daily basis. The FOCUSPDCA (find, organize, clarify, uncover, start--plan, do, check, act) model was chosen as the framework for this quality improvement project (Table 1). The PDCA model was created by physicist, Walter Shewhart, PhD, in the 1930s, and later was adopted by W. Edwards Deming, PhD, who added the FOCUS components. (1) The FACETS (ie, feasibility, appropriateness, consequences, efficiency, effectiveness, training, satisfaction) model was used to analyze each selected improvement to determine if these were the right improvements to make at the time. The FACETS model provides a framework to improve a process or system (Table 2). (2)

GETTING STARTED

A quality improvement team, which included members from the surgery and central processing departments, was formed to identify the primary issues. This team reported its ongoing progress to the surgical quality committee so that members of the administrative team could monitor project results on a bimonthly basis.

Team members defined the goal of instrument availability to mean that any and all instruments, including sets and individual items, will be available immediately before the start of the procedure. This definition included preparing items by any means necessary, which might include terminal or flash sterilization to ensure that instruments would be available for the procedure. This was considered a lofty goal, but team members were striving for perfection rather than setting their sights too low.

Collaboratively, surgeons and members of the surgical quality council developed a documentation tracking tool that included detailed information regarding items missing from sets, mislabeled, broken, and stored in the wrong location and incorrect items pulled for procedure set-ups (Table 3). The council met on a bimonthly basis to incorporate surgeons' perceptions and daily experiences into the project. In addition to helping develop collection tracking tools, the surgeons also made recommendations for staff member education and ongoing reporting of the data. The progress of the project became a standing report in the surgical quality council and remains so today.

The task of data collection was daunting. Typically, a sample of procedures would be chosen to be evaluated in specific quality improvement projects. For this project, the surgeons insisted that every procedure be tracked. This required daily reminders during report, at staff meetings, and at education meetings to ensure that staff members completed the tracking tool. Signs also were posted throughout the department to remind surgeons to report problems, delays, or even a change in a plan of care that resulted from unavailability of instruments.