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Eliminating Missing Instruments CIS SELF-STUDY LESSON PLAN Lesson No. CIS 281 (Instrument Continuing Education - ICE) Sponsored by: Eliminating Missing Instruments BY MARJORIE WALL, MLOS, CRCST, CIS, CHL, CSSBB Certified Instrument Specialist (CIS) lessons provide members with ongoing education in the complex and ever-changing area of surgical LEARNING OBJECTIVES instrument care and handling. These lessons are 1. Discuss the importance of maintaining accurate count sheets designed for CIS technicians, but can be of value 2. List steps to build an effective replenishment system to replace missing and nonre to any CRCST technician who works with surgical pairable surgical instruments instrumentation. 3. Review the Six Sigma technique of 5S for instrument organization 4. Discuss the importance of flow through Sterile Processing decontamination and Earn Continuing Education Credits: assembly areas to eliminate preventable missing instruments Online: Visit www.iahcsmm.org for online grading. By mail: For written grading of individual lessons, send completed quiz and $15 to: issing instruments are and SPD runners to stop their work to go Purdue University - Online Learning a common challenge search for the missing critical instrument. Young Hall, Room 527 for Sterile Processing It is not uncommon for multiple SPD 155 S. Grant Street West Lafayette, IN 47907 departments (SPDs). This technicians to be pulled from their job Mlesson will address the importance of assignments and spend 15 minutes or Subscription Series: Purdue Extended Campus minimizing the occurrence of missing longer searching for a critical instrument, offers an annual mail-in or online self-study lesson subscription for $75 (six specific lessons worth 2 instruments and developing and which creates waste, frustration and points each toward CIS recertification of 6 maintaining an organized storage and backlogged work. hours). Call 800.830.0269 for details. reorder system. Organizations spend hundreds of Scoring: Each online quiz with a passing thousands of dollars annually replacing score is worth 2 contact hours toward your CIS Objective 1: Discuss the importance in missing instruments. This stems from the recertification (6 hours) or CRCST recertification maintaining accurate count sheets surgical procedure itself being delayed or, (12 hours). Most SPDs track tray errors. These even worse, canceled because the missing More information: IAHCSMM provides online typically involve incorrect instruments, instrument is critical to the procedure. grading service for any of the Lesson Plan packaging errors, damaged instruments, When surgeons schedule procedures, varieties. Purdue University provides grading services solely for CRCST and CIS lessons. Direct etc. Most departmental leaders do not they count on the instrument trays any questions about online grading to IAHCSMM count missing instruments as a tray error being complete and ready for surgery. at 312.440.0078. Questions about written if the instrument is marked “missing” on Missing instruments are a problem SP grading are answered by Purdue University at 800.830.0269. the tray menu and labeled on the outside Instrument Specialists should strive to of the tray; however, most surgeons and prevent proactively – before they have a Surgical Services leaders would argue chance to impact the OR. that missing instruments are the highest Many may wonder what causes missing frequency tray error and are a direct instruments, and the answer will likely contributor to delays and frustration in vary depending upon who is asked. Some the surgical suite. Missing instruments in SP Instrument Specialists might claim surgical trays can halt surgical cases and the OR is largely responsible. Those in cause Operating Room (OR) circulators the SPD typically blame the OR team CIS SELF-STUDY LESSON PLAN for throwing away instruments with the “bread and butter” instruments correct tray. For the other examples, drapes on the back table. On the other memorized like Mayo scissors and SP technicians may put a variety of hand, many OR team members might #3 knife handles, and advanced SP lengths or thicknesses of Allis forceps envision a black hole of sorts in the technicians will have a variety of in instrument trays. Additionally, SPD where all the critical instruments instruments memorized from an technicians may not be able to replace are mysteriously collecting. Healthcare assortment of service lines. For example, an instrument because they do not have administrators do not care what is they can explain the difference between enough information. Often, hospitals causing the problem; they just want Debakey, Satinsky and Cooley vascular use their own jargon on tray menus. For an end to the never-ending expenses clamps. Even the most experienced SP example, a Rochester Eastman retractor associated with replacing missing surgical technician, however, may struggle to is listed as a Kelly retractor. There is no instruments. In reality, the root cause know the differences between similar sizing information and it is the incorrect of missing instruments is complex. instruments on ear, eye and other name. The OR cannot understand why Missing instruments are typically caused microsurgery instruments. Without those in the SPD cannot get it right. SP by instruments mixed between sets, the manufacturer’s catalog information technicians must get it right, and the prioritization systems that leave critical on tray menus, new hires will struggle way to get there is by having accurate instruments behind, bad data on critical to learn the jargon and memorize the tray menus with standard nomenclature tray count sheets, and no replenishment specialized instruments in their new SP for instrument names. The following system to replace damaged instruments. roles – and even long-term employees is an example of a simple instrument For the purpose of this lesson, let’s focus may struggle or avoid trays with less- standard nomenclature that is effective: on what the SPD can control. familiar instruments. The result for instrument type, inventor or scientific both groups is the wrong instruments in name, description of direction/curvature, Counting on Count Sheets trays and instruments marked “missing.” length, and thickness (if applicable). Surgical tray menus are the critical tool When the manufacture’s catalog This structure ensures technicians can ensuring the success or failure of SPDs. information is accurate and included on quickly read tray menus to match their Count sheets are the communication tool tray count sheets, experienced and new instruments to the count sheet. It also where the OR team ensures that the SPD SP technicians can “paint by number” to ensures they have the information to team knows exactly which instrument assemble specialized surgical instrument find their instrument in other trays or belongs in which tray. Bad data on tray trays. When this happens, tray assembly from the back-up wall, and it drastically menus leads to the wrong instruments speed and accuracy is improved, reduces the risk for technicians putting in trays, no information to order missing instruments can be located, and the incorrect instrument in a surgical replacement instruments, and failure to replacement instruments can be ordered, instrument tray. follow the manufacture’s instructions if needed. As instrument count sheets are cleaned for use (IFU) for instrument processing. One of the root causes to missing and completed, the SP leader needs Instrument Specialists are set up for and/or incorrect instruments is poor to ensure the technicians understand failure if count sheets do not have the descriptions for surgical instruments on that “close enough” substitutes are critically needed information, including count sheets. Considering the following: not acceptable. When an organization the manufacturer, catalog numbers, • Forcep Allis has had poor information for years, instrument descriptions, and quantity. • Allis Clamp the surgical instrument trays likely Whether a tray menu is electronic or • Allis Clamp Med have years’ worth of poor instrument hard copy, the count sheet must be • Allis Clamp 7in substitutes or incorrect instruments. As accurate to ensure that SP technicians • Forcep Allis Tissue Straight 6 ¼” trays are processed through the SPD, can get the right instrument in the right wrong instruments will be removed, tray. All of these descriptions may be asking and correct instruments will be placed Because there are hundreds of for the same instrument; however, in trays. This may result in a short- thousands or surgical instruments, only the last instrument description term increase in missing instruments as critical pieces of the tray menu are (Forcep Allis Tissue Straight 6 ¼”) will incorrect instruments are removed and manufacturer information and catalog result in SP technicians consistently replacement instruments are unavailable. numbers. Most SP technicians have putting the correct instrument in the CIS SELF-STUDY LESSON PLAN Objective 2: List steps to build an effective area should be organized in a way that Standardize: The fourth step in a 5S replenishment system to replace missing makes it easy to locate instruments project is to standardize. One of the most and nonrepairable surgical instruments quickly. Six Sigma has an organization effective tools for standardizing a back- Surgical instruments undergo wear technique known as 5S. This technique, up wall is use Kanban cards. Kanban is and tear during surgical procedures. which includes the following, results in a visual indicator
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