Teamwork and Communication within the CSSD throughout the process

1. Teamwork and Communication within the CSSD throughout the process Forecasting, Huddles, scripting, and loaner drop offs.

2. SPONSORED BY: Connecticut Central Service Association President 2008 09 10 11 12 13 DONE!! AAMI STWG40 (ST79) voting member IAHCSMM Ortho council IAHCSMM Technical Advisory Committee IAHCSMM Executive Board 2011-12 2012-2013 IAHCSMM President Elect 2013-2015 IAHCSMM President 2015-2016 IAHCSMM Immediate past President 2016-2017 David Jagrosse Consulting L.L.C. President 203-465-8502 Manager Middlesex HospitalCentral Sterile Service28 Crescent StreetMiddletown, CT 06457860-344-6269 “One of Youz Guyz” David Jagrosse CRCST CHL

3. Objectives: • Discuss and define Teamwork • Discuss and define Communication • Case study of process at Middlesex Hosp • Forecasting of surgical schedule • Team Huddles • Scripting with Vendors • Drop off log in dept • Day of surgery and post case considerations

4. Discussion about ‘teamwork” • What do we do? Why do we do it? • How do we do it? Empathy, understanding & Human factors

5. Communication Verbal non verbal Method- email /boards/meetings/huddles Computer system- Tdoc/ Microsystems/Censitrac etc

6. Middlesex Hospital • Number of Beds:300 • Number of ORs serviced:10 + 3 offsite • Number of Shifts in Central Services: 3 with 16 FTE’s • Number of complaints 0* *3RD shift when no one is there!

7. Case study of process at Middlesex Hospital Most facilities (hopefully) have some sort of process or procedure (written?) regarding loaners and borrowed equipment and implants

8. If you don’t you better!! • Do you have AAMI ST79 or the CSA standards at hand? • Do you have written policy and procedures? • Are you alive and breathing? Especially during this presentation??? For a start with loaners at least there is IAHCSMM for help…

9. https://www.iahcsmm.org/resources.html

10. This helps and is a start.. Its only one segment of the process The process really begins with the Doctor outside of the hospital..

11. Current State Or at least some version of it……

12. Doctor tells office staff to book case • Calls office typically there is a procedure to book a case at hospital • Middlesex Booking utilized(going electronic) Slip lists equipment needs (loaners) etc. • More importantly the doctor is typically vague and office staff are not clinically trained to know our equipment

13. Doctor calls the reps ? • Calls reps or has office staff call rep with vague descriptions or requests

15. Day before surgery reps show up.. Or a courier or maybe Fedex or UPS And of course its always during the absolute worse time of the day for CSSD. Maybe we have what they need maybe we don’t..

16. Come on Now!!

17. Step 1 booking and MDs • Work on process with MDs so they understand the impact and bad outcomes and confusion that result with improper booking and poor communication with Booking office and MD office staff. • Get Reps involved so if MDs are texting or calling they will call CSSD

18. My case cart

19. Booking slips • Robust • Specific • Enforced or no case booked • Ask for specifics on equipment • These ‘notes” are added to schedule notes. Especially if equipment is loaner items

20. FORECASTING

22. Step one of solution: Forecast Forecast is printing the schedule a week in advance and looking at cases and notes on cases for equipment requests. This is the pre-amble to the Huddle See handout example

25. Next step HUDDLES • Team Huddle • O.R. /CSSD/Booking and whomever is a stakeholder • Quick and to the point. Less than 20min • Look at next 5 business days • Reps are confirmed • Equipment verified for cases within 24-48 hrs

26. Post Huddles: Scripting • CSSD lead call vendors and reps • We called it scripting because we wrote a script duh!! See handouts • See sheet for bullets that mattered to us. • This changes the dynamic of the loaner drop off later so when a rep shows up we don’t say “who the heck are you” we say ‘We were expecting you where's our 4 pans and IFU’s!!”

29. Scripting: This is your enforcement tool 48 hr rule • IFU’s • How many pans • 25lb rule • Approved for use? • Scripts are matched to drop off logs in CSSD later in process Whatever you need to enforce

30. Back to OR huddle again For cases that are 24-48 hrs out the reps are confirmed on the schedule and any last minute schedule notes or equipment questions are resolved

31. CSSD Huddle • Daily • Quick 15 min • Not a complaint session. • Covers • safety • Today's priorities (loaners turnovers) • Tomorrows priorities (loaners turnovers) • Gen hosp announcements • Whats Dave doing today ---for real!

33. Drop off 48 hr before surgery • It can happen if you make it happen See example of drop off log hand out

34. At MH we call it an engagement!

35. Drop off engagement • Face to face to ask questions • Script is matched to drop off logs “We were expecting you” What there is only 3 pans?? Where's the 4th? Ohh its coming later! • Any discrepancies are resolved asap • NO IFU NO processing-Policy

38. At this point you can use IAHCSMM • Use IAHCSMM loaner policy as guide • Develop what works for your facility • Tracking system? No..paper system • Use Tyvek tags for marking • Label sets Open only if necessary • WASH ALL SETS REGARDLESS!! • Look for peeling rubber coatings on pans

39. Other tips and hints … Reallocation of unused pans Hold area for ‘clean” pans Hold reps responsible for cleanliness check at drop off. Partners in grime I will make these slides available to your chapter

40. Other points but we can do a whole program on it! • Onetray and containerization of wrapped loaners. 25 lb rule

41. AAMI TIR63 Management of loaned critical andsemi-critical medical devicesthat requiresterilization or high-level disinfection

42. What are loaned medical devices? Medical devices not owned by the health care facility that are loaned through an loan agreement with a vendor or another health care facility

43. Loaner Policy a) roles and responsibilities of the sender b) roles and responsibilities of the receiver c) requisition d) scheduling e) receipt f) return g) tracking and documentation 3 Policy development

44. Communication Healthcare Facility A procedure to ensure communication is clear and consistent to all involved. Included in the communication chain are: The surgeon Operating room personnel CSSD personnel Health care technology management personnel (if an equipment safety check is required) Supply chain personnel The sender 4.3.1 Communication

45. Loaner Requisition When the procedure for the loaner is scheduled, the surgeon or designee should provide the following information: Patient name Loaner set(s) to be expecting Date and time of the procedure 4.4 Requisition

46. Processing Time The loaner(s) should arrive at the time agreed upon The healthcare facility should not accept loaner(s) if they do not arrive in sufficient time to follow its procedures (except in an emergency). 4.5.3 Processing time

47. Receiving Prior to use, all loaned medical devices should be reprocessed according to the manufacturer's written IFU and in accordance with the facility's policy and procedures. 4.6 Receipt

48. Loaner Return The vendor/sender should be check the instrumentation to be sure it is in working condition. Document broken or defective, instruments Document missing parts 4.7 Return

49. Implant/Implantable device According to FDA, “device that is placed into a surgically or naturally formed cavity of the human body if it is intended to remain there for a period of 30 days or more. FDA may, in order to protect public health, determine that devices placed in subjects for shorter periods are also implants