Sterile U Webinar Loaners...

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3M™ Sterile U Network3M™ Sterile U Web Meeting – January 19, 2011

Something Borrowed? Monitoring of Loaner Trays

Today’s meeting times: 9:00 a.m., 11:00 a.m. and 1:00 p.m. CST

Welcome!

Topic: Something Borrowed? Monitoring of Loaner Trays

Facilitators: Diane Koch, 3MDorothy Larson, 3M

Speaker: Mark Duro CRCST, FCS

2© 3M 2012. All Rights Reserved.

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Housekeeping• Questions

• Mute feature (*7 = unmute; *6 = mute)

• “Chat” feature

• Technical difficulties

• Post session follow-up

For more information: www.3M.com/3MSterileU

Next week, all of today’s meeting participants will be sent an email containing instructions for obtaining a CE Certificate for today’s meeting.

The email will be sent to the email address you provided when l d i t t d ’ ti If th th li t i

How do I get a CE Certificate?

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you logged-in to today’s meeting. If there are others listening with you today who did not log-on, you may forward the CE certificate email to them.

© 3M 2012. All Rights Reserved.

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Disclosure Statement

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Mark Duro, CRCST, FCS, IAHCSMM Approved InstructorManager, Central Sterile Processing Department New England Baptist Hospital

Boston, MA [email protected]

Speaker is a consultant to 3M © 3M 2012. All Rights Reserved.

Describe the impact that loaner instruments have on CSSD.

Discuss the complexity of some loaner devices and how short notice and flawed policies can have adverse affects in the OR.

Learning Objectives

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Identify basic needs that are important in the acquisition of loaners.

Describe how to use IAHCSMM’s Loaner Policy Template.


• noun \lō-nər\• 1. a person or thing that loans.

• 2. something, as an automobile or appliance, that is lent especially to replace an item being serviced or repaired.

Loaner

66 © 3M 2012. All Rights Reserved.

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• Insufficient inventory

• Trials

• Patient specific

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• Cost issues

• Lack of storage

• Multiple cases

• Newer technology

• Sent out for service

• Item/set missing


• Poor acquisition of loaned instruments can result in disruption to the function of the operating room and CSSD.

• Poor communication between facility and vendor can lead to a failed patient outcome.

Loaners - The negative impact on CSSD and OR


Failed acquisition can lead to inadequate processing of loaned instruments. Last minute arrivals can result in:

• Lack of processing time.

• Failure to obtain instructions for use.

• Failure to ensure sufficient processing staff are available.

• Failure to ensure processing capacity is available.

Loaners - The negative impact on CSSD and OR

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p g p y

• Failure to ensure implants can be properly monitored.

• Failure to ensure staff are in-serviced or trained on how to process sets and to focus on complex medical devices.

• Failed labeling and set identification.

• Failure to ensure all loaned instruments and implants are accounted for.

• Unnecessary stress!

Last minute arrivals can have a serious impact on patient outcome and facility disruption


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Time is of the essence!

• Facility responsibility - Surgeon, Surgical Material Coordinator or designee should contact the vendor to arrange timely arrival of loaned instruments.

Loaners - The impact on CSSD and OR

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• Last minute arrivals do not allow for proper processing.


All trays received from the outside on loan must be reprocessed.

Do not accept a tray for use in the OR that comes from another facility that is not involved within your own system unless you have a transport policy in place and have identical sterilization practices.

Loaners – Where do these trays come from?

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p p y p p

Many loaners arrive wrapped in “ready to use” condition from vendors –They must be completely reprocessed.


Loaned instruments are not in a condition for use when they arrive.

• They usually are coming direct from another facility, warehouse, garage or trunk of a car. Storage and handling is most likely not monitored to recommendations or your hospital practice.

• We do not have any record of their processing, who processed or

Loaners – Where do these trays come from?

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how it was cleaned.

• Even if all processing was done correctly, is a tray sitting in the trunk of a car at 90° on a humid day for hours still good to use?

• Is transport from a car to a hospital in the rain or snow acceptable?

• Do not accept a wrapped tray from a vendor into your OR.


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Loaned instruments are not in a condition for use when they arrive.

You don’t know where that tray has been!


Loaned instruments are not in a condition for use when they arrive.We all have a little junk in our trunk!

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Most vendor transport vehicles are not suitable for transport – all items must be cleaned. Instruments should not be accepted as clean and then only sterilized. Instruments should go through the entire process – cleaning, decontamination, inspection, packaging, and sterilization.


noun \in-struhk-shuhns-fawr- yooz\

1. A manual usually accompanying a technical device and explaining how to install or operate.

2. A book of instructions, directions for use, guide,

IFU – Instructions for Use

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2. A book of instructions, directions for use, guide, guidebook, instruction manual, operating instructions or directions.


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IFU’s and training are also everything!

• IFU’s will provide us with most of the guidance needed to process surgical instruments.

Basic elements needed in an IFU:

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Cleaning – solutions, brushes, rinses, sonic, mechanical and automated wash.

Assembly-Disassembly – is instruction given on complex items prior to cleaning and sterilization.

Packaging – containers - wraps

Sterilization – sterilization method, exposure and dry.


Some IFU’s are good and provide excellent guidance. Others are poorly written and do not give guidance for specific complex instrumentation.

In some cases it is up to us, the user, to identify some of the cleaning challenges for complex devices. This is because the IFU does not i l h i t ti t f ifi bl ti


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give us clear enough instruction to focus on specific problematic instruments.

Unfortunately, we may not know or have time to investigate problematic items if trays do not arrive in a timely fashion.

The following slides show items where IFU’s do not provide clear guidance for processing. Users find out on their own and address the challenge.


Instrument complexity – Do the IFU’s help us all the time?


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Instrument Complexity – In-servicing needed for some instruments

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Some IFU’s do not guide us well enough to deal with complex instruments


Read the IFU

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• Some IFU’s are very clear about removing instruments from their cassettes prior to washing.• Some also state that their instruments can not be containerized. We can not just containerize everything.


Managing Loaners

• There are some basics that can help manage loaners.

The following are some

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• The following are some suggestions from the IAHCSMM Loaner Policy template.


(Note: Not an actual book; for illustration purposes only.)

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IAHCSMM Loaner Policy Template

• In 2011 IAHCSMM’s Orthopedic council finalized its updated Loaner Policy Template and Position Paper.

• The position paper was update by Rose Seavey and both

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• The position paper was update by Rose Seavey and both documents were posted on the IAHCSMM website in July.

• As mentioned in the Loaner Policy Template, IAHCSMM is not a standards making organization and that the template is to be used as a tool to develop loaner policies.


IAHCSMM Loaner Policy TemplateThe Loaner Policy template and position paper can be found at:

www.iahcsmm.org

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IAHCSMM Loaner Policy TemplateAfter arriving on the IAHCSMM News site. Select the link below.


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IAHCSMM Loaner Policy TemplateThen Select the link below. It will open in a pdf.


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IAHCSMM Loaner Policy Template - Introduction

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The document starts with an introduction and comment regarding IAHCSMM. The intent of the document is for users to cut and paste information to accommodate loaner management in their facilities.


IAHCSMM Loaner Policy Template - Introduction

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The subject may stay the same.

The scope may need to be modified based on the facility using the document.


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IAHCSMM Loaner Policy Template - Policy

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The policy comments are clear. There is definition that items outside of a system where no policy is in place will be considered unsterile.


IAHCSMM Loaner Policy Template - Procedure

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The timely acquisition of loaners is a key aspect in processing loaners, as it allows users to obtain needed tools, training and processing time to efficiently process instruments on loan.


IAHCSMM Loaner Policy Template – OR Responsibility

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Communication between the OR and CSSD are mentioned here. IUSS is discouraged.


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IAHCSMM Loaner Policy-Template Sales Rep Duties

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Emphasis was placed on sales rep duties as they are a key player in loaner management and delivery.



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Arrival time, weights and configurations are mentioned here. Identification is also addressed.



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Inservicing is mentioned as part of the duties of the sales representative. This can help address some of the challenges in processing complex instruments.


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IAHCSMM Loaner Policy-Template Sales Rep DutiesPost Surgery

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Timing for removal of loaned instruments, as well as confirmation of all items present upon removal are mentioned.

Some facilities may decide to charge a fee for shipping if items are not removed as instructed.


IAHCSMM Loaner Policy - CSSD

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Detail pertaining to tray weights, handling and following the IFU are mentioned here.



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Documentation is addressed as well as preparing items for departure from the facility.


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Often times loaner sets that are reused can get lost in the mix. The policy states they need to go through the process again. This will help avoid that situation.


IAHCSMM Loaner Policy – Billing and Definition


• Many facilities have a vendor tracking program in place. Positive vendor relationships are better maintained with these systems in place Vendors that fail to comply with

Additional Support - Vendor Compliance

A thought that can help with Vendors that do no not want to comply with hospital policy.

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these systems in place. Vendors that fail to comply with hospital policies can be noted in these systems and with the correct vendor management policy in place we can ensure we are getting all that is requested from our vendors.


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Additional Support – Tracking Systems

• Items delivered are items needed.• Accurate and complete instructions for processing. • Incorporate into standard documentation process. • Ability to integrate into preference card system.• Complete traceability and full audit trail.• Reporting / Decision-support Tools


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• Reporting / Decision-support Tools.


Key Learnings

Loaner instruments need to be managed in a specific fashion to ensure proper processing.

All loaned instruments that are not part of a system need to be entirely processed as you do not know where they have been.

Users need to have an understanding of complex items, where to find

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g p ,them, how to process and sterilize to ensure sterility.

There are tools available that can help with loaner management.


Next week, all of today’s meeting participants will be sent an email containing instructions for obtaining a CE Certificate for today’s meeting.

The email will be sent to the email address you provided when you logged-in to today’s meeting. If there are others listening

How do I get a CE Certificate?

4545

y gg y g gwith you today who did not log-on, you may forward the CE certificate email to them.


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Next 3M™ Sterile U Web Meeting:• February 16, 2012• You Can't See Clean: Clean Monitoring in the CSSD

Thank You!

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Register at www.3m.com/SterileU/WebMeetings


References


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