New place – an impulse for changes
The word ”end” means not just the end, but also the goal. In Polish the ”end” is rarely used as the goal, and more can be associated with the closure of one stage and the start of a new and different one from the current reality. Thinking straight the end is a new beginning i.e. changes.
Changes are often associated with fear and temporary difficulties, which people are not always ready for. The need to leave the safe and tame zone always causes fear of what will happen.
If the proceedings are recorded in the medical procedure, the change of this action seems to be very difficult and unreasonable, because the current performance of procedures was effective and unchanged for many years. However, it often happens that the change involves a number of positive consequences, and thus modification of the previously stable reality in a very positive way.
The effects of changes associated with the introduction of ready-for-use-sets and the benefits resulting from that are discussed by:
Master of Nursing with specialisation in epidemiological nursing – Dr. Władyslaw Biegański Regional Specialist Hospital in Grudziądz
Monika Cerkaska: Why did you decide to work with specialist sets? Is it only because of the relief for the Central Strerilisation Unit?
Emilia Zawadzka: From the moment the CSU started to support 11 operating rooms, we decided to use it only for the sterilisation of instruments. Relieving the work of CSU we resigned from creating sets of dressings material inside the hospital and decided to use sterile procedure and operative sets. I am thinking of ready-for-use sterile products, in a single package containing both the dressing material, Op-drapes and other components needed to perform a particular procedure. In this way the responsibility for the sterility of the material is transferred onto the manufacturer, and the CSU can focus on the preparation of sterile surgical instruments.
Due to such a decision, a large work load relief was also felt by nurses who were expected so far to prepare sets of dressing material. Not only the work comfort increased, but also ensured our and patients’ safety. The use one set specifically designed for a given surgical procedure eliminates the risk of error and thus minimises the risk of complications. In addition, the time devoted to prepare all the necessary materials for the surgery is much shorter, which is especially important in life-saving situations.
„The use one set specifically designed for a given surgical procedure eliminates the risk of error and thus minimises the risk of complications.”
M.C.: What kind of response from the doctors and nurses, the direct users of the sets, did you meet while changing into ready-for-use sets?
E.Z.: Any change or introduction of a new solution causes some concern among those who are directly affected. So it was in our case. Both among the doctors and nurses there were concerns that quickly disappeared when they started working with the sets. We all experienced better working conditions, and today we cannot imagine return to the previous state. It is much easier and safer to open one set than a few products in aseptic packages. While opening one package, we reduce the possibility of contamination of products and patients with pathogenic microorganisms. In high-risk procedures with high risk of complications the elimination of errors translates into patient’s safety, which is the most important thing for us.
M.C.: Which elements of the set are the most important for you?
E.Z.: First of all, the set should be complete, but not exaggerated. Unused elements constitute waste, for which, unfortunately, you would need to pay. Therefore, the most important are the basic elements, which if necessary can be supplemented with sterile material. In an emergency, when there is time pressure, it is important that the set contains everything necessary to carry out the procedure.
An important advantage of the product in the form of the set is the fact that the order of arrangement of individual elements can enforce the execution of particular activities, e.g. first the instrument table is covered, the OP-field is disinfected and secured in the right way. These are the activities which are always followed one another, and the order in which they appear has a big impact on the safety of the procedure.
M.C.: What about human habits? Do they not induce resistance to the use of medical devices in such a form?
E.Z.: The procedure should be carried out in a safe manner and habits should most of all provide the security. I do not see any conflict of interest.
Speaking of safety one must also think about legal security when a patient can claim against the hospital, like in the case of medical incidents. The awareness of patients is increasing, the affairs between the patient and the hospital quickly become media events, and each won process generates another claim. Therefore, it is important to have evidence that all the procedures in the treatment of the patient are carried out in a secure way. Medical records are proof in this case, which are facilitated by a TAG label i.e. stickers that can be stuck into the patient’s medical history and the documentation of the operating theatre.
M.C.: Which arguments do you think are stressed by the hospital manager?
E.Z.: I’m sure that epidemiological safety and costs. The cost reduction and of course the set price is very important, and for the director / manager the transparency of costs. The set price is equal to the real cost for the ward for the performed procedure. We are talking about a simple ratio: the number of sets is equal to the number of performed procedures. In this case we eliminate the so-called hidden costs and limit the possibility of manipulation of the costs of individual procedures.
M.C.: The economic aspect is a very strong argument. What about work ergonomics in the ward? Is it changing?
E.Z.: Of course. It great relief is felt by the personnel. Workload for nurses is very high, and in a situation where we use ready-made sets, all the energy is focused on the patient.
In addition, the use of sets streamlines logistics inside the hospital. Products are transported easier and safer.
M.C.: Thank you very much for your time.
The use of large operative sets in the operating theatre of the Nicolaus Copernicus Provincial Specialist Hospital in Łódź are discussed by:
Deputy Head of the Operating Theatre for Nursing – Nicolaus Copernicus Provincial Specialist Hospital in Łódź
Monika Cerkaska.: What urged you to start working with ready-made sets?
Sylwia Dąbrowska: The decision to introduce the standard use of disposable sets in the operating theatre happily coincided with the renovation of the operating theatre. Once, that is before the renovation, within the operating theatre we had a sterilisation unit, where in addition to current work for the needs of the theatre, there were also sets of non sterile materials prepared that in the next step were sterilised. After the renovation of the operating theatre, the sterilisation unit was closed and today the hospital has only a delivery and receipt point dealing with logistics, mainly of instruments and hospital clothing. Due to such a decision at one time we started to use disposable products such as surgical drapes, gowns and procedure or operative sets.
The renovation of the operating suite also reduced the size of storage space that we have. Therefore, we cannot afford to maintain a very large stock of non sterile products, which always occupied a lot of space. Nowadays, we use a very large number of implants, and they mainly take place in the operating room. Dressing materials are stored outside the operating room, and therefore it is easier and safer then to use a ready set. Such an organisational approach is very reasonable. Reducing the storage space, the space for the patient increases. And this is of course connected with money.
„One move is enough to open the set, one set designed for a given procedure, and one label that allows the transfer of information to the documentation highly limit the time devoted to prepare for a surgery. This allows the medical staff to concentrate on their work around the patient.”
M.C.: You mentioned the safety. It’s probably one of the most important reasons for the hospital, for which you have decided to work with the ready-for-use product?
S.D.: Of course, and it is for the hospital as a whole. This is a very strong argument for the manager – because the responsibility for sterility lies with the manufacturer – and for the entire epidemiological staff – for the use of sets reduces the number of hospital-acquired infections. It is also very important for us – as the medical staff. It is safer to open one packaging rather than opening individual packages of products needed to complete the procedure. The removable part of the label is a very safe element. To eliminate the error, which can be committed in the process of rewriting the data into the documentation, in this case only one sticker with a product code and expiration date is transferred. The product code fully identifies the contents of the package and there is no need for a more detailed label. At the big amount of material used and also having a limited amount of place in the documentation, the size label is adequate.
Another advantage of using the sets is to increase work comfort. One move is enough to open the set, one set designed for a given procedure, and one label that allows the transfer of information to the documentation highly limit the time devoted to prepare for a surgery. This allows the medical staff to concentrate on their work around the patient This is especially important in a situation where for example on call there are three operating rooms functioning, and there is just an enough number of nurses to do the work on the ward. Using the finished product allows for smooth work throughout the operating suite on duty. Of course, the comfort of using the sets is experienced not only in emergency situations, but also in our daily work. We minimise the duration of the procedure, which translates into individual savings, i.e.: lower consumption of energy and air conditioners, shorter anaesthesia, shorter work of a surgeon, anaesthetist and nurses. Minimising the time devoted to the preparation for a surgery, combined with efficient team work makes the performance of the procedure faster and cheaper.
M.C.: The cost is still to be discussed, but yet another question arises. Do I understand it correctly that the work with the sets increases the efficiency of the operating room?
S.D.: By all means yes. In addition to the mentioned sets also the high quality of disinfectants that allow for very rapid turnover of patients in the operating room contributes to better efficiency. Taking our hospital into consideration, I can say that until recently, daily we performed four procedures e.g. strumectomy. Today we can perform five operations and we have still some reserve time. This shows the efficiency and getting in sync of the team, as well as shorter time devoted to prepare for a surgery. This is most noticeable while analysing the productivity of the operating suite for a month or a year.
M.C.: Yet another question about the waste. Can we assume that the amount of waste gets reduced?
S.D.: It depends. Generally, the amount of medical waste coming from the operating theatre increases. This happens in all medical units using disposable products like disposable OP-drapes, medical devices, gowns, etc. However, the amount of waste, in the case of unit packages of the products used during the treatment certainly drops and is limited to a few, and not as it once was – a dozen or even dozens.
M.C.: So how do the costs of a procedure change after implementing disposable ready-for-use sets?
S.D.: I have no doubt that this solution is far more profitable for the hospital, because we have a finished and adjusted for our needs set, sterilised and delivered. Completing components inside the hospital in our reality would involve an additional job position, and that means an increase of the cost of the procedure. The best and the most advanced solution are sets dedicated for a particular medical procedure. This reduces not only the amount we opened dressing materials, but also in such sets you can find OP-drapes, a Mayo table cover, covers for equipment and cables, organisers for the equipment used during a surgery – a very useful and work ordering thing i.e. a whole load of sterile material. In this case, the cost of the given procedure is countable and very readable. The number of performed procedures is equal to the amount of used sets.
M.C.: Thank you very much for your time.