When our hospital decided to adopt a new software scheduling system, we left binders of surgical preference cards behind (the picture below brings back bad memories) and put an integrated computer system on the job.

Preference cards are, of course, integral to the function of the OR. In addition to properly supplying your physicians' cases, accurate preference cards can help reduce the amount of supplies idling on shelves and decrease waste per case in the OR. The cards also provide data for utilization reports, case costing and inventory control.

An article in the summer 2004 issue of the Journal of Healthcare Information Management notes that computerizing preference cards can contribute significantly to OR safety. For instance, if a latex allergy is reported in the pre-surgical evaluation or the patient's medical history, latex-free products can easily be substituted on supply pick lists and preference cards through such a system.

Advantages of automation
We'd previously used five-by-eight-inch index cards to record our surgeons' preferences, but we later upgraded to typing them into Microsoft Excel spreadsheets.

The integrated system was a big change, especially for some of our older staff members with limited computer literacy. One of our staff nurses has been directing the input of the more than 1,200 preference cards we have on file here at Phoenixville (Pa.) Hospital. Her clinical knowledge, as well as her patience and thoroughness, have ensured a smooth transition. We've also relied on the vendor for a lot of support, and its availability to offer support has been essential to the task.

The system's flexibility and customization to our hospital's particular needs are only the beginning of its advantages. Here are some of its most notable improvements over our old preference card process.

• It's simple. To pull a preference card, you select the surgeon's name, select the procedure he's performing, click print and you're done.
• It's automatic. In our manual system, we had to pull preference cards individually. Our electronic system generates all the cards when cases are scheduled.
• It's organized. We can list the preference card's items in an order conforming to their locations in the storage room, making it less time-consuming to pull supplies for a case. This has saved us up to 45 minutes per procedure, in some instances.
• It offers quick comparisons. Obtaining cost comparisons per surgeon or per case has never been easier.
• It provides more information. There's more detail available on computerized preference cards than we'd have ever written by hand. On our index cards, we'd list the surgeons' names and their supplies. The electronic records include material management numbers and reference/re-order numbers as well, which help to ensure you're pulling the correct items.
• It's more descriptive. We can be as specific as we want to in listing the items. At the same time, our materials manager can use the primary description she needs to identify the item as well.
• It builds a history. Using the reports our system produces, we can review case trends, such as surgical times, and use that data to adjust our practices for more efficient performance in the future.

We also anticipate that electronic preference cards will provide long-term time and financial rewards in billing and inventory management once we fully link our material management program to the system.

Challenges on the way there
With any change, there are also always potential drawbacks in implementation. We faced a few minor bumps in the road, and you should keep in mind that your transition will most likely require a bit of fine-tuning as well. Here are some of the snags we faced.

• Manual entry. We were hoping to upload the information straight from Excel into our new system. We couldn't. Everything had to be typed in manually, again.
• No generic card. We'd also hoped to fill in the blanks of one generic procedure card to fit each surgeon. That didn't work because it overlooked too many details.
• Staff training. How do you underline that item for emphasis on your index card? You reach for a pen. How do you pull a preference card? You open the binder. A computerized system will require your staff to learn how to do the simplest tasks all over again.
• Change during change. As you're implementing your system and entering all the paper information, a surgeon makes changes to his card. It's a constant juggling act to stay up to date while the process is in transition.
• Bugs in the system. After we'd input all the cards, we learned that there was still the possibility of inaccuracy. Exercise caution and work under the assumption that each card could potentially be wrong. Your surgeons' feedback will let you know if they are.
• Trust issues. You'll need to put all of your faith in the computer, since there'll be no paper to back it up. Either that or spend twice the time and twice the space maintaining a duplicate preference card system (and all the duplicate changes) on paper. That's not very logical.
• A different look. The cards aren't going to look exactly like your old ones, and it'll take time for your staff to adjust to the new form.

Wisdom of experience
In my mind, the advantages surely outweigh the drawbacks. Still, there are a few additional tips you'll want to keep in mind in order to avoid the worst headaches, offered by someone who's been through the implementation.

• Recruit the right people. Use a small core group of people you know to be meticulous, patient, steadfast and possessing strong clinical knowledge. You'll save time in the long run if there are fewer corrections to be made.
• Work from the ground up. Start your data entry from scratch. Sure, it's more time-consuming, but your cards will be more accurate. As I mentioned above, we didn't, then wasted time redoing a lot of cards.
• Print and file. While keeping paper copies of every card defeats the purpose of an electronic system, keeping printouts of your busiest surgeons' most common procedures on file can be convenient in the evenings, in the event of an emergency or when there's no time to log on to the system.

Foaming handwash for hand hygiene needs
Kindest Kare Antimicrobial Foaming Handwash, developed by Steris Corp., was designed and clinically tested to meet the FDA's TFM and the CDC's guideline recommendation for the use of mild products, says the company. Kindest Kare is dermatologist-tested, dye-free, hypoallergenic and classified as a health care personnel handwash (HCPHW) for use in high-risk areas. The foaming solution incorporates highly effective emollients and skin conditioners to maintain skin integrity, says the company, and its fragrance further encourages hand hygiene compliance.

The product has been clinically tested to produce a 2-log reduction from a baseline after a single wash and a 3-log reduction (99.9%) on human skin in 30 seconds in a HCPHW test after the tenth wash, says Steris. It is 0.75% Triclosan-based and available in two different dispensers.

Kindest Kare Antimicrobial Foaming Handwash lists for $96.24 per case of six one-liter wall-mountable containers and $154.62 per case of 18 15-ounce standing pump containers. For more information, call (800) 548-4873, visit www.steris.com or circle number 167 on your Reader Service Card.

Low-flow anesthesia in open architecture
The ergonomic design of DRE Medical's Integra AVS allows maximum workstation integration with the unit's standard AVS ventilator and A200SP absorber, says DRE. It includes a mechanical anti-hypoxic device and Air/N2O interlock. The AVS ventilator is equipped with volume, PCV and PSV modes, printer/data outputs, integrated oxygen monitor and spirometry, electronic PEEP and a 30-minute battery backup.

The unit also features large, backlit flowmeters for its twin oxygen, single nitrous oxide and single air yokes and a large color touchscreen. The AVS ventilator's selectable dual waveform display offers clear, precise depiction of pressure versus time, volume versus time or pressure versus volume, adds DRE.

The Integra AVS from DRE starts at $29,995. For more information, call (800) 462-8409, visit www.dremed.com or circle number 168 on your Reader Service Card.

A bevy of beakers
Stackable, tri-sided disposable beakers from EPS now come in six sizes ranging from 50 ml to 1000 ml, manufactured with specially notched corners for easier pouring and less spillage. Made out of durable, translucent polypropylene for resistance to most acids and bases, the beakers have graduation markings in ounces and milliliters molded into the material to prevent deterioration. A flat bottom adds stability and allows for stacking and storage, says the company. The beakers are autoclavable up to 145 degrees F.

EPS Tri-sided Plastic Disposable Beakers range in price from $22 to $46.50 per case of 100 depending on size. A starter kit is also available for $20 per pack, which includes five of each size beaker. For more information, call (800) 523-8966, visit www.medidose.com or circle number 169 on your Reader Service Card.

Line your bins to reduce infection risks
Daschner Bin Liners from Health Care Logistics fit neatly inside storage bins to reduce the risk of passing along nosocomial infections. While cleaning out the bins may remove some of the offending debris, the practice often fails to reduce the risk for disease and improve infection control, says the company. Nine types of liners are available in a wide range of sizes. List price varies, from $3.90 to $31.90 per package of 25. For more information, call (800) 848-1633, visit www.healthcarelogistics.com or circle number 170 on your Reader Service Card.

Meet JCAHO requirements with new med labels
Two manufacturers are offering solutions to JCAHO's new National Patient Safety Goal requirement to label all medications and medication containers in perioperative and procedural settings.

Xodus Medical says you can customize its Patient SAF-T Label System labels to meet your needs, including options for printed or blank labels, label size and background and text color. The coated labels resist ink smudging or wet label peeling, says the company. A permanent marker designed for use with the labels is included. Prices range from $1.50 to $2.50 per pack of labels, depending on sheet quantity. For more information, call (800) 963-8776, visit www.ORmedlabels.com or circle number 171 on your Reader Service Card.

You can buy Cardinal Health's Presource Standard Medication Label Sheets in Cardinal's custom procedure packs or as single sterile items, says the company. The waterproof labels are available with or without spaces for initials and dates. Cardinal Health didn't disclose pricing. For more information, call (800) 766-0706, visit www.cardinalhealth.com or circle number 172 on your Reader Service Card.

Mix and deliver cement with ease
Arthrocare has developed the Parallax Integrated Delivery System (IDS), a fully enclosed cement cartridge using state-of-the-art technology to effectively mix and deliver cement into a reservoir ready for injection into your patient's vertebrae during vertebroplasty and kyphoplasty procedures.

The cement cartridge contains precise amounts of monomer and polymer as well as a mating reservoir. The cartridge locks into the Parallax IDS reservoir and through a plunging motion fills the reservoir with cement ready for injection, says the company. Delivering a consistent mix each time, it virtually eliminates OR staff exposure to toxic monomer fumes.

The product also provides precise cement volume control, a large cement reservoir that allows a case to be completed without refilling and a 17-inch injection tube that minimizes the operator's exposure to radiation, adds the company.

The Parallax Integrated Delivery System's suggested cost is $484. For more information, call (877) 620-BACK, visit www.arthrocare.com or circle number 173 on your Reader Service Card.

Custom, affordable powered storage
Simplicity, security and safety mark Spacesaver's Eclipse Powered System, a high-density mobile storage structure, says the company. Features and options can be chosen on an a la carte basis to build the system you need while also allowing for future upgrades. In addition, fewer moving parts, non-contact limit switches, no-touch circuit boards and heavy-duty engineering spell better reliability, adds Spacesaver.

The system's Zero Force Sensor detects people or objects in open aisles to prevent carriage movement until the aisle is vacated. Its Photo Sweep stops carriage travel if the system makes contact with a person or object. The Power Link remote monitoring system alerts service technicians to potential problems. And a backup power option automatically switches to battery power in the event of a power outage.

Eclipse also offers an energy saving aisle lighting option that illuminates only the occupied aisle and automatically turns out lights after a period of inactivity.

The Eclipse Powered System's list price ranges from $3 to $4 per linear shelf inch, depending on options. A storage volume of about 15,000 linear shelf inches would list for about $45,000 to $60,000. For more information, call (800) 492-3434, visit www.spacesaver.com or circle number 174 on your Reader Service Card.

Tattoos and labels aid wrong-site surgery prevention
Dinosaurs, a mouse and an elephant can help to prevent wrong-site surgery in pediatric cases when you use Correct Site Tattoos from Health Care Logistics. The cartoon drawing tattoos, one inch in diameter, include the words "correct site" and "yes" as a visible adjunct to site verification. The latex-free, non-toxic tattoos remain legible for up to seven days on all skin tones, says the company. Green and white tattoos featuring the words only are available for use on adult patients.

Health Care Logistics also offers Operative Site Adhesive Labels for placement in your patients' charts. At 1.5 inches by 2.5 inches, the visual aids let surgical team members mark the site intended for surgery, says the company. Eighteen varieties of anatomical illustrations, from full body to individual extremities, are available.

The cartoon character tattoos range in price from $62.01 to $68.90 per package of 100, depending on quantity. The green and white text tattoos range from $31.05 to $39.50 per package of 50. Operative Site Adhesive Labels cost $6 per roll of 500. For more information, call (800) 848-1633, visit www.healthcarelogistics.com or circle number 175 on your Reader Service Card.