Procedure packs can shrink turnover times and improve efficiency, but only if you manage their contents wisely and if your surgeons and staff use the packs properly - which are easier said than done. What if not all your surgeons are happy with what's inside? Or if vendors swap one product for another without telling you? Or if it takes so long to make changes to your packs that you stockpile the unwanted supplies? Here's practical advice for dealing with that and more.

1. Focus on saving more than money.
The difference in cost is negligible when you compare procedure packs to buying supplies individually. You'll come out ahead in other areas. "Compare your cost of recycling, laundry or disposal to whatever items you intend to include in the packs to prove out the cost savings ahead of time," says Lesley Nace, RN, of Woodbury and Landmark Ambulatory Surgery Centers in Woodbury, Minn.

You can also measure the savings in minutes. Packs reduce the time it takes to set up a room - grabbing one pack off the shelf beats pulling many supplies every time. This has let Karen Gabbert, RN, BSN, the clinical director of the Surgery Center of Kansas in Wichita, Kan., reduce her payroll. "My staff can come in 30 minutes later in the morning," she says. "All they have to do is wipe the room down and get the pack before we're ready to go."

You also save the time you'd spend accounting for individual items in the inventory, says Theresa Lute, RN, CNOR, perioperative clinical educator at Southern Ohio Medical Center in Portsmouth, Ohio. "We don't have to worry about special items and small orders," she says.

And since the packs are stocked with disposable items, you don't have to worry about wear and tear that commonly come with reused items such as linens, says JoAnn Forno, RN, BS, MPM, CNOR, manager of surgical services at Garrett County Memorial Hospital in Oakland, Md. "The staff doesn't have to make up the packs or resterilize them, which saves us a lot of time," she says.

2. Hold vendors accountable.
You don't want to unwrap any unwanted surprises, yet vendors can mistakenly send you damaged, unsterilized packs or substitute something you ordered with another product. Stay in contact with your staff to find out if there are any such problems that can compromise the benefits.

Ms. Forno recalls two instances when her staff opened a pack and found a piece of hair mixed in with the supplies. Another time they found black flecks while flushing out an irrigation syringe. When this happens, expect vendors to replace the packs at no charge, says Ms. Gabbert. "We have to track the lot numbers on the pack, the run-dates, that kind of stuff, so they can go back to quality management within their plant," she says. "But we never had difficulty getting the pack replaced."

A bigger problem for Ms. Forno is when the vendor changes items in the pack without telling her. Once, for example, drapes that had ties suddenly had Velcro-like hook and loop fasteners. "And it seemed like they were made out of a cheaper material," she says. "The new ones weren't holding up as well as the old ones."

If Ms. Forno receives a complaint from her staff, she says solving the problem means sending the information to her purchasing and materials management department so they can call the sales rep. "Usually, the problem is that there hasn't been communication between us and the vendor," she says.

One other detail to be on the lookout for, says Ms. Forno: If what you asked for in a pack isn't available, make sure the vendor doesn't make a substitution without notifying you or charge full price for a pack that's one supply light.

3. Think three months ahead.
OK, you just decided you want to change a product in your pack. You call your rep, she enters the change - but you likely won't be shipped the new packs for another three months. Most vendors pre-assemble a supply you must exhaust before you can receive revised packs. Helen Morar, RN, BS, the director of surgical services for Inland Hospital in Waterville, Maine, asked for Foley catheters for her gynecology packs, but found they weren't getting used as much as she'd thought. "The staff had to live with it for longer than they liked," she says. To keep three months without a perfect pack from becoming a year or longer, review how well the packs are working with your OR staff every three to six months to be sure they aren't having any problems, says Ms. Morar.

Being certain of what you need before you make the order can go a long way toward keeping your packs efficient. Ms. Gabbert says this starts with keeping a list of everything you need for the procedures you're considering getting packs for. When meeting with vendors, she suggests giving them these lists so they can make a prototype pack suitable for OR use. The staff can go through the pack and suggest what they'd like to see more of or think they could get rid of, and then try using it for a few procedures during an initial run to see what other changes are needed. "Over six months, with very small runs, we were finally able to get to the point where once in a while we may have an extra Kerlix, but for the most part everything in pack is used," she says.

Developing a workable prototype was also an important component for Ms. Lute when her facility was considering vendors for its procedure packs. In six weeks to two months they were able to create something that satisfied the whole staff. Once, she says, they ordered a run without getting a prototype first and found themselves missing some devices and dealing with some extra ones. "It was a disaster," she says.

"You really have to work with the vendor and get items everyone is comfortable with," says Ms. Lute. "And be sure there are no substitutions or, if there are substitutions, that everybody is happy with them."

4. Mind the storeroom.
Procedure packs can help you reduce your storeroom's clutter of miscellaneous items, but Ms. Lute says that the packs' bulkiness can also cause problems. "Make sure you've got the shelf room for them," she says.

Since the packs take up a lot of space, Ms. Morar says planning is very important, although changes in your physician roster may affect what your OR needs. "We maintain our par level carefully, but if you have a change in surgeons or procedures there can be a backlog," she says. "We had a gynecologist move, and some of the items we had in the pack were ones he had been the driving force for including. When he left, the other docs didn't feel they needed those items due to changes in their procedures. Some things in the pack were outdated, so we stopped ordering the pack, broke down the ones we had and picked a time to use all the supplies that were still usable."

Using the packs has reduced the amount of inventory Ms. Gabbert's facility needed for individual items, but occasionally unused items can come back to the storeroom. "If our OR staff doesn't use something, they pass it off to the back table, where it can be used as a non-sterile item in another application," she says. "Instead of throwing it away, you're recycling something you already paid for."

But to keep from ending up with a storeroom full of odds and ends, Ms. Lute says it's important to know your vendor's return policy. "Make sure they'll take back things you won't need, or see how you will dispose of these things," she says. "You'll want to know that up front so you don't get stuck with a lot of things you don't need."