Your ORs should contain no unnecessary equipment and furniture "for the same reason that a drawing should have no unnecessary lines and a machine no unnecessary parts."1 Follow our proven method to tidying your ORs and you'll soon realize more on-time starts, faster room turnovers and improved staff morale. A point to keep in mind before we begin: When reorganizing your ORs, don't bite off more than your staff can chew. Here's how to roll out your de-cluttering project in a few easy-to-digest courses.
A Straightening Success Story
There's a huge difference between cleaning and organizing an OR. We implemented the reorganization model recommended by our health system's administration (and detailed in this article) and have seen huge improvements in our daily productivity. Staff doesn't spin their wheels looking for supplies and equipment; they prepare for each case of the day knowing items are in their designated storage locations. Trust me, not having to worry about finding supplies and equipment does wonders for the overall attitude of the surgical teams.
Instituting a new organization system in your ORs will be a difficult task. Maintaining the changes will be even more challenging. Identify responsible members of your staff to serve as service line coordinators. They'll be responsible for managing the equipment and supply inventories related to their specialty. When new equipment is added or additional supplies are rotated through their ORs, they must inform the clinical team, identify a storage area, affix proper labels and update the supply picture book.
Serving as a service line coordinator is a tough job. Those picked for the gig should be detail-oriented and willing to take direct ownership in maintaining a clutter-free clinical environment. Their added responsibilities deserve a bump in salary or some other form of recognition (although, let's be honest, money talks). The additional expense will be more than paid back to you in increased case efficiency and reduced headaches.
Lisa Richardson, MHA, RN, CNOR
Ms. Richardson ([email protected]) is administrative director of surgical services at Community Hospital in New Port Richey, Fla.
1. Draw a map. Ask your staff to decide how they'd like equipment and furniture arranged in each OR. They know the setups that promote efficiency and the required equipment for procedure-specific rooms. After they decide on ideal layouts, create simple computer-generated maps of each OR's design. Label the placement of everything in the room, from the anesthesia machine to the Mayo stands and kick buckets.
Some labels will be by the book "Bovie machines" or "patient warmers," for example while others will be unique to facility insiders. One OR team in our health system mapped the location of a surgeon's chair they wrote "Dr. Reed's chair" right on the map because they know he's a stickler for sitting in the same spot during each case. Making notes of unique needs like that is a perfect example of why mapping OR layouts ensures only required equipment nothing more, nothing less is in the right location before each case. That will keep the OR clear of unneeded items and primed for efficient use. Make your maps (a sample appears above) large enough for staff to reference from anywhere in the OR during room turnovers. Take the maps to your local copy center, enlarge them into laminated posters and hang them in the ORs they depict.
2. Name the rooms. Differentiate each OR with specialty-specific designations. Using color codes is simple and effective the red room, blue room and green room, for example. Simply numbering them works, too. Involve your staff and have fun with the labeling. One of our clinical teams, for example, named their GYN suite the "purple room" because the surgeon who operates there is known for always wearing her purple surgical scrubs.
3. Name the spaces. Many facilities don't have adequate storage space for large equipment and are reduced to using hallway nooks and crannies to park equipment. While not ideal, those de facto storage areas are invaluable to facilities operating in the real world. Make those areas official storage locations, assign each a color designation and label the spot with a simple sign or color-coded marking. Do the same for your conventional storage rooms. Clearly mark every supply or equipment storage area in your facility.
4. Label the equipment. Now place corresponding color-coded or numeric labels on the equipment assigned to each storage area. For example, label the Bovie machine that belongs in OR 1 or the "Green OR" with a "1" or a small piece of green tape. Whatever label you use needs to be bio-med and infection control friendly, and must withstand repeated cleanings. Matching equipment labels to the areas or rooms you've designated for their storage makes placing and finding equipment in the correct location an easy task. When the clinical team in the "Blue OR" borrows that Bovie machine from the "Green OR," staff resetting the rooms between cases or at the end of the day know where to return the unit. A C-arm with a strip of red tape on its frame tells staff to return it to the red storage room, identified with an identical piece of tape on the nameplate outside the door.
Equipment labels can also be incorporated in electronic operative reports. We programmed the serial numbers of each piece of equipment into our EMR system. Instead of typing 12 digits into the op report to document the use of a patient warming device, for example, staff simply key in the one number that corresponds to the warming unit's home room. The software program automatically notes the entire serial number in the patient's permanent op record.
Don't Forget About Safety
Did you know a surgical fire could fill an OR with smoke in less than 30 seconds? Most people don't realize how quickly they have to act to move patients and themselves when the unexpected happens. Keeping the floors in your clinical spaces free of tripping hazards is as much about patient and staff safety as it is about surgical efficiencies.
Storage cabinets, carts and booms are excellent tools for keeping ORs organized and floors clear. We constantly monitor the placement of our storage devices during monthly safety rounds, confirming the 20-inch buffer between stored supplies and the ceiling required by fire codes. Carts or racks must be 8 inches above the floor, too, with a solid bottom base to protect the stored supplies and equipment from dust and contaminates.
We've placed strips of red tape on the walls near carts, racks and cabinets to remind staff about the mandated floor and ceiling cutoffs.
Equipment booms also keep staff from having to move heavy monitors and video equipment over cords and in and out of ORs between cases. That may not seem like much of a chore, but ask the nurse who has to do it over and over again, day after day.
Nancy Jones, RN, CNOR
Ms. Jones ([email protected]) is senior director of perioperative services at the Doctors Hospital of Sarasota, Fla.
5. Write a book. Once your equipment, supplies and storage areas are color-coded and labeled, develop a picture book of commonly used equipment and supplies. Keep the book in a centralized location for quick reference by any member of the clinical staff. When equipment or supplies are needed, staff unfamiliar with your storage areas or veterans who need a quick reminder can see where the needed item is located with a quick reference to the picture book.
For example, a nurse who needs a Jackson table flips to the J's in the book; there she'll find a picture of the table and directions to the storage location. Include a picture of the table in its actual storage location for easier recognition by staff.
The picture book is relatively easy to make. We snapped digital pictures of equipment and supplies in designated storage locations and imported the images into a Microsoft Word document. We arranged the listings in alphabetical order by supply or equipment name. Each listing includes the product's official name; nicknames or alternate names commonly used by staff and the item's assigned storage location. Our picture book is about 14 pages long with three to four listings on each page.
6. Shuffle the cards. Reorganize your supply pull cards by considering how you write your weekly grocery list to match the order of the store's aisles. Produce first, followed by meats, dairy, and finally, the deli. The same concept applies to physician pull cards. Supplies listed on each card should match the order of the aisles and bins in the storage room. In other words, set up the cards to direct staff through supply shelves in sequential order, from Shelf 1, bin A to Shelf 20, bin Z. There's no jumping from aisle to aisle and no time wasted.
Our turnover times have dropped every month for the three years since we began our OR reorganization project. Staff flip rooms quickly when they can walk freely around your facility, know exactly where supplies and equipment are stored and have pride in their stride in always finding items in those assigned locations.
1. Strunk, William. Elements of Style. Ithaca, N.Y.: Priv. print. [Geneva, N.Y.: Press of W.P. Humphrey], 1918.