OCTOBER 1999, VOL 70, NO 4 P R A C ‘ I ’ I C A L I N N O V A T I O N S

Sterile finding a

pace may be described as “the final frontier” in Star s Trek episodes; however, in

the sterile processing department (SPD) at Tuomey Healthcare Systems, Sumter, SC, it has been a continuing consideration-and a problem-for a long time. An increase in both volume and variety of supplies needed to serve the OR and other sterile areas of this 266-bed institution created an acute space shortage. Shelves and room corners were overflowing with everything from surgical kits and catheters to IV pumps and specialty carts. New supplies tended to be squeezed in or piled up wherever there was room.

This problem greatly impeded the work of perioperative nurses and SPD staff members who used supplies. At this institution, materials are pulled from the SPD an average of 150 to 200 times per day, loading approxi- mately 40 procedure carts daily. The ongoing overflow and relo- cation of supplies slowed staff members’ work and added to frustration, especially in emer- gency situations. Moreover, with the facility’s steady growth of patients and services, it seemed that the situation would only become worse over time.

LOOKING FOR A SOLUTION Increasing the amount of

floor space beyond the existing SPD storage was not an option. Like most health care facilities, Tuomey Healthcare Systems was

supply storage- place for everything

not in a financial position to increase its sterile storage area, particularly when space that sat- isfies clean room requirements can cost from $300 to $400 per square foot or more for new construction.‘

Based on the facility’s success with mobile storage systems in other departments (eg, radiology, human resources, medical records), SPD administrators decided to investigate the feasibil- ity of mobile systems for sterile storage. In contrast to stationary shelving or drawers, mobile stor- age systems use wheeled car- riages mounted on floor rails. They are compacted when not in use and can be opened on demand when a user needs to enter a particular aisle. By elimi- nating the need for multiple aisles, these carriages can double the amount of storage capacity of an area or reduce the floor space needed for comparable storage by approximately 50%.2 Equally important, high-density mobile systems can help keep supplies neatly organized and close to the area where they are used.

With the assistance of the designer and installer of the hos- pital’s other mobile systems,

CLARICE McFADDlNCST/CSPDVs the director of the sterile processing department, Tuomey Healthcare Systems, Sumter; SC.

KAREN EARNHARDT, RN, is an associate at J . E. Pope Co, Char- lotte, NC.

SPD administrators evaluated the potential of a mobile storage sys- tem for their needs. To learn more, SPD staff members partic- ipated in site visits to other hos- pitals to examine mobile storage systems in clinical supply areas.

Administrators then met with the installer to develop an optimal storage design for the SPD. Perioperative nurses and SPD staff members were recruited to develop a “wish list” of how they believed materials should be organized. For example, in the past, catheters needed to be folded in half to fit into their assigned space. For the new storage sys- tem, staff members requested built-in drawers with dividers to match the length of the catheters.

BENEFITS OF MOBILE STORAGE Tourney administrators de-

cided to install eight mobile car- riages, each 12 ft long, 21 ft wide, and 7 ft high. Each carriage contains three 4-ft shelving units with four to five openings each (Figure 1). They can be config- wed appropriately for supplies ranging from needles and gauze, to 36-in x 36-in soak pans for cystoscopy procedures, to large boxes housing cesarean section kits. As more than one person often pulls supplies from the shelves at the same time, the mobile system is designed to permit simultaneous access to two aisles.

More room. Installing the mobile system at least doubled the SPD’s available storage capacity.

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It created room for four stationary shelving units with drawer stor- age along the wall near the mobile system, as well as room for procedure carts, which were previously scattered about the room (Figure 2) . It also created room for a suture work area with- in the SPD as the SPD staff mem- bers maintain and restock suture inventory for the OR, emergency department, and the off-site facili- ties. In addition, the carriages contain room for anticipated growth in supply requirements.

Better organization. A mobile storage system permitted, for the first time, a logical organization of all SPD supplies. They now are grouped in categories (eg, orthopedics, plastics, gynecolo- gy, urology) with their contents clearly marked on the sides of the carriages. Perioperative nurs- es can quickly find the supplies they need, and procedure carts can be prepared and loaded in a manner most compatible to the sequence of typical OR proce- dures. Moreover, new SPD staff members can be oriented more quickly because the location of all items is consistent.

Improved cart filling and retrieval. As many of the facili- ty’s procedure carts are filled using computer assistance, the improved organization helped streamline the loading flow. Previously, scattered and ever- changing shelf stocking meant that staff members often needed to “backtrack” to obtain sup- plies-in effect negating the benefit of computerization.

According to Tuomey Healthcare Systems representa- tives, the mobile storage system is a great time-saver. Procedure cart retrieval accuracy has improved from 78% to 97%

accuracy because staff members do not have to backtrack down the aisles. The system’s organi- zation makes retrieval easy, fast, and accurate.

Greater flexibility. After the mobile storage system was origi- nally set up in the SPD, hospital managers decided to move the department to a new but not larger area. The mobile storage system could be completely dis- mantled and reinstalled in the new location as long as the floor met the weight-bearing require- ments of high-density storage. At the time, SPD administrators were given the opportunity to

Figure 1 Each mobile carriage contains three 4 4 shelving units that can be configured for a variety of supplies- doubling the storage capaci- ty of the sterile processing department.

Figure 2 The mobile carriages create new space for stationa ry shelving units and procedure carts.

modify the system before it was reinstalled in its new home. They decided to add small bin fronts to some of the shelves to stabilize lightweight items as the mobile carriages were moved.

USER CONSIDERATIONS Mobile storage can be cus-

tomized to meet the specific needs of any SPD or OR-supporting area and other storage require- ments of the facility. The follow- ing are general suggestions when considering such a system.

Involve representatives at all staff levels in planning. This not only generates valuable input

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from those on the “front lines” of operations, but it also encourages acceptance of the system after it is in place. By actively soliciting SPD staff member and OR nurse input from the start, the change can be embraced instead of resis- ted because everyone has the opportunity to make it a change for the better.

Examine existing installa- tions. Determine the effective- ness of the current system as compared to a desired system. Review the increasing number of mobile systems used in sterile departments throughout the United States and Canada; how- ever, keep in mind that a storage system does not necessarily have to be used in a health care appli- cation for it to be relevant to a health care facility’s needs.

Plan mobile storage into building deslgn and engineering. In new construction, ensure that floors in a proposed mobile stor- age area are engineered to handle the weight of the system and that the area is clear of any obstacles to carriage movement. Involve the mobile storage contractor early in the design and construction phase to reduce installation costs of components such as floor rails. Some users even install additional rails during the floor-pouring phase in anticipation of future growth.

In existing buildings, make sure that floor space can handle the greater concentrated weight of high-density storage. Floor loading requirements for sterile supplies average 80 to 100 lbs per square foot or more if instru- ment trays are stored on the

N O T E S

mobile system. Additional rails often can be installed to help spread the system’s line load. The hospital building engineer and contractor should consider these factors before making a mobile storage decision.

Select a system with maxi- mum flexibility. Even with the most careful preparation, there likely will be discrepancies between anticipated storage needs and what is actually required after the system is in use. Supply sizes such as catheter packages can change as well. Make sure to choose a system with shelving and other storage housings that can be easily reconfigured to meet changing needs. The size of any drawer in Tuomey ’s SPD system can be changed by moving a few screws or dividers.

Choose operating controls and other features based on the facility‘s needs. Mobile storage carriages can have a variety of control devices, including manu- al, mechanical assist, power assist, or programmable electron- ic that require only a touch to operate. As the price of the oper- ating systems increases with their sophistication, it is impor- tant to determine what features are important to a facility and what are not.

loaded carriages be? Does it have above-average needs for material protection, safety, secu- rity, or access by employees with disabilities? These and other considerations should dictate whether the facility opts for a more fully featured electronic operating system or a less expen-

How heavy will the facility’s

sive hand-operated one. Tuomey SPD administrators determined that the mechanical-assist con- trols, which multiply hand- cranked leverage through con- cealed roller chains and sprock- ets, fit their specific needs most cost-effectively.

Consider prospective manulac- turers and contractors carefully. Both are equally critical to the ultimate success of the storage system. Mobile storage systems are more sophisticated than sta- tionary shelving and carry higher requirements for design, manufac- ture, and installation. A system that provides years of satisfactory operation requires not only a rep- utable manufacturer, but also a contractor who is experienced in the special requirements of the mobile system. The larger the installation, the more important it is that both parties have the resources to handle the facility’s needs. Again, be sure to talk to others who have used the manu- facturer and contractor for similar projects.

Do not assume that anything is impossible. By asking ques- tions, many users have sparked design innovations, saved money by reusing existing materials, and in other ways obtained the most from their particular mobile stor- age system. For example, much of the wire shelving and dividers from the Tuomey SPD’s previous stationary shelves were able to be modified and used in the new mobile system, thus reducing its final cost. The best vendors should be creative and flexible to be able to customize their “solu- tion” to a facility’s needs. A

Systems (Ft Atkinson, Wis: Spacesaver Corp, 1996). 1. Spacesaver Information and Materials Storage 2. Ibid.

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