Transforming Sterile Services

1
Transforming Sterile Services

• The Princess Alexandra Hospital
• NHS Trust
• Harlow

2
Background The Princess Alexandra Hospital
NHS Trust

• DGH within the East of England SHA
• Local population 258 000
• Turnover 136M
• Employees 3000 ( approx 2000 wte)
• Beds 489 total (401 of these for
  Medical Surgical admissions)
• Dedicated Elective Unit 28,000 elective
  admissions p.a
• Transformation Programme launched June 2006

3

Sterile Services Department

• Customers
• - 10 Main Theatres
• - 4 Day Case Theatres
• - Outpatients 7 sites
• 2,700 trays in circulation (599 tray types)
• Ave. 864 instrument trays per week (range 604 to
  1199)
• 31 WTE establishment (in post 24 WTE)
• 24hr service Monday to Friday
• 7am to 11am Sat and Sun
• ISO 9000 June 2007

4
SSD Department Flow
In
Wash room
Processing And Packing
Washers x 4
Autoclaves x 3
Clean Dispatch
Out
Offices Rest/Change Rooms
staff
5
Lean Event February 2007

• Sterile Services
• To improve efficiency and productivity within SSD
  
• To improve SSD store areas
• To support the achievement of ISO Accreditation
• Theatres
• To reduce the time spent locating equipment
• To reduce time spent looking for SSD trays
• To improve storage systems

6
Lean Event February 2007

• Current state processes mapped
• Baseline measures identified
• - No trays processed per hour per area
• - Source of demand
• - Tray turnaround times
• - Staff resources available by hour
• - Phones calls per day by reason
• - Time taken to locate SSD trays theatre
  equipment
• - Tray inventory
• Future state mapped and tested
• Just do its and projects agreed at out-brief

7
Current State Key Findings

• Sterile Services
• Processing time 10hrs 12mins (median)
• High proportion of urgent tray requests
• Batching wash area and packing
• Staff budget overspent despite being under
  establishment
• Staff mismatch - Demand v Capacity
• Poor IT system no tracking outside theatres
• Constant phone interruptions
• Poor system for instrument replacement/repairs
• Low morale and poor communication exhausted
  staff

8
Current State Key Findings

• Theatres
• Multiple instrument stores
• Hoarding basic and specialised instruments
• 60 trays of out of date/damaged in theatre SSD
  store
• Inadequate storage - Instruments and equipment
• Opening of second trays commonplace
• Poor staff understanding of sterilisation process
  
• Blame culture

9
Future State Actions

• Sterile trays centralised to SSD
• Store areas reorganised in theatres (6S event)
• Bleep system introduced single point of contact
• Dirty runners introduced hourly collections
• Second wrapper introduced in packing area
• Spare instruments sorted and catalogued
• Visual tools installed

10
Theatre SSD store

Before
After
11
New SSD store

12
Main Theatre Corridor

Before
After
13
3 Month Review
14
Evaluation

• Centralised tray store
• - Letting go difficult for theatre staff
• - Identified extent of cannibalisation
• Tray requesting system
• - Reference system for identifying trays for
  lists
• - Assumption of theatre staff that SSD staff
  all
• understand the operations,
  instruments and their use
• Instrumentation
• - Extent of type variation
• - Perceived need for additional instruments
• SSD Staffing
• - Skill mix issues
• - Demand v capacity mismatch late afternoons,
  evenings w/es
• Information
• - SSD Man reporting functionality

15
Quotes from Staff
SSD Assistant Its a real pleasure coming to
work now before the change I was ready to leave
Theatre Manager The impact of the store changes
in theatre has been extraordinary. The whole
theatre environment feels calmer and more
professional.
Theatre Nurse We could spend ages looking for
sets and still never find them. Now its so much
easier