Aplicação da ferramenta de gestão na padronização e processamento de material ventilatório no Centro de Material e Esterilização / Implementation of a management tool to standardize and process ventilation devices in the Sterile Processing Department

Objetivo: Relatar a experiência da aplicação da ferramenta de gestão 5W2H para a padronização e processamento de material ventilatório no Centro de Material e Esterilização (CME) de um hospital de referência. Método: Trata-se de um relato de experiência com uma equipe de enfermagem atuante no CME em um hospital referência em cirurgia de alta complexidade e aplicação da ferramenta de gestão 5W2H para a padronização e processa-mento de material ventilatório. Resultados: Foram aplicadas quatro etapas: implementação da ferramenta de gestão e do quiz, capacitação da equipe de enfermagem, realização da padronização do material ventilatório e formulação do catálogo do material ventilatório. A ferramenta 5W2H favoreceu o pla-nejamento do processo de trabalho desenvolvido no CME e a identificação das fragilidades da equipe de enfermagem durante o processamento dos itens do material ventilatório. Conclusão: O uso da ferramenta de gestão para o detalhamento do problema associado à capacitação da equipe de enfermagem e à padronização do material ventilatório possibilitou reduzir os problemas relacionados à montagem incorreta e ao extravio dos materiais ventilatórios

Objective: To report the experience of implementing the 5W2H management tool to standardize and process ventilation devices in the Sterile Processing Department (SPD) of a referral hospital. Method: This is an experience report of a nursing team working in the SPD of a referral hospital for high-complexity surgery on the implementation of the 5W2H management tool to standardize and process ventilation devices. Results: The pro-cess consisted of four steps: implementing the management tool and administering the questionnaire, training the nursing team, standardizing the ven-tilation devices, and producing a catalog for the ventilation devices. The 5W2H tool helped plan the work process developed in the SPD and identify the nursing team's weaknesses during the processing of items from the ventilation devices. Conclusion: Using the management tool to detail problems associated with the nursing team training and with the standardization of ventilation devices allowed reducing issues related to incorrect assembly and loss of ventilation devices

Objetivo: Relatar la experiencia de la aplicación de la herramienta de gestión 5W2H para la estandarización y procesamiento de material ven-tilatorio en el Centro de Material y Esterilización (CME) de un hospital de referencia. Método: Se trata de un relato de experiencia con un equipo de enfermería actuante en el CME en un hospital referencia en cirugía de alta complejidad y aplicación de la herramienta de gestión 5W2H para la estanda-rización y procesamiento de material ventilatorio. Resultados: Fueron aplicadas cuatro etapas: implementación de la herramienta de Gestión y del quiz, capacitación del equipo de enfermería, realización de la estandarización del material ventilatorio y formulación del catálogo del material ventilatorio. La herramienta 5W2H favoreció la planificación del proceso de trabajo desarrollado en el CME y la identificación de las fragilidades del equipo de enfer-mería durante el procesamiento de los ítems del material ventilatorio. Conclusión: El uso de la herramienta de gestión para el detalle del problema aso-ciado a la capacitación del equipo de enfermería y a la estandarización del material ventilatorio posibilitó reducir los problemas relacionados al montaje incorrecto y al extravío de los materiales ventilatorios

The Supervision and Management Mode of Disinfection Supply Center Improves the Standardization of Sterile Goods Management in Clinical Departments.

Background: In daily inspection, the nonstandard management of sterile articles in clinical departments of hospitals often leads to the destruction of the sterilization effectiveness of sterile articles. Therefore, it is necessary to strengthen governance and improve this phenomenon. This study intends to investigate the mode in which the disinfection supply center participates in the supervision and management of the management of sterile items in clinical departments. It played a role in improving the standardization of the management of sterile articles in clinical departments and ensured the closed-loop management of the sterilization effectiveness of sterile articles. Methods: Every quarter, the disinfection supply center of our hospital will inspect the standardized management of sterile articles in all clinical departments of the hospital, mainly including the storage environment and facilities of sterile articles, the cleanliness of storage cabinets, placement principles, whether they are stored by category, and the quality and validity management of sterile articles. The quarterly inspection results were summarized and analyzed to find the existing problems and the causes. The disinfection supply center shall supervise the improvement. After the disinfection supply center inspected the standardized management of sterile articles in all clinical departments of the hospital for the first time according to the inspection contents, under the guidance and assistance of the nursing department and the hospital infection department, it improved the sterile article management system, conducted knowledge training for the whole hospital, and incorporated the standardized management of clinical sterile articles into the quality control inspection of the nursing department. In the later stage, the disinfection supply center is responsible for conducting routine inspection and supervision on the standardized management of sterile articles in all clinical departments of the hospital every quarter according to the inspection contents, including summarizing, analyzing, and urging the clinical departments to achieve the improvement of the management of sterile articles in clinical departments. Results: The standardization of aseptic articles after improvement was significantly higher than before and during improvement, and the qualified rate was significantly different (99.4% vs 97.9% vs 89.5%, P < 0.05). The average number of lost packages caused by nonstandard management in the department was significantly reduced. The average rate of lost sterile packages during and after the improvement was significantly lower than that before the improvement (10.5% vs 97.9% vs 89.5%, P < 0.05). It also effectively reduced the cost caused by the loss of sterile packages. Conclusion: The disinfection supply center participates in the quality control and management of sterile articles in the nursing department and regularly inspects and supervises the management of sterile articles in clinical departments. It can effectively improve the standardized management of sterile articles in clinical departments, ensure the safety of sterile articles, and form a closed loop of sterilization effectiveness.

Leadership development of nursing students in a material and sterilization center / Desarrollo de liderazgo de estudiantes de enfermería en un centro de material y esterilización / Desenvolvimento de liderança de acadêmicos de enfermagem em um centro de material e esterilização

ABSTRACT Objective: To analyze the experiences of Nursing students during the mandatory hospital internship at a Material and Sterilization Center with a focus on leadership development. Method: This is an experience report of a mandatory hospital curricular internship anchored in the national curricular guidelines for Nursing, of a descriptive-reflective nature, and carried out in a general university hospital in southern Brazil, from March to June 2019. Results: Activities were developed in order to develop leadership aspects such as people, orthotics and prosthetics management, surgical planning, conflict management, and assertive communication. Final considerations: The mandatory hospital curricular internship at the Material and Sterilization Center favored the students in the leadership process, management, decision-making, and development of autonomy for leading nurses.

RESUMEN Objetivo: Analizar las experiencias de los estudiantes de enfermería durante el internado hospitalario obligatorio en un Centro de Material y Esterilización con enfoque en el desarrollo del liderazgo. Método: Se trata de un relato de experiencia de internado curricular hospitalario obligatorio anclado en los lineamientos curriculares nacionales de enfermería, de carácter descriptivo-reflexivo, realizado en un hospital universitario general del sur de Brasil, de marzo a junio de 2019. Resultados: Se desarrollaron actividades que brindaron el desarrollo de aspectos de liderazgo como el manejo de personas, manejo de ortesis y prótesis, planificación quirúrgica, manejo de conflictos y comunicación asertiva. Consideraciones finales: La internación curricular hospitalaria obligatoria en el Centro de Materiales y Esterilización favoreció a los estudiantes en el proceso de liderazgo, gestión, toma de decisiones y desarrollo de la autonomía por parte de enfermeras líderes.

RESUMO Objetivo: Analisar as vivências de acadêmicos de enfermagem durante o estágio curricular obrigatório hospitalar em um Centro de Material e Esterilização com foco no desenvolvimento de liderança. Método: Trata-se de um relato de experiência de estágio curricular obrigatório hospitalar ancorado nas diretrizes curriculares nacionais para a enfermagem, de cunho descritivo-reflexivo, realizado em um hospital geral universitário no sul do Brasil, no período de março à junho de 2019. Resultados: Foram desenvolvidas atividades que proporcionaram o desenvolvimento de aspectos de liderança como gestão de pessoas, gestão de órteses e próteses, do planejamento cirúrgico, da gestão de conflitos e comunicação assertiva. Considerações finais: O estágio curricular obrigatório hospitalar em Centro de Materiais e Esterilização favoreceu aos estudantes o processo de liderança, a gestão, a tomada de decisão e desenvolvimento da autonomia de enfermeiros líderes.

An Enhanced Kaizen Event in a Sterile Processing Department of a Rural Hospital: A Case Study.

Operating Rooms (ORs) generate the largest revenues and losses in a hospital. Without the prompt supply of sterile surgical trays from the Sterile Processing Department (SPD), the OR would not be able to perform surgeries to its busy schedule. Nevertheless, little emphasis has been brought in the medical literature to research on surgical instrument processing in the medical literature. The present study was done applies an Enhanced Kaizen Event (EKE) in the SPD of a rural hospital to identify sources of waste and minimize non-value-added steps in the SPD processes. The EKE consisted of three successive Plan-Do-Check-Act (PDCA) cycles, which focused on improvements at the departmental level first, then at an area level, and finally at the station level. The EKE yielded an improved streamlined workflow and a new design for the SPD layout, one of its areas, and a workstation. This paper aims at building a methodology, including identified steps. Results exhibited a 35% reduction in travel distance by the staff, eliminating non-value-added processes, reducing errors in the sterilization process, and eliminating cross-contamination for sterilized materials.

Papel dos trabalhadores de enfermagem no centro de material e esterilização: revisão integrativa / Papel de los trabajadores de enfermería en la central de esterilización: revisión integrativa / The role of central sterile supply department nursing team members: an integrative review

RESUMO Objetivo Analisar o papel dos trabalhadores de Enfermagem em Centros de Material e Esterilização. Método Realizou-se uma revisão integrativa. Buscas compreensivas foram realizadas nas seguintes bases de dados: CINAHL via EBSCOhost, IBECS, LILACS, MEDLINE via PubMed, e Scopus. O método de comparação constante foi aplicado para analisar os achados dos estudos. A classificação inicial de subgrupos baseou-se no conceito de papel do Sistema Conceitual de King. Resultados Vinte e nove artigos de pesquisa foram selecionados, e três categorias identificadas: Percepções dos trabalhadores de Enfermagem do Centro de Material e Esterilização (CME) sobre seu papel; Percepções dos trabalhadores de unidades consumidoras sobre o papel de trabalhadores de Enfermagem no CME; e Funções dos trabalhadores de Enfermagem no CME. Conclusão e implicações para a prática As funções dos trabalhadores de Enfermagem do CME foram conceitualizadas como atividades de cuidado indireto. A visibilidade limitada da atribuição do CME conduz à percepção de status inferior na organização hospitalar e nos conflitos de papel.

RESUMEN Objetivo Analizar el papel de los miembros del equipo de Enfermería en Centrales de Esterilización. Métodos Se realizó una revisión integradora. Se realizaron búsquedas exhaustivas en CINAHL via EBSCOhost, IBECS, LILACS, MEDLINE via PubMed y Scopus. Se aplicó el método de comparación constante para analizar los resultados de las investigaciones. La clasificación inicial de subgrupos se basó en el concepto de rol del Sistema Conceptual de King. Resultados Se seleccionaron veintinueve artículos de investigación. Se identificaron tres categorías: las percepciones de los miembros del equipo de Enfermería del Central de Esterilización (CE) sobre su función; percepciones de los trabajadores del departamento de consumidores sobre el papel de los miembros del equipo de enfermería de CE; y las funciones de los miembros del equipo de enfermería CE. Conclusión e implicaciones para la práctica Las funciones de los miembros del equipo de enfermería de CE se conceptualizaron como actividades de cuidado indirecto. La visibilidad limitada del trabajo de este departamento lleva a una percepción de un estado inferior en la organización del hospital y conflictos de roles.

ABSTRACT Objective to analyze the role of nursing team members in Central Sterile Supply Departments. Methods an integrative review was conducted. Comprehensive searches were conducted in CINAHL via EBSCOhost, IBECS, LILACS, MEDLINE via PubMed, and Scopus. Constant comparison method was applied to analyze the study findings. The initial subgroup classification was based on the King's Conceptual System's concept of role. Results twenty-nine research articles were selected. Three categories emerged: Central Sterile Supply Department (CSSD) nursing team members' perceptions of their role; Consumer department workers' perceptions of the role of CSSD nursing team members; and CSSD nursing team members' functions. Conclusion and implications for practice the CSSD nursing team members' functions were conceptualized as indirect care activities. The limited visibility of this department's work leads to a perception of lower status in the hospital organization and role conflicts.

Identificação da carga de trabalho da enfermagem em Centro de Material e Esterilização / Identificación de la carga de trabajo de enfermería en el Centro de Material y Esterilización / Identification of nursing workload in the Sterile Processing Department

RESUMO Objetivo Determinar a carga de trabalho em Centro de Material e Esterilização como parâmetro para o método de dimensionamento dos profissionais de enfermagem. Método Estudo de natureza quantitativa, observacional, realizado em quatro instituições hospitalares da cidade de São Paulo, em três etapas: mapeamento das atividades em posições de trabalho; determinação do tempo padrão de processamento dos materiais e estabelecimento da carga média diária de trabalho. Resultados Foram obtidas 1315 amostras de tempo nas 15 posições de trabalho mapeadas. Os valores de tempo não apresentaram diferenças significativas, possibilitando determinar o tempo padrão de processamento dos materiais. As cargas médias diárias de trabalho corresponderam à: 217,4; 294,0; 123,1 e 189,1 horas. Conclusão Além de propor um método para determinar a carga de trabalho, a presente investigação indica parâmetros para o processamento de materiais e constitui importante referencial para elaborar propostas consistentes para o planejamento, alocação e distribuição de profissionais de enfermagem nessas unidades.

RESUMEN Objetivo Determinar la carga de trabajo en el Centro de Material y Esterilización como parámetro para el método de dimensionamiento del personal de enfermería. Método Estudio cuantitativo, observacional realizado en cuatro hospitales de la ciudad de São Paulo en tres pasos: mapeo de actividades en puestos de trabajo; determinación del tiempo estándar de procesamiento de materiales; y establecimiento de la carga de trabajo diaria promedio. Resultados En los 15 puestos de trabajo mapeados, se obtuvieron 1315 muestras de tiempo. Como los valores de tiempo no mostraron diferencias significativas, fue posible determinar el tiempo de procesamiento estándar de los materiales. Las cargas de trabajo diarias promedio correspondieron a 217.4; 294,0; 123,1; y 189,1 horas. Conclusión Además de proponer un método para determinar la carga de trabajo, el presente estudio indica parámetros para el procesamiento de materiales y constituye una referencia importante para desarrollar propuestas consistentes para la planificación, asignación y distribución de profesionales de enfermería en estas unidades.

ABSTRACT Objective To determine the workload in the Sterile Processing Department as a parameter for the method of nursing staff sizing. Method Quantitative, observational study conducted in four hospitals in the city of São Paulo, in three steps: mapping of activities in work positions; determination of the standard processing time of materials; and establishment of the average daily workload. Results In the 15 mapped work positions, 1315 samples of time were obtained. As the time values did not show significant differences, it was possible to determine the standard processing time of materials. The average daily workloads corresponded to 217.4; 294.0; 123.1; and 189.1 hours. Conclusion In addition to proposing a method to determine the workload, the present study indicates parameters for the processing of materials and serves as an important reference to develop consistent proposals for the planning, allocation and distribution of nursing staff in these departments.

Using a systematic approach for adopting new technologies in sterile processing departments and operating rooms.

Technological advancements in health care can potentially have substantial benefits on efforts to improve patient care. Organizations are often hesitant to consider new devices or technologies, particularly if the new technology is expensive, not addressed in current standards, or affects multiple departments, such as the sterile processing department, operating room, and infection prevention. Organizations considering new technology should create a multidisciplinary risk assessment committee tasked with using a systematic approach to evaluate and make recommendations on new products or technologies.

Can the number of surgery delays and postponements due to unavailable instrumentation be reduced? Evaluating the benefits of enhanced collaboration between the sterilization and orthopedic surgery units.

INTRODUCTION: The development of outpatient surgery, cost-reduction pressures and instrumentation storage limitations have led to their use "just-in-time". A recent study showed that stoppage of surgical procedures immediately before the incision (No-Go) was often due to the management of supplies and implantable medical devices. To our knowledge, since the development of outpatient surgery and the shortening of hospital stays, managing the flow of instrumentation has not been optimized. At our hospital, we used a two-prong approach consisting of a tool to manage instrumentation and working group from the sterilization and orthopedic surgery units. The aims of this study were to: 1) evaluate whether this approach led to better notification of the risk of supply shortage for instrumentation and 2) determine whether it could reduce by at least half operating room disruptions such as delays or cancellation of surgical procedures. HYPOTHESIS: This approach results in better notification of the risk of supply shortage for instrumentation and reduces by at least half operating room disruptions such as delays or cancellation of surgical procedures. MATERIAL AND METHODS: A tool was developed to manage instrumentation flow based on a retrospective analysis of data from 2015. This tool consisted of: (1) a list of instrumentation needed for each surgical procedure from an analysis of the surgical schedule and verification of traceability labels of the instrumentation actually used, (2) a list of reasons for supply shortage identified from an analysis of non-conformities occurring in the sterilization process of instrumentation kits. These analyses resulted in the development of checklists for instrument sets for each procedure, while identifying those with a high risk of shortage. In 2017, a working group focused on instrumentation was set up with personnel from the sterilization unit and the orthopedic surgery unit. Based on the check-lists and the schedule 24hours before the surgery, the sterilization unit alerted the surgery unit by email of the risk of material shortage; the surgery ward replied with potential changes to the material or the surgery planning. This approach (instrumentation management tool and working group) was named just-in-time (JIT). The main outcome was the number of notifications of potential supply shortage with and without JIT over a 10-week period. The secondary outcomes were the number of notifications resolved in time and the occurrence of operating room disruptions (delay>30min or postponement of surgery) related to unavailable instrumentation. RESULTS: Nine reasons for potential supply shortage were identified such as instrumentation kits used for several types of procedures, those with fast rotation and low stock, or in double pathways (on loan and on deposit). The working group reported 163 potential shortages with JIT versus 41 without (p<10-5), of which 150 (92.5%) were resolved. Thirteen operating room disruptions occurred; only one was not detected by the JIT approach. CONCLUSION: Our JIT approach (instrumentation management tool and working group) is effective at preventing instrumentation supply shortages. LEVEL OF EVIDENCE: III, prospective comparative study.

The work of sterile processing departments: An exploratory study using qualitative interviews and a quantitative process database.

BACKGROUND: The sterile processing of surgical instruments and equipment is an essential part of surgical operations. Although clean instruments prevent infections, little is known about the departments that conduct this work. We sought to describe sterile processing departments (SPDs) and to identify factors impacting them. METHODS: We analyzed data from 22 qualitative interviews of staff and managers and a quantitative benchmarking database. RESULTS: Qualitative results indicated 4 primary factors impacting sterile processing work: (1) role and visibility, (2) relationships and communication with other departments and vendors, (3) staffing and management, and (4) technical problems and solutions. Quantitative analysis revealed significant differences in SPD responsibilities and scope. DISCUSSION: Relationships with operating room staff were of paramount importance in the ability of the SPD to accomplish its job and in staff motivations and feelings. Differences in management practices, communication strategies, and problem-solving resources were also emphasized. Both quantitative and qualitative data showed concern for the role of the SPD in patient safety, particularly concerning practices such as the use of immediate-use steam sterilization. CONCLUSIONS: To more completely address adverse patient events and surgical patient safety, we must move toward examining the entire surgical process, including the vital role of SPDs.

Dimensionamento de pessoal no centro de material e esterilização de um hospital universitário / Dimensionamiento de personal en el centro de material y esterilización de un hospital universitario / Staff sizing in the material and sterilization center of a university hospital

RESUMO Objetivo Aplicar os parâmetros de tempo padrão das atividades de enfermagem propostos pela Resolução COFEN n.º 543/2017 para dimensionar o quantitativo de técnicos de enfermagem no centro de material e esterilização de um hospital universitário e comparar o quadro projetado com o existente no setor. Método Pesquisa exploratória e descritiva, com a coleta de dados realizada nas folhas de controle de esterilização e observação direta das etapas do processo de trabalho nas diferentes áreas do setor. Resultados Apenas uma das 15 atividades descritas não era realizada no setor; as mais realizadas, que apresentaram maior carga de trabalho e requeriam maior número de pessoal foram a recepção de materiais contaminados e a organização e distribuição do material esterilizado; as áreas que requeriam maior quantitativo de funcionários foram o preparo de materiais e o expurgo. Não foi observada diferença entre o número de pessoal requerido nos diferentes turnos de trabalho, e o quantitativo de pessoal calculado foi semelhante ao existente ao resultado do dimensionamento realizado utilizando os chamados sítios funcionais. Conclusão As propostas analisadas neste estudo podem ser utilizadas para o cálculo de pessoal no setor estudado e em outras instituições.

RESUMEN Objetivo Aplicar los parámetros de tiempo estándar de las actividades de enfermería propuestos por la Resolución COFEN nº 543/2017 para dimensionar la cantidad de técnicos de enfermería en el centro de material y esterilización de un hospital universitario y comparar el cuadro diseñado con el existente en el sector. Método Investigación exploratoria y descriptiva, con la recolección de datos llevada a cabo en las hojas de control de esterilización y observación directa de las etapas del proceso laboral en las distintas áreas del sector. Resultados Solo una de las 15 actividades descritas no era realizada en el sector; las más realizadas, las que presentaron mayor carga laboral y requirieron mayor número de personal, fueron el recibimiento de materiales contaminados y la organización y distribución del material esterilizado; las áreas que requirieron mayor cantidad de funcionarios fueron la preparación de materiales, su limpieza y desinfección. No se observó diferencia entre el número de personal requerido en los distintos turnos laborales y la cantidad de personal calculada fue semejante a la existente en el resultado del dimensionamiento realizado utilizando los llamados sitios funcionales. Conclusión Las propuestas analizadas en este estudio pueden utilizarse para el cómputo de personal en el sector estudiado y en otros centros.

ABSTRACT Objective To apply the standard time parameters of nursing activities proposed by COFEN Resolution No. 543/2017 to determine the number of nursing technicians in the material and sterilization center of a university hospital and compare the projected framework with the existing one in the sector. Method An exploratory and descriptive study with data collection performed on the sterilization control sheets and direct observation of the work process stages in the different sector areas. Results Only one of the 15 described activities was not conducted in the sector; those most performed which presented more workload and required more personnel were the receiving of contaminated materials and the organization and distribution of sterilized materials; the areas that required the highest number of employees were for materials preparation and cleaning/disinfection. No difference was observed between the number of staff required in the different work shifts, and the calculated staff quantity was similar to that existing in the result of the staff sizing performed using the functional sites. Conclusion The proposals analyzed in this study can be used to calculate staff size in the studied sector and in other institutions.

Diagnóstico de estrutura para processamento de produtos para saúde na atenção primária / Diagnostic study of primary health care products processing structure / Diagnóstico de estructura del procesamiento de equipos no desechables en atención primaria

Objetivo: caracterizar quanto à estrutura, os locais de processamento de produtos para a saúde de todas as 29 unidades da atenção primária à saúde de um município do interior paulista. Método: trata-se de um estudo descritivo- de abordagem quantitativa realizada em 2012, com aplicação de indicadores de estrutura para a atenção primária. Resultados: identificou-se baixa conformidade da estrutura (inferior a 75%), particularmente por ausência de espaço exclusivo ou fluxo adequado para processamento, de registros de normas e rotinas e de manutenção preventiva de equipamentos, além do uso de invólucros não recomendados. Todos os profissionais envolvidos possuíam formação adequada para a atividade. Conclusão: a estrutura física destinada ao processamento de produtos para saúde na área do estudo está aquém do recomendado, e o uso de indicadores validados e específicos, possibilitou a mensuração dos resultados.

Objective: to characterize the health care product processing structure and sites at all 29 primary health care facilities in a town in Sao Paulo State. Method: this quantitative descriptive study, conducted in 2012, applied primary health care structure indicators. Results: poor structure compliance (below 75%) was found, especially for lack of exclusive space or proper flow for processing, records of standards and routines and preventive maintenance of equipment; in addition, inappropriate packaging was found. All staff involved had been adequately trained for this activity. Conclusion: the physical structure for processing of health care products falls short of recommendations and the use of specific, validated indicators enabled results to be measured.

Objetivo: caracterizar la estructura del local del proceso de preesterilización/esterilización/desinfección de equipos no desechables en todas las 29 unidades de la Atención Básica de una ciudad del estado de São Paulo. Método: estudio cuantitativo, descriptivo, que se pasó en 2012, y utilizó indicadores de estructura para la Atención Básica. Resultados: identificaran baja tasa de conformidad para la estructura (inferior al 75%), por la ausencia de exclusividad de espacio para este local o flujo adecuado para el procesamiento, registros o normas, mantenimiento preventivo de los equipos y el uso de embalajes adecuados. Conclusión: la estructura física para el procesamiento de equipos no desechables incumple el codiciado y que el uso de indicadores validados permitió la mensuración de los resultados.

Where are my instruments? Hazards in delivery of surgical instruments.

BACKGROUND: Unavailability of instruments is recognised to cause delays and stress in the operating room, which can lead to additional risks for the patients. The aim was to provide an overview of the hazards in the entire delivery process of surgical instruments and to provide insight into how Information Technology (IT) could support this process in terms of information availability and exchange. METHODS: The process of delivery was described according to the Healthcare Failure Mode and Effects Analysis methodology for two hospitals. The different means of information exchange and availability were listed. Then, hazards were identified and further analysed for each step of the process. RESULTS: For the first hospital, 172 hazards were identified, and 23 of hazards were classified as high risk. Only one hazard was considered as 'controlled' (when actions were taken to remove the hazard later in the process). Twenty-two hazards were 'tolerated' (when no actions were taken, and it was therefore accepted that adverse events may occur). For the second hospital, 158 hazards were identified, and 49 of hazards were classified as high risk. Eight hazards were 'controlled' and 41 were 'tolerated'. The means for information exchange and information systems were numerous for both cases, while there was not one system that provided an overview of all relevant information. CONCLUSIONS: The majority of the high-risk hazards are expected to be controlled by the use of IT support. Centralised information and information availability for different parties reduce risks related to unavailability of instruments in the operating room.