You are on page 1of 5

CIS Self-Study Lesson Plan

Lesson No. CIS 233 (Instrument Continuing Education - ICE) by Peggy Pittenger, RN, CRCST
Implementation Consultant/Customer Support
Sponsored by: Unibased Systems Architecture, Inc.

Checklists for Central Sterile


Supply Departments
M
Learning Objectives odErN mEdICINE haS bEComE aN ExtraordINarILy
1. Explain the important role that check complex environment. as a result, patients may experience medical
lists can play in improving the effective- errors, which result in complications and even death. this is not because
ness of Central Sterile Supply Depart- the many people involved in their care lack knowledge about the right
ment personnel. thing to do. rather, the complexity of the technologies used to diagnose and treat med-
2. Review procedures to maximize the ical problems has become increasing difficult to manage.
usefulness of one Central Sterile Supply Consider the numbers: Currently, the World health organization (Who) identi-
Department checklist: preference cards. fies over 13,000 diseases, syndromes or injuries. the combination of these maladies
3. Describe useful tactics to plan and raises the number of possibilities exponentially and makes patient care incredibly
develop CSSD checklists. challenging. treatment options for those conditions include over 6,000 pharmaceutical
products and over 4,000 medical or surgical procedures. Considering the technology
and number of healthcare specialists involved, delivering treatment on time and safely
Instrument Continuing Education (ICE) lessons
provide members with ongoing education in during a patient stay becomes a daunting task.
the complex and ever-changing area of surgical In response to the rapidly growing body of knowledge and technology involved with
instrument care and handling. These lessons are patient care, Who has turned to another industry – the airlines – to research methods
designed for CIS technicians, but can be of value
to any CRCST technician who works with surgical for improving patient care and reduce complications related to healthcare. the airline
instrumentation. industry is comparable to the healthcare industry on many levels.
Checklists in aviation date back to 1935. an investigation into the crash of a boeing
Earn Continuing Education Credits:
Online: You can use these lessons as an in-service 299 that year revealed pilot error. the bottom line was that the plane had become “too
with your staff, or visit www.iahcsmm.org for online complex for pilots to fly.” a new locking mechanism remained in the “on” position but,
grading at a nominal fee. with so many other new technical features, the pilot forgot to check it before the flight.
By mail: For written grading of individual lessons, after this disaster, pilots collaborated to develop a simple solution: use a checklist to
send completed 15-question quiz and $15 assure critical steps are completed. Ultimately, this same airplane, later called the b-17
to: PEC Business Office, Purdue University, Stew- or “flying fortress,” flew nearly 2 million miles without further incident.
art Center Room 110, 128 Memorial Mall, West
Lafayette, IN 47907-2034.

Scoring: Each 15 question online quiz with a Why ChECkliStS? this occurs, the results can be the medical
passing score of 70% or higher is worth two points
(2 contact hours) toward your CIS re-certification Like the airplane pilot who knew the equivalent of a plane crash.
(6 points) or CRCST re-certification (12 points). steps required to prepare the plane for another challenge in modern medi-
IAHCSMM provides online grading service for flight, healthcare providers know the re- cine relates to the ongoing time pressures
any of the Lesson Plan varieties. Purdue University
provides grading services solely for CRCST and quired steps to plan and conduct medical experienced by busy healthcare providers.
CIS lessons. procedures. however, also like the pilot, it this may result in knowingly overlooking
is possible for them to miss a step because routine but very critical steps required for
More information: Direct any questions about
online grading to IAHCSMM at 312.440.0078. of the many complexities and distractions a successful patient outcome. Carefully
Questions about written grading are answered by in today’s healthcare environment. When developed checklists become the lifeline
Purdue University at 800.830.0269.
CIS Self-Study Lesson Plan

for clinicians, just as they are with pilots, CSSD ChECkliStS checklists and be very knowledgeable
to jog one’s memory and ensure the com- Checklists are a normal part of the rou- about the procedures used to organize
pletion of all vital tasks. tine in Central Sterile Supply department and maintain them.
many facilities have adopted the Who (CSSd). For example, the Instrument For example, there are several alternatives
checklist in the operating room (or) tray List or the Preference Card used to available to optimize the required informa-
to confirm that all critical steps are build case carts for or procedures are tion when creating preference cards in
carried out during perioperative care basically checklists. CSSd personnel have either a Word document or as part of
(see Figure 1). a task as simple as been successfully using these checklists operating room management Software
verifying the patient’s identity and for many years. however, the recently (ormS). basic information will include:
procedure, as well and body location renewed interest in the use of checklists • Patient identifiers
for the procedure, ensures that the right suggests new ways to create and maintain • Date and time of the procedure
patient receives the planned operation them. how should Certified Instrument • Facility and room number
on the correct side of his or her body. Specialist (CIS) technicians manage • Procedure(s) scheduled
additional checkpoints confirm that checklists for instruments and/or supplies • Name of surgeon(s)
required instruments and equipment to ensure a greater percentage of accu-
are present and properly prepared. racy? they must take an active role in the individual item(s) to be pulled,
understanding the process for creating as well as the quantity required, will be
Figure 1: WHO Surgical Safety Checklist

SURGICAL SAFETY CHECKLIST (FIRST EDITION)


Before induction of anesthesia Before skin incision Before patient leaves operating room

SIGN IN TIME OUT SIGN OUT

PATIENT HAS CONFIRMED CONFIRM ALL TEAM MEMBERS HAVE NURSE VERBALLY CONFIRMS WITH THE
• IDENTITY INTRODUCED THEMSELVES BY NAME AND TEAM:
• SITE ROLE
• PROCEDURE THE NAME OF THE PROCEDURE RECORDED
• CONSENT SURGEON, ANESTHESIA PROFESSIONAL
AND NURSE VERBALLY CONFIRM THAT INSTRUMENT, SPONGE AND NEEDLE
SITE MARKED/NOT APPLICABLE • PATIENT COUNTS ARE CORRECT (OR NOT
• SITE APPLICABLE)
ANESTHESIA SAFETY CHECK COMPLETED • PROCEDURE
HOW THE SPECIMEN IS LABELLED
PULSE OXIMETER ON PATIENT AND FUNCTIONING ANTICIPATED CRITICAL EVENTS (INCLUDING PATIENT NAME)

DOES PATIENT HAVE A: SURGEON REVIEWS: WHAT ARE THE WHETHER THERE ARE ANY EQUIPMENT
CRITICAL OR UNEXPECTED STEPS, PROBLEMS TO BE ADDRESSED
KNOWN ALLERGY? OPERATIVE DURATION, ANTICIPATED
NO BLOOD LOSS? SURGEON, ANESTHESIA PROFESSIONAL
YES AND NURSE REVIEW THE KEY CONCERNS
ANESTHESIA TEAM REVIEWS : ARE THERE FOR RECOVERY AND MANAGEMENT
DIFFICULT AIRWAY/ASPIRATION RISK? ANY PATIENT-SPECIFIC CONCERNS? OF THIS PATIENT
NO
YES, AND EQUIPMENT/ASSISTANCE AVAILABLE NURSING TEAM REVIEWS: HAS STERILITY
(INCLUDING INDICATOR RESULTS) BEEN
RISK OF >500ML BLOOD LOSS CONFIRMED? ARE THERE EQUIPMENT
(7ML/KG IN CHILDREN)? ISSUES OR ANY CONCERNS?
NO
YES, AND ADEQUATE INTRAVENOUS ACCESS HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVEN
AND FLUIDS PLANNED WITHIN THE LAST 60 MINUTES?
YES
NOT APPLICABLE

IS ESSENTIAL IMAGING DISPLAYED?


YES
NOT APPLICABLE

THIS CHECKLIST IS NOT INTENDED TO BE COMPREHENSIVE. ADDITIONS AND MODIFICATIONS TO FIT LOCAL PRACTICE ARE ENCOURAGED.
CIS Self-Study leSSon Plan

CIS technicians should participate in the or, as well as for CSSd personnel who
must pull and then restock unused sup-
process of building and maintaining instru- plies in storage area. developing guide-
lines or a methodology for removing
ment lists and preference cards. Understand- unused items creates greater proficiency
for both departments.
ably, the OR staff and physician will deter-
ChECkliSt DEvElOpMEnt taCtiCS
mine the list of instruments and supply items Consider the following points to assure
maximum returns on the use of check-
required; however, a process must be in place lists, such as Instrument tray Sheets or
Preference Cards:
to assess the items listed and ensure accuracy. 1. the use of a checklist should be
mandatory. there should be no devi-
ation from the policy to use the list.
listed in the preference card. an addition- ing items by type or by location within 2. develop the team. one of the critical
al column may inform or staff that the storage areas. Ideally, CSSd items will be Who requirements for the or is to
item is meant to be available but is being sequenced by location to expedite the pause before the procedure begins
held until the surgeon confirms the item process of pulling supplies. Conversely, and review the checklist. Each mem-
is needed. sorting supplies by their type may expe- ber on the case states his or her name
the description of each item or instru- dite the preparation of and charging for and role, such as anesthesia staff, scrub
ment should be carefully considered. For supplies in the or. Ideally, representatives tech or circulating nurse. this tactic
example, some manufacturers’ descrip- of both departments will collaborate to enhances teamwork because each
tions are not always clear or user-friendly. determine a method that meets every- member of the team is identified as
or and CSSd employees may use nick- one’s needs. part of the team and will be critical to
names or alias descriptions, and this can For maximum effect, consider us- a successful outcome. Note: CSSd
result in confusion about which item is ing comment fields available in ormS personnel, while not represented in
needed for a specific case. software. Comments may provide detail the or during the procedure, are just
Checklists or preference cards for at the individual line level or for groups as critical to a successful outcome.
instrument sets should allow for an alias of supplies. additional comments may developing healthy relationships
description to be included. developing an provide instructions specific to the or between or and CSSd personnel
option on the checklist to print the man- staff. Comment fields may also provide helps ensure that checklist details
ufacturer’s and/or the alias description al- directions for CIS technicians as they contribute to the immediate avail-
lows the card to be customized. Including organize items on the case cart or for the ability of the correct case supplies
the manufacturer’s catalog number and/ or staff to describe how supplies should and instruments for the case.
or bar code on the preference card pro- be treated during the case. 3. develop a method for periodic review
vides an ideal method to confirm that the CIS technicians should participate in and updates for checklists. Corrobo-
correct product or instrument is pulled. the process of building and maintaining rating with or staff and/or managers
Including the storage location for each instrument lists and preference cards. Un- is essential to the success of this process.
line item on the preference card further derstandably, the or staff and physician 4. Encourage CIS technicians to make
assures accuracy in pulling the correct will determine the list of instruments and recommendations for improvements
supply item for the case cart. supply items required; however, a process in checklist design and suggestions
the order or sequence in which sup- must be in place to assess the items listed about items and/or comments to
plies or instruments are listed should be and ensure accuracy. Including supplies include in the checklist.
carefully considered. most ormS soft- on the preference card that are not used 5. When preference cards or other
ware systems include options for group- in the or is highly unproductive for the checklists are created or updated,
CIS Self-Study Lesson Plan

collaboratively test (and test again!), Prevention (CdC) reports that as many CiS SElF-StuDy
ideally with or participation, to as 25% of patients contracting a CLabI lESSOn planS
assure that : will die. the incidence of infections in
• Wording is simple and precise ICUs has dropped 58% since 2001, saving
• Language and layout is standardized lives and reducing costs. one reason: a tEChniCal EDitOR
• The layout is broken into meaning- simple checklist was developed to help CaRla MCDERMOtt, Rn, aCE,
ful sections ensure evidence-based best practices are CRCSt
• The layout corresponds with followed for every patient. Clinical Nurse III
the order of items being pulled for CSSd professionals should embrace South Florida Baptist Hospital
the case and more fully utilize existing checklists Plant City, FL
• The list has been tested and initiate other processes to assure
6. Incorporate a standard method for improved patient outcomes. one ideal SERiES WRitER/EDitOR
two team members to sign off on place to begin is to consider other “rou- JaCk D. ninEMEiER, ph.D.
the instrument tray or preference tine” CSSd operations that would merit Michigan State University
card checklist as case carts are checklists. East Lansing, MI
completed. this will assure a higher
degree of accuracy because a second REFEREnCE IAHCSMM is looking for volunteers to
set of eyes provides verification. 1. Atul Gawande. “The Checklist Manifesto: write or contribute information for our
7. develop a method for tracking errors How to Get Things Right.” Henry Holt and Com- CIS Self-Study Lessons. Doing so is
related to instrument sets or case pany. 2010. a great way to contribute to your own
cart completion. as common issues professional development, to your
are identified, methods for improve- aDDitiOnal REaDingS Association, and to your Central Sterile
ment to the process or the checklist OR Economics: A Hard-Wired Process for Prefer- Supply Department peers.
may become known, and actions for ence Card Review. MTORS Vol. 27, No 12, Our Team will provide guidelines
improvement can be taken. pg. 11. December, 2011. and help you with the lesson to assure
8. outline a method for communicating it will be an enjoyable process. For more
any changes in checklists. CDC Vital Signs. March, 2011. information, please contact Elizabeth
9. train staff to use checklists during Berrios (elizabeth@iahcsmm.org).
their orientation as well as inservice
sessions. 1 IAHCSMM acknowledges the assistance of the
following two CSSD professionals who reviewed
COnCluSiOn: a Final ExaMplE this lesson plan:
Checklists have proven their value by liSa huBER, Ba, CRCSt, aCE, FCS; Sterile
catching mental lapses or lack of attention Processing Manager, Anderson Hospital,
where multiple distractions are inher- Maryville, IL
ent. a great example in healthcare is the paula vanDivER, CRCSt, CiS, CS technician;
checklist widely accepted for use when Orthopedic Specialist, Anderson Hospital,
inserting central venous catheters (CVSs; Maryville, IL
commonly called “central lines”). over
the years, the insertion of central lines in Instrument Continuing Education (ICE) lessons
patients to monitor vital signs and deliver provide members with ongoing education in
medications has become more common. the complex and ever-changing area of surgical
at the same time, the number of central instrument care and handling. These lessons
line associated bloodstream infections are designed for CIS technicians, but can be of
(CLabIs) has increased dramatically. value to any CRCST technician who works with
the Centers for disease Control and surgical instrumentation.
Sponsored by:
CIS Self-Study Lesson Plan Quiz -
Checklists for Central Sterile Supply Departments
Lesson No. CIS 233 (Instrument Continuing Education - ICE) • Lesson expires Sept. 2015

1. What is one reason for the increased importance 6. The best way to sequence CSSD items for 11. How many team members should sign-off on
of checklists in modern healthcare operations? pulling is by: an instrument tray list or preference card
a. They are required for federal government a. Bar code number checklist as case cards are completed?
reimbursements b. Location a. One
b. They are required by healthcare insurance c. Manufacturer’s model number b. Two
organizations d. Type of procedure c. Three
c. They help busy healthcare providers d. The CSSD director and one CIS technician
remember critical steps in a procedure 7. What is the ideal way to sequence instruments
d. Checklists for processing procedures must to expedite the preparation of and charging for 12. When should staff be trained in the use of
be filed with the FDA supplies in OR room? checklists?
a. By bar code number a. During orientation
2. An instrument tray list or preference card is b. By type b. During inservice sessions
a common example of a checklist used by c. By manufacturer’s model number c. Each day in a before-shift line-up session
Central Sterile Supply Department personnel. d. None of the above d. A and B above
a. True e. All the above
b. False 8. CIS technicians should participate in the pro-
cess of developing and maintaining instrument 13. Using a checklist when inserting a Central Line
3. Which is not required information in a prefer- tray lists and preference cards. has reduced the number of Central Line
ence card? a. True Associated Bloodstream Infections by:
a. Patient identifier b. False a. 15%
b. Facility and room number b. 20%
c. Name of surgeon 9. Who determines the instruments and supply c. 46%
d. Name of CIS technician pulling instruments items required for a procedure? d. 58%
a. OR staff
4. The use of nicknames and alias descriptions b. Physician 14. CSSD personnel should be represented in
can result in confusion about items needed for c. CIS personnel the operating room to comply with World Health
a specific case. d. A and B above Organization (WHO) requirements for pre-
a. True e. All the above procedure introductions.
b. False a. True
10. There is little need to periodically review and b. False
5. What is an ideal method to confirm that the update checklists for specific types of procedures?
correct product or instrument is pulled? a. True 15. Including supplies on a preference card that
a. Include the manufacturer’s catalog number b. False are not used in the OR is highly unproductive
b. Include bar code information for both the OR and for CSSD personnel.
c. Include the storage location for each line item a. True
d. A and B above b. False
e. All the above

RequeSt foR pApeR/penCIl SCoRIng (please print or type information below)


RequeSt foR onlIne SCoRIng (payment and scoring made directly online at www.iahcsmm.org using either online check or credit card)
m I have enclosed the scoring fee of $15. (please make checks
_______________________________________________________________________________
payable to Purdue University. We regret that no refunds can Name
be given)
m Check here if you have a change of address _______________________________________________________________________________
Mailing Address (be sure to include apartment numbers or post office boxes)
m Check here if you wish to have your results emailed to you
_______________________________________________________________________________
DetACH quIz, folD, AnD RetuRn to: City State/Province Zip Code/Postal Code
Purdue University
PEC Business Office (_______________________________________________________________________________
)
Stewart Center, Room 110 Daytime telephone IAHCSMM Membership Number
128 Memorial Mall _______________________________________________________________________________
West Lafayette, IN 47907-2034 Email Address
800.830.0269 If your name has changed in the last 12 months, please provide your former name
Purdue University is an equal access/equal opportunity institution