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.

Vaporized Hydrogen Peroxide: A Well-Known Technology with a New Application

Hydrogen peroxide has a multitude of uses and the vapor form was first identified as a sterilant in late 1970s. Following a number of developments, vaporized hydrogen peroxide (VHP) became widely adopted in early 90s as a substitute for ethylene oxide (EO) in device and instrument processing and reprocessing in healthcare facilities. Often VHP was hailed as the replacement technology for EO. Because of key limitations such as scale, penetration, and compatibility with packaging materials, adoption to terminal sterilization of single-use devices has not commenced to any significant level. However, recent developments in sterilization chamber design and process development provide new opportunity for consideration. For future products, such as those that require “end of production line sterilization,” such limitations may be reconsidered and overcome. This article describes those challenges and how they have been addressed, with practical examples. The development of global consensus standards and leveraging the well-established knowledge of VHP sterilization with regard to microorganism inactivation and material compatibility will help facilitate wider consideration of VHP technology as a true alternative to EO in certain product applications.

Streamlining workflows and redesigning job roles in the theatre sterile surgical unit

The theatre sterile surgical unit (TSSU) is an essential core to support the operating theatres in National University Hospital. Surgical instruments and supplies are processed, packaged and sterilised safe for surgical procedures. A rapid improvement event adopting lean methodology was conducted with the TSSU team to streamline the workflows in this area.The project aimed to identify TSSU work processes that can be streamlined or automated, improving timeliness while identifying potential for role redesign and maximising human resource.The team successfully implemented initiatives to eliminate unnecessary workflows and achieve workload levelling. This reduced instrument processing time by 5%, while replenishment times of surgical supplies to the operating theatres decreased by 29%. The team successfully redesigned the TSSU job roles, converting several nursing staff to non-nursing roles. Long-term initiatives such as the use of disposables and an improved theatre instrument management system were planned for as well.Initiatives derived from this project can be spread to other sterile supply units within the hospital, further optimising the use of resources at a hospital level. The concept of role redesign was found to be applicable to healthcare, highlighting its potential in other areas of the hospital.

Analisis Sebaran Penelitian Skripsi Mahasiswa Program Studi Pendidikan Matematika Universitas Muhammadiyah Mataram

Abstrak: Penelitian ini bertujuan untuk mendeskripsikan sebaran jenis penelitian, tema yang popular serta kesulitan yang dihadapi mahasiswa dalam menyelesaikan atau menyusun skripsi program studi Pendidikan Matematika Universitas Muhammadiyah Mataram. Manfaat dari penelitian ini yaitu 1) diperoleh informasi tentang sebaran jenis penelitian dan tema penelitian yang paling sering atau paling banyak diambil oleh mahasiswa program studi Pendidikan Matematika Universitas Muhammadiyah Mataram; 2) kesulitan yang dialami mahasiswa dalam menyusun skripsi dapat menjadi landasan untuk evaluasi kualitas pembelajaran dikelas. Jenis penelitian yang digunakan yaitu penelitian deskriptif kualitatif. Subjek penelitian adalah mahasiswa yang sedang mengerjakan atau mengambil mata kuliah skripsi dalam rentang waktu bulan Oktober 2016 sampai dengan Maret 2017. Kesimpulan dari penelitian ini yaitu: 1) sebaran penelitian mahasiswa dominan pada penelitian kuantitatif dan penelitian R&D; 2) tema yang diminati (popular) dikalangan mahasiswa yang terkait dengan model penelitian; 3) kesulitan yang dihadapi mahasiswa meliputi penyusunan proposal, instrumen penelitian, pengolahan dan analisis data. Abstract: The purpose of the research to describe the distribution of undergraduate thesis,that conducted by the Mathematics Education Department students in terms of the research type, theme and also describe they difficulties experienced. The benefit of the research is 1) obtained the distribution of research themes are often or most taken by students of mathematics education department of Muhammadiyah Mataram University, 2)student difficulties in arrange they undergraduate thesis used to evaluate quality of learning.This research is a descriptive qualitative case study. The subjects of the research are Mathematics Education Department students whom taking a thesis course until Ocober 2016 to march 2017. Results of this research are: 1)distribution of the research are dominant in quantitative research and R&D research; 2)the most popular theme are about leraning model; 3) difficulties face by the student arebout arrange a proposal, research instrument, processing and analysis of data

Optimizing surgical instrument sets for cases involving breast and plastic surgeons.

33 Background: Processing operative instrumemt sets is a major cost for surgical cancer care. Optimizing standard sets requires availability of instruments reflecting varied surgeon preferences while minimizing unnecessary instruments. Additionally, increasing utilization of oncoplastic reconstruction after mastectomy and lumpectomy requiring breast and plastic surgery sets further expands the number of instruments required. The goal of our study was to optimize standard sets used for cases combining breast and plastic surgeons and to determine cost savings Methods: Baseline data was recorded over a 2 week period (13 cases) including number of instruments available and number unused for non- flap breast-plastics combo (BPC) cases. An independent observer timed instrument set-up times. 22 breast and 14 plastic surgeons were polled for their requested instruments for designated cases. A BPC set was designed based on this data and reviewed with surgeons to update preference cards. After a 6 week implamentation/education period, repeat data was recorded (18 cases). Cost of instrument processing was based on labor and supply cost of $0.22/instrument. Results: Two breast surgery sets (65 and 97 instruments) and one plastics set ( 93 instruments) were used at baseline. The median number of available instrumeets was 172.5/case, with median 126.5 instruments unused. A mean of 3.8 separately packaged instruments were required per case with mean set-up time of 4m46s. The new BPC set contains 103 instruments. A median of 106.5 instruments were available after implementation. The median number of unused was reduced by 53% to 59.5, with a drop in number of separately processed instruments to 2.5. Mean set-up time was reduced to 2m16s. Reducing the size of of standard sets reduced processing costs by $12.10 or $19.14/case (depending on the breast set used for comparison). Combining sets resulted in an additional cost savings of $6.56/case by reducing extra packaging costs. Conclusions: combining breast and plastic sets and eliminating unnecessary instruments resulted in cost savings of $18.66-$25.70/case. It also reduced OR instrument set-up time by 2.5 minutes/case which has significant impact at high volume centers.