How Efficient is Your Custom Pack Program in the Operating Room?

A custom pack or module is a specific way in which surgical supplies used for surgery are placed in a convenient pouch-pack. By opening one pouch or wrapper everything you need is already sterile and prepared for your surgery. Many institutions have custom pack programs that are geared to save operating room (OR) start-up time, reduce turnover between cases, create a standard practice, and generate savings for the healthcare institution.

What many hospitals dont realize is that although the intent of the pack is to save money, a custom pack program can actually increase expense and waste per case. Whether you are creating a new program of custom packs or reevaluating the success of a current program, it is advisable to examine four factors:

1. The current practice of surgical team members 
2. Current hospital equipment such as OR tables, mayo stands, prep tables, etc.
3. OR staff knowledge, meaning the comprehension level of protection needed for that surgery, that case, quality of drapes; gowns, recommended practice and cost 
4. Your facilitys current policy as well as standards from the Association of periOperative Registered Nurses (AORN) and how they stand up next to current staff protocol

The Four Factors in Detail

1. The current practice of surgical team members: Depending on a service, such as orthopedics or OB-GYN for example, a surgeon preference, or OR size, practice or set-up can vary from correct recommended practice to significant misuse, such as an overuse of patient drapes, tables covers and mayo stands. This can be a result of staff preference and comfort regardless of an actual need or recommended practice for set-up. For example, a minor surgical procedure being set up on long or high tables, thus requiring the use of longer drapes, or the use of extra-wide mayo stands requiring opening and using an extra large mayo stand cover vs. a standard size. Another example is opening supplies potentially needed vs. actual need. There are many supplies that should be in the OR but should not necessarily be opened. Staff members, including surgical technicians and preoperative nurses, have huge variances in practice among shifts and teams. Seniority is also a factor in appropriate use of supplies vs. inappropriate practice.

The result of surgical team members misuse of supplies can result in:

• Over-draping

• Over-gowning

• Draping too long or too short

• Increased cost

• Increased OR time

• Decreased efficiency 

2. Current hospital equipment: This includes but is not limited to size, height, preference and availability of instrument tables, prep stands, OR tables with different attachments, and mayo stands. Hospital equipment is very much a factor of the surgical team preference. For example, if a Gerhardt table is in a room, staff members may set up for a case regardless of actual need per case or amount of equipment, thinking, Why go looking for an appropriate table for the case? Set up and work with what you have. This creates tremendous waste. While your custom pack may have a 60x70 regular table drape it will not fit the Gerhardt table. The surgical team member then opens a Gerhardt table drape and, depending on the hospitals contracted price, that procedure has now increased by $5 to $7 dollars per case.

3. OR staff knowledge: Knowledge of staff is not limited to education, years of experience or expertise in a service. Knowing your staffs knowledge in regard to the level of protection of gowns needed, amount of equipment required for a service, case and length of a procedure, is essential. Examples include:

• The use of supplies based on actual need vs. potential need

• The use of a regular table drape vs. a heavy-duty drape

• The use of poly-reinforced gowns vs. fabric-reinforced, breathable and non-reinforced minimal protection gowns regardless of the actual recommended level of protection based on the Association for the Advancement of Medical Instrumentation (AAMI)s liquid barrier classification 

Eleonora Shapiro, RN,MHA, is perioperative director of Mount Sinai Hospital in New York.