Name: Randalyn Harreld

Employer/Position: Former Sterile Processing Manager, CRCST, CIS, CHL, CSPM, CFER, BLS at the Medical University of South Carolina

Q: How do “dirty” preference cards affect the efficiency of your department?

A: “Efficiency is nonexistent when it comes to the dirty preference cards. Not only does it slow the work flow and the process behind missing cases but I have to heavily staff the “distribution” area with a minimum of 3 personnel to successfully meet all the required needs. Not only are the words incorrect, but tray nomenclature is not accurate and CPT codes are wrong or mis-scheduled. The amount of detailed reading and investigating it takes the SPD tech to understand the actual request is time consuming and not efficient.

The conception that all SPD techs have taken a medical terminology course, or understand the difference when an OR staff “ hand writes” tray requests on pref cards is a huge misunderstanding. It is my goal and dream for all the techs to have this knowledge base buts its not mandated nor always available. The requester must understand we work as an assembly line does. One tech’s duty is a direct response from the previous tech’s completion of their duties. The domino effect is in full force when one thing goes wrong or one emergency takes place. Schedulers/OR staff/Periop/ surgeons/residents should treat the preference cards as gold when handling and send them to SPD in a timely fashion.”

Q: What is the biggest impact of dirty preference cards on day to day workflow?

A: “Daily operations currently at the case cart distribution area is so inefficient due to the “TIMING” we receive the preference cards. If the first case needs are not identified until after 3 pm, in which 25% are incorrect, 10% ask for duplicate quantities (as a backup), CPT codes are used incorrectly on 5% because the 1 out of 200 schedulers posted the procedure wrong equals a sterile tray return of over 5000 items in a month. This impacts all areas of our department, not to mention the increase in holes in the blue wraps for the simple tray movement. Last week, I tracked a vendor set that was sent up to the OR 12 times before it had been opened. We had one Peds Set that traveled to and from the OR 7 times before it was used. “

Q: What impact do these inefficiencies have on staff morale?

A: “Morale is at an all time low. An SPD Tech is also not always educated in “reading” or following the notes section on the surgeon pref. Card versus pick list. There is a designated spot where the tray needs should be listed and by quantity as well as the supplies, etc. There are many times where the instrument list area has 1 tray listed but the “notes” [section] lists detailed specifications for the procedure (such as what the procedure is and the screw sizes or implants needed). Again, this is not something we have had the privilege of teaching all our techs at this current state. This affects my techs [morale] because they do want to understand and they do not want to make mistakes but deliver the product to the patient in a timely fashion.”

Q: What is the value of an accurate preference card?

A: “Preference cards should be 100% accurate just like a recipe. We could not successfully bake a cake if we substituted coffee grounds for baking powder or make a loaf of bread by simply guessing on the yeast measurements. It’s just not efficient or productive and it is a waste of resources, time, and not to mention ingredients!

Summary:  Pref cards / recipes/ pick lists + accuracy = Success”