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The Anatomy of an A+ Instrument Count Sheet
By Hank Balch

Firemen have their fire engines. Construction workers have their hard hats. Teachers have their chalk boards. But what is the defining accessory of a sterile processing professional? Few things are as central to who we are as instrument experts as the surgical instrument count sheet. Also known as an instrument recipe, these critical pieces of the reprocessing puzzle should be the roadmap and best friend of sterile processing technicians in the assembly stage, but they often end up being more of a hindrance than a help. What should be a clear and concise description of the contents of a surgical tray can leave technicians in the uncomfortable position of trying to remember or guess at reprocessing excellence, which we can all agree is not a good model of repeatable quality and consistency.

What’s the difference in an A+ surgical instrument count sheet and one that deserves a big red F–? Here are five pieces that make up the anatomy of an excellent instrument count sheet.

Standard set and instrument names
As basic as it may sound, using the same naming convention for instrumentation is a critical aspect of count sheet quality. Nearly every SPD leader with an instrument-tracking system can share horror stories of how ridiculously different instrument names can become over just a few short years of unmaintained databases. Mayo Scissors Short; Short Mayo Scissors; Short Scissors, Mayo; Scissor, Mayo, 6; Curved Mayo Scissor Short—wait, were those other ones also curved? How long is short? Who knows? If your technicians don’t know, how can they ensure they’re actually putting into the tray what the OR team needs to do their case?

Standard stringer/processing order
If standard naming taps into the quality portion of count sheets, then standard stringer/processing order highlights the impact that excellent count sheets can have on a technician’s ability to process as efficiently as possible. For example, let’s say you have four trays that include both Mosquito and Kelly Clamps. Creating a standardized stringer order means agreeing that the Mosquito Clamps will always be listed on the count sheet beforethe Kelly Clamps, rather than a random ordering based upon who created the original count sheet or left up to the preference of individual reprocessing technicians. This standard order can extend outside of stringed instruments as well, including things like listing heavier items first on the count sheet to ensure technicians place them in the bottom of the tray, instead of on top of delicate instruments.

Important instrument specifications
As we mentioned, instrument specifications are an important part of ensuring SPD technicians have all the information they need to accurately and efficiently complete the mountain of surgical trays sitting in the assembly area. Too many times, instrument count sheets operate under the assumption that technicians will intuitively know if a scissor should be straight or curved, or a retractor sharp or dull. While this type of tribal knowledgemay seem to work for smaller facilities with a small number of reprocessing technicians, the siloed nature of important instrument information is a serious process flaw. What if this tenured technician with all the knowledge suddenly retires? What if another facility within your system wants to duplicate the tray? Without instrument specifications such as length, tip variation, model, etc., these challenges become nearly insurmountable and improvement becomes impossible.

Actual product numbers
Even though instrument specifications are a must-have for excellent instrument count sheets, measurements alone cannot account for the variations (and physician preferences) found within different manufacturers of the same instrument type. That is why the presence of product numbers on your count sheets is nonnegotiable. For better or worse, not every Crile-Wood Needle Holder is created equal. Without instrument product numbers listed on the count sheet, reordering lost instrumentation can become extremely time-consuming for your SPD/OR team, and give you no guarantee that you are replacing the item with what should actually live in the tray. From an efficiency standpoint, if the product number listed on the count sheet does not match the product number listed on the actual instrument, assembly times can be unnecessarily extended when a simple cross-reference could have sufficed.

Quality and completion reminders
The final aspect of excellent surgical instrument count sheets involves creating quality and completion reminders within the documents themselves. Do you have an insulated laparoscopic grasper that requires insulation testing at the assembly stage? Then there should be a field on the count sheet for technicians to confirm this test occurred for this assembly cycle. Are there specific instructions for how the surgical team wants the set contents arranged? Set photos can be attached to digital count sheets to provide technicians with a visual guide for proper assembly. Even things like internal indicators can be listed to remind technicians to place them at the greatest point of challenge.

If someone reviewed your facility’s count sheets, what grade would they get? Would they be top-of-the-class, A+ valedictorian of surgical instrument university, or would they need a little extra help to bring their grade up from a disappointing C+? As in anatomy class, there are a lot of parts that go into making a surgical count sheet work the way it should. Hopefully, these tips can help your SPD team ace the instrument assembly stage and ensure your trays make it to the OR magna cum laude.



Feature articles exclusively for Ultra Clean Systems by Weston “Hank” Balch, BS, MDiv, CRCST, CER, CIS, CHL

Weapon of Mass Microbial Destruction * Professional Clean Freak * Podcast Host * Safety Addict * CS/SPD Consultant

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