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

Scoring: Each 15 question online quiz with a
passing score of 70% or higher is worth two points
(2 contact hours) toward your CIS re-certification
(6 points) or CRCST re-certification (12 points).
IAHCSMM provides online grading service for
any of the Lesson Plan varieties. Purdue University
provides grading services solely for CRCST and
CIS lessons.
More information: Direct any questions about
online grading to IAHCSMM at 312.440.0078.
Questions about written grading are answered by
Purdue University at 800.830.0269.
Why ChECkliStS?
Like the airplane pilot who knew the
steps required to prepare the plane for
flight, healthcare providers know the re-
quired steps to plan and conduct medical
procedures. however, also like the pilot, it
is possible for them to miss a step because
of the many complexities and distractions
in today’s healthcare environment. When
this occurs, the results can be the medical
equivalent of a plane crash.
another challenge in modern medi-
cine relates to the ongoing time pressures
experienced by busy healthcare providers.
this may result in knowingly overlooking
routine but very critical steps required for
a successful patient outcome. Carefully
developed checklists become the lifeline
 CIS Self-Study Lesson Plan
for clinicians, just as they are with pilots,
to jog one’s memory and ensure the com-
pletion of all vital tasks.
many facilities have adopted the Who
checklist in the operating room (or)
to confirm that all critical steps are
carried out during perioperative care
(see Figure 1). a task as simple as
verifying the patient’s identity and
procedure, as well and body location
for the procedure, ensures that the right
patient receives the planned operation
on the correct side of his or her body.
additional checkpoints confirm that
required instruments and equipment
are present and properly prepared.
Figure 1: WHO Surgical Safety Checklist
SURGICAL SAFETY CHECKLIST (FIRST EDITION)
Before induction of anesthesia
SIGN IN
PATIENT HAS CONFIRMED
• IDENTITY
• SITE
• PROCEDURE
• CONSENT
SITE MARKED/NOT APPLICABLE
ANESTHESIA SAFETY CHECK COMPLETED
PULSE OXIMETER ON PATIENT AND FUNCTIONING
DOES PATIENT HAVE A:
KNOWN ALLERGY?
NO
YES
DIFFICULT AIRWAY/ASPIRATION RISK?
NO
YES, AND EQUIPMENT/ASSISTANCE AVAILABLE
RISK OF >500ML BLOOD LOSS
(7ML/KG IN CHILDREN)?
NO
YES, AND ADEQUATE INTRAVENOUS ACCESS
AND FLUIDS PLANNED
THIS CHECKLIST IS NOT INTENDED TO BE COMPREHENSIVE. ADDITIONS AND MODIFICATIONS TO FIT LOCAL PRACTICE ARE ENCOURAGED.
CSSD ChECkliStS
Checklists are a normal part of the rou-
tine in Central Sterile Supply department
(CSSd). For example, the Instrument
tray List or the Preference Card used to
build case carts for or procedures are
basically checklists. CSSd personnel have
been successfully using these checklists
for many years. however, the recently
renewed interest in the use of checklists
suggests new ways to create and maintain
them. how should Certified Instrument
Specialist (CIS) technicians manage
checklists for instruments and/or supplies
to ensure a greater percentage of accu-
racy? they must take an active role in
understanding the process for creating
Before skin incision
TIME OUT
CONFIRM ALL TEAM MEMBERS HAVE
INTRODUCED THEMSELVES BY NAME AND
ROLE
SURGEON, ANESTHESIA PROFESSIONAL
AND NURSE VERBALLY CONFIRM
• PATIENT
• SITE
• PROCEDURE
ANTICIPATED CRITICAL EVENTS
SURGEON REVIEWS: WHAT ARE THE
CRITICAL OR UNEXPECTED STEPS,
OPERATIVE DURATION, ANTICIPATED
BLOOD LOSS?
ANESTHESIA TEAM REVIEWS : ARE THERE
ANY PATIENT-SPECIFIC CONCERNS?
NURSING TEAM REVIEWS: HAS STERILITY
(INCLUDING INDICATOR RESULTS) BEEN
CONFIRMED? ARE THERE EQUIPMENT
ISSUES OR ANY CONCERNS?
HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVEN
WITHIN THE LAST 60 MINUTES?
YES
NOT APPLICABLE
IS ESSENTIAL IMAGING DISPLAYED?
YES
NOT APPLICABLE
checklists and be very knowledgeable
about the procedures used to organize
and maintain them.
For example, there are several alternatives
available to optimize the required informa-
tion when creating preference cards in
either a Word document or as part of
operating room management Software
(ormS). basic information will include:
• Patient identifiers
• Date and time of the procedure
• Facility and room number
• Procedure(s) scheduled
• Name of surgeon(s)
the individual item(s) to be pulled,
as well as the quantity required, will be
Before patient leaves operating room
SIGN OUT
NURSE VERBALLY CONFIRMS WITH THE
TEAM:
THE NAME OF THE PROCEDURE RECORDED
THAT INSTRUMENT, SPONGE AND NEEDLE
COUNTS ARE CORRECT (OR NOT
APPLICABLE)
HOW THE SPECIMEN IS LABELLED
(INCLUDING PATIENT NAME)
WHETHER THERE ARE ANY EQUIPMENT
PROBLEMS TO BE ADDRESSED
SURGEON, ANESTHESIA PROFESSIONAL
AND NURSE REVIEW THE KEY CONCERNS
FOR RECOVERY AND MANAGEMENT
OF THIS PATIENT

CIS technicians should participate in the
process of building and maintaining instru-
ment lists and preference cards. Understand-
ably, the OR staff and physician will deter-
mine the list of instruments and supply items
required; however, a process must be in place
to assess the items listed and ensure accuracy.
listed in the preference card. an addition-
al column may inform or staff that the
item is meant to be available but is being
held until the surgeon confirms the item
is needed.
the description of each item or instru-
ment should be carefully considered. For
example, some manufacturers’ descrip-
tions are not always clear or user-friendly.
or and CSSd employees may use nick-
names or alias descriptions, and this can
result in confusion about which item is
needed for a specific case.
Checklists or preference cards for
instrument sets should allow for an alias
description to be included. developing an
option on the checklist to print the man-
ufacturer’s and/or the alias description al-
lows the card to be customized. Including
the manufacturer’s catalog number and/
or bar code on the preference card pro-
vides an ideal method to confirm that the
correct product or instrument is pulled.
Including the storage location for each
line item on the preference card further
assures accuracy in pulling the correct
supply item for the case cart.
the order or sequence in which sup-
plies or instruments are listed should be
carefully considered. most ormS soft-
ware systems include options for group-
ing items by type or by location within
storage areas. Ideally, CSSd items will be
sequenced by location to expedite the
process of pulling supplies. Conversely,
sorting supplies by their type may expe-
dite the preparation of and charging for
supplies in the or. Ideally, representatives
of both departments will collaborate to
determine a method that meets every-
one’s needs.
For maximum effect, consider us-
ing comment fields available in ormS
software. Comments may provide detail
at the individual line level or for groups
of supplies. additional comments may
provide instructions specific to the or
staff. Comment fields may also provide
directions for CIS technicians as they
organize items on the case cart or for the
or staff to describe how supplies should
be treated during the case.
CIS technicians should participate in
the process of building and maintaining
instrument lists and preference cards. Un-
derstandably, the or staff and physician
will determine the list of instruments and
supply items required; however, a process
must be in place to assess the items listed
and ensure accuracy. Including supplies
on the preference card that are not used
in the or is highly unproductive for the
CIS Self-Study leSSon Plan
or, as well as for CSSd personnel who
must pull and then restock unused sup-
plies in storage area. developing guide-
lines or a methodology for removing
unused items creates greater proficiency
for both departments.
ChECkliSt DEvElOpMEnt taCtiCS
Consider the following points to assure
maximum returns on the use of check-
lists, such as Instrument tray Sheets or
Preference Cards:
1. the use of a checklist should be
mandatory. there should be no devi-
ation from the policy to use the list.
2. develop the team. one of the critical
Who requirements for the or is to
pause before the procedure begins
and review the checklist. Each mem-
ber on the case states his or her name
and role, such as anesthesia staff, scrub
tech or circulating nurse. this tactic
enhances teamwork because each
member of the team is identified as
part of the team and will be critical to
a successful outcome. Note: CSSd
personnel, while not represented in
the or during the procedure, are just
as critical to a successful outcome.
developing healthy relationships
between or and CSSd personnel
helps ensure that checklist details
contribute to the immediate avail-
ability of the correct case supplies
and instruments for the case.
3. develop a method for periodic review
and updates for checklists. Corrobo-
rating with or staff and/or managers
is essential to the success of this process.
4. Encourage CIS technicians to make
recommendations for improvements
in checklist design and suggestions
about items and/or comments to
include in the checklist.
5. When preference cards or other
checklists are created or updated,
 CIS Self-Study Lesson Plan
collaboratively test (and test again!),
ideally with or participation, to
assure that :
• Wording is simple and precise
• Language and layout is standardized
• The layout is broken into meaning- simple checklist was developed to help
ful sections
• The layout corresponds with followed for every patient.
the order of items being pulled for
the case
• The list has been tested and initiate other processes to assure
6. Incorporate a standard method for
two team members to sign off on
the instrument tray or preference
card checklist as case carts are
completed. this will assure a higher
degree of accuracy because a second
set of eyes provides verification.
7. develop a method for tracking errors
related to instrument sets or case
cart completion. as common issues
are identified, methods for improve-
ment to the process or the checklist
may become known, and actions for
improvement can be taken.
8. outline a method for communicating
any changes in checklists.
9. train staff to use checklists during
their orientation as well as inservice
sessions. 1
COnCluSiOn: a Final ExaMplE
Checklists have proven their value by
catching mental lapses or lack of attention
where multiple distractions are inher-
ent. a great example in healthcare is the
checklist widely accepted for use when
inserting central venous catheters (CVSs;
commonly called “central lines”). over
the years, the insertion of central lines in
patients to monitor vital signs and deliver
medications has become more common.
at the same time, the number of central
line associated bloodstream infections
(CLabIs) has increased dramatically.
the Centers for disease Control and
Prevention (CdC) reports that as many CiS SElF-StuDy
as 25% of patients contracting a CLabI lESSOn planS
will die. the incidence of infections in
ICUs has dropped 58% since 2001, saving
lives and reducing costs. one reason: a tEChniCal EDitOR
CaRla MCDERMOtt, Rn, aCE,
ensure evidence-based best practices are CRCSt
Clinical Nurse III
CSSd professionals should embrace South Florida Baptist Hospital
and more fully utilize existing checklists Plant City, FL
improved patient outcomes. one ideal SERiES WRitER/EDitOR
place to begin is to consider other “rou- JaCk D. ninEMEiER, ph.D.
tine” CSSd operations that would merit Michigan State University
checklists. East Lansing, MI
REFEREnCE IAHCSMM is looking for volunteers to
1. Atul Gawande. “The Checklist Manifesto: write or contribute information for our
How to Get Things Right.” Henry Holt and Com- CIS Self-Study Lessons. Doing so is
pany. 2010. a great way to contribute to your own
professional development, to your
aDDitiOnal REaDingS Association, and to your Central Sterile
OR Economics: A Hard-Wired Process for Prefer- Supply Department peers.
ence Card Review. MTORS Vol. 27, No 12, Our Team will provide guidelines
pg. 11. December, 2011. and help you with the lesson to assure
it will be an enjoyable process. For more
CDC Vital Signs. March, 2011. information, please contact Elizabeth
Berrios (elizabeth@iahcsmm.org).
IAHCSMM acknowledges the assistance of the
following two CSSD professionals who reviewed
this lesson plan:
liSa huBER, Ba, CRCSt, aCE, FCS; Sterile
Processing Manager, Anderson Hospital,
Maryville, IL
paula vanDivER, CRCSt, CiS, CS technician;
Orthopedic Specialist, Anderson Hospital,
Maryville, IL
Instrument Continuing Education (ICE) lessons
provide members with ongoing education in
the complex and ever-changing area of surgical
instrument care and handling. These lessons
are designed for CIS technicians, but can be of
value to any CRCST technician who works with
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

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