When Paul McGuire, RN, BSN, MBA, arrived at the Peninsula Regional Medical Center in Salisbury, Md., four years ago, he had a lot on his mind about how he wanted to get things done. But not all of his thoughts were directly related to the cardiovascular and neurosurgical procedures he'd be supervising as clinical OR manager for those departments.

"One of my first thoughts was, ?We've got to get our OR central core better organized,'" he recalls. The storage room, which contained about 2,000 square feet of floor space, was crammed with at least 70 baker's racks.

"Wire shelving all over the place, row upon row and lining every free space along the walls," says Mr. McGuire. "It was so disorganized the way everything was laid out." Whatever advantages the shelves had originally offered were lost, as the storage system grew too large for efficient use.

Rethinking your supply storage system can be an overwhelming, easy-to-put-off task, given the need for extensive planning, on-site renovations and staff education, not to mention a willing budget. As with any improvement, however, it can be seen as a step-by-step process, and manufacturers' latest offerings in high-density and mobile storage can provide solutions that are cost-effective as well as space-efficient (see "What's New in Supply Storage Systems" on page 66). Here are some of the first steps.

Overcoming status quo
As Mr. McGuire discovered, overhauling his facility's storage system required a bit of convincing once he'd proposed the idea.

"The standard answer was, ?This is the way we've always done it,'" he says. "I've been a professional nurse for more than 30 years, though, and in my experience, there's always a better way, a more organized way, to do anything." He recruited the facility's director and purchaser to his plan and worked from the top shelf down.

You might have to climb a financial obstacle as well. "Storage rooms don't make money, so it's not uncommon for there not to be an adequate amount of space," says Lynne Ingle, RN, MHA, CNOR, an equipment planner for Gene Burton & Associates.

Mr. McGuire says his facility was fortunate in that administrators found budget funds that had been earmarked for just such a project. Organization saves time, however, and saving time saves money. If you're able to present a storage improvement proposal in terms of real efficiency gains, it might make your plan more attractive.

"You need to look at things other than cost," says Mr. McGuire. "In the healthcare market, we're so cost-conscious, and there's nothing wrong with that, but you might have to spend a little more for something that works."

Time and motion
For the staff, saving time is an incentive for change in itself. The aesthetics of organization creates a more work-friendly environment, while helping to reduce the amount of time it takes to pull supplies for a case.

"An OR core that looks sloppy or messy or thrown together is a very big discouragement for the staff," says Mr. McGuire. "It also makes the job that much more difficult to get from point A to point B."

Since major changes to a facility's daily workflow will affect nearly everyone, gathering a team effort by involving as many OR managers, nurse administrators and educators as possible will ease the transition. It will also ensure that staff input will help to build a storage system that works for as many users as possible. Because above all, a new storage and retrieval system must be usable. Whether it's instrument sets and disposable items that are pulled every day or equipment that's needed in the OR right this minute, everything must be in a convenient place where everyone knows to find it.

"If you're fighting with central supply to find a piece of equipment, and it's on your shelves, that's a big problem," says Mr. McGuire.

A system that works
Mr. McGuire and his colleagues arranged for presentations by three storage system manufacturers. Since they wanted to see the systems in action, they made site visits - including one elsewhere in their own facility. "None of us realized that our pharmacy department had one of their products installed," he says, noting that its efficiency had been serving them already.

Assessing a storage system's functionality and how well it will fit into your facility depends on more than just how accessible it makes your supplies and how efficiently it uses the space it occupies.

You must also consider the ergonomics of supply storage, and how well a system works for staff to reduce reach and strain. "Facilities want shelves that are easily adjustable," says Ms. Ingle. "And shelves that can hold heavier things, like instrument trays, at waist level," so as not to risk staff injury through bending over to lift up or reaching up to pull down weighty supplies.

"You'll also want to consider how you protect the things you put on the shelf," she says. Wire shelving is less expensive than solid shelves, for instance, but the bottom shelf of a unit should be solid and a sufficient height above the floor to avoid contamination from mopping. Another detail you might consider is overlays for the upper wire shelves, in order to prevent wire edges from tearing holes in wrapped supplies.

Meeting your needs
As mentioned earlier, you get what you pay for in terms of storage systems, so you might not want to settle for an out-of-the-catalog solution when many manufacturers will customize their products to your specific storerooms.

"We had the attitude of, ?We have this space, what can we do with it?'" says Mr. McGuire. "The response of the company we eventually chose was a big factor. It worked to accommodate our needs."

Given the unique needs of each facility's storage situation, the more individual a manufacturer's attention is, the more likely it is you'll end up with a better result.

Ms. Ingle points out that your facility's architect can send dimensions to the manufacturer or manufacturers of your choice, but adds that many companies are willing to send consultants to measure your site, develop recommendations and provide preliminary drawings, which makes retrofitting a system to your space entirely possible.

On a smaller scale, companies can also work with you to customize each shelf with drawers, bins, slanted racks and other organizing devices, or expand on them with spaces to incorporate bar coding for automated stock-keeping and electronic inventory control.

In Ms. Ingle's view, "the marriage between shelves and supply management to control costs" is a growing trend.

"What you want for supplies is the least amount of wasted space," she says. "You want to get as much in the limited space as you can."

Benefits of mobility
Mr. McGuire and the Peninsula Regional Medical Center eventually chose a high-density, mobile supply storage solution to bring efficiency back to their OR core.

Unlike rows of stationary shelves, which eat up space by requiring a specific width between them as aisles, mobile storage shelves sit on wheels and in-floor tracks, letting users push unused shelves together and eliminate the space of unused aisles. Without the multiple aisles, the shelving's smaller footprint enables more storage capacity or frees up space for other uses.

"It's very efficient. It works very well," says Mr. McGuire, who became familiar with mobile storage at a previous hospital he'd worked at. "Mobile storage gets it done right."

Mobile storage, whether manually-operated or motorized, has become an increasingly common choice among new facilities, says Ms. Ingle. "I don't see carts around the room too much anymore for places that are just setting up," she says. Mobile "is somewhat more expensive, but it can provide you with more room. And room is at a premium."