Central Supply Room

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The centralization of supplies in hospitals is not a new idea. It has always been used, and with much success, but the centralization of surgical supplies and special equipment is the .result of experiments which had their inception about 20 years ago.

Definition: Centralization, as the term is used here, means the concentration of all equipment in one place, under one head, where it may be cared for with the greatest efficiency and used to the best advantage.

The department in which this imortant work is carried out has been given several names, but the most common designation is Central Supply Room. It is then defined as a unit in the hospital which issues sterile supplies and most of the special equipment needed in the care of patients.

Location: This Central Supply Room should, if possible, be centrally located and must be directed by a competent supervisor. These two factors are of vital importance. With the former, time, labor, and money are saved in the service rendered, and without the latter, it would not be possible to carry out its extremely important function.

Scope: The size, scope and capacity of this unit will be determined, in large measure, by the individual requirements of the hospital. It will, therefore, vary widely in hospitals of different sizes. It may be the place where surgical supplies are prepared and distributed, or if the plan of the hospital lends itself to a large department, it may control all surgical supplies from dressings to sterilization of obstetrical and surgical packs and all special equipment, including rubber goods. This takes in the preparation of sterile trays for certain treatments. In some hospitals, the collection and storage of blood has been added to the facilities offered by this room.

Solutions: Solutions for intravenous use may be made in this department. A room for the exclusive making of solutions must be used, as the air must be free from dust and lint. Special equipment is necessary and the person making solutions must be reliable and experienced. The water used must be especially distilled so that it will be free from impurities and minute particles of foreign material, sometimes found in ordinary distilled water. The other ingredients used must be the purest obtainable. The bottles and tubing are washed and rinsed with the greatest care and the tubing inspected regularly. These factors are as important as the making of the solution itself. Standard solutions for intravenous use may be secured in sealed flasks from commercial firms. The tubing requires the same care.

These factors will regulate the number of persons required to give exacting 24-hour service.

Purpose: The purpose of the Central Supply Room is to conserve time and material by reducing the duplication of supplies and effort. Such duplication has heretofore existed when dressings and sterile supplies were taken care of on the wards and floors, or in the dressing rooms in connection with each hospital department. The aim of the hospital in maintaining a Central Supply Room is to render to doctor and patient the best and most efficient service in the interest of each.

Before the inauguration of such service, it was the custom to issue all supplies from the main storerooms to the wards, and replacements were made as needed. Gauze and cotton were at one time included in these supplies, and dressings were secured from the operating room. This may still be the rule in some hospitals where dressing rooms off wards are considered necessary. Catheterization, douche, and bladder trays were set up as well as intravenous and hypodermoclysis trays. The solutions for the intravenous and hypodermoclysis trays came from the operating room.

With the advent of the Central Supply Room, this procedure has changed, and trays and solutions for all these treatments are now provided through this central organization. The transfer from wardsand floors to a single source where perfect technic/is guaranteed is a definite forward step in the care of patients.

Services: The following services are given the various departments: Bladder irrigation, catheterization. coionic irrigation, douches, eye treatments, gastric analysis, gavage, hot and cold compresses, hand immersion containers, poultices, enteroclysis, myringotomy, and mortuary. Trays for such work are equipped, supplied, and supervised in the Central Supply Room in readiness for the nurse from the department in charge of the patient. Each hospital is obliged to work out its method of requisitioning equipment taken from this room. Everything must be signed "out" by the person taking it and reported "in" when it is returned. Trays are checked to make certain that everything has been returned in good condition. Each hospital, also, has its method of charging, and when this applies to the services rendered by this room, charge tickets are written when the equipment is given out.

Other trays used for dressings, aspiration, gastric decompression, intravenous therapy, hypodermoclysis, spinal puncture, cisternal puncture, and tracheotomy are taken care of by the nurse in the Central Supply Room, as is also the fracture cart.

The Central Supply nurse goes to the patient's bedside with specific equipment, assists with the treatment and makes certain that the nurse left in charge understands the subsequent procedure and further application of the recommended treatment.

Included in the list of equipment available through the Central Supply Room are bed elevators, respirator, resuscitator, oxygen tent or tank with special face or nose attachment, and an electric breast pump, if this item is not under the care of the obstetrical department The glass .parts for the enumerated apparatus are sterilized in the Central Supply Room. Other equipment which may be called for by the nurses in the several departments or delivered, as is routine in each hospital, includes the following articles: Atomizers, crib sides, hypodermic trays, luer syringes and accessory trays, electric heating pads, dressings, inhalators, stupe kettles, tongue depressors, restraints, drainage bottles, rubber goods, and equipment for isolating the individual patient in the ward, together with cans for disinfection of material from typhoid patients.

Rubber Goods: When rubber goods are considered a part of the supplies in the Central Supply Room all replacements are made from there. In this way, every department of the hospital has the advantage of first class equipment and material readily available and always in perfect condition. In the Central Supply Room, all supplies are carefully and regularly checked, needed repairs made, and materials held ready for immediate call or stored for future use. Consequently, single pieces of equipment may be used where previously several were necessary and many important items which were earlier considered too expensive for routine handling may be serviced through this central department.

It is, therefore, easily apparent that the introduction of this so called "Room"-really a large department-constitutes actual progress in the standardization of hospital supplies.

II. The Personnel

The graduate nurse in charge of the Central Supply Room may have had a postgraduate course in operating technic or surgical nursing, or some postgraduate work in one or more Central Supply Rooms, or perhaps she is a nurse with particular aptitude for this work and interested in its every phase. In addition to her training, as a person she must be thoroughly conscientious, tactful, and adaptable in order to cope successfully with the constantly changing program involved in this work. Her students must give particularly intelligent and conscientious service, for here human lives are at stake in their hands, and the most scrupulous attention must be paid to all details.

While there is routine work which must be performed at the same time every day, all the emergency requirements are met with equipment from this department. It is obvious that cooperation must be an essential feature of this service. Upon the nurses in the Central Supply Room rests the responsibility for the efficient working of life-saving equipment.

Nurses from the Central Supply Room are frequently among the first to see patients after admission to the hospital. A special treatment may be necessary or the patient may have to be prepared for immediate operation, in which case the patient receives the attention of the Central Supply Room nurse. Thus her work can and does carry her into the hospital's "front line." This nurse must be able to meet people easily, create a good first impression, and exercise discretion at all times. Sick people are not ordinarily in a very happy frame of mind. They know an effort will be made to restore them to health, but they have entrusted themselves to strangers and look about them for some sign of personal sympathy.

The number of nurses needed to carry on the work of the Central Supply Work varies with the routine of the hospital. According to observation, a hospital of 250 beds with an active surgical service requires one supervisor, five students, and one night nurse. It is importantto have Just enough nurses. Often the department is limited as to space and with too many nurses there is likely to be confusion. Naturally, an insufficient number makes the work difficult. A general staff nurse is vital to this room and the service it affords. She is in the unit when the supervisor is busy on the outside or is teaching or off duty.

A senior student nurse who is particularly interested in this type of work may be able to take charge of the room at night, but, where the service is very active, the responsibilities are frequently too great to be assumed by so young a nurse. A qualified general staff nurse who is conscientious and reliable, and who can handle the many angles of this important department when alone, is the one to assume this responsibility.

In some nursing schools, the enire training of students in the Central Supply Room and its technic is given at one time, with two weeks assigned to each branch of the work and eight weeks allotted for the complete service. In other schools, one month during the junior year and another in the senior year are designated for this work.

The night duty term in Central Supply Room is given after these other weeks have been completed. As the understanding of the intricate night duties grows, a Central Supply Room night nurse should be chosen with care in order that she may render to the patients theservice for which the department was intended.

The use of a maid is optional, but there are many things which she can do well while the nurses are attending to more important tasks. The same is true of an orderly. If the department is large and all supplies are to-be delivered by the department, an orderly is required. Otherwise, it will only be necessary to call an orderly from a department whenever heavy or awkward equipment is to be transferred.

III. Dressing Carriage

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The dressing carriage is so comlete in itself that it could be called an emergency room on wheels. It holds everything the doctor will need in doing a dressing or performing a slight operation.

The size of the hospital and the number of surgeons operating daily will determine the number of dressing carriages needed, and the number of dressings each attends will regulate the amount of equipment or each carriage.

In some large hospitals, dressings are done in a special room off the ward; in others, however, they are done in the wards and in the private rooms. With this complete carriage. the dressings can be done without moving the patient, and the slight operation which may be performed in the patient's room, with the sterile supplies on the carriage, is a saving in time to the surgeon and a saving in money to the patient, as it removes the necessity of taking the patient to the operating room.

Technic of Dressing: By the time the student is permitted to take the carriage out alone, she is thoroughly familiar with everything in it. This is one of the chief reasons why the doctors are so enthusiastic about the Central Supply Room. The nurse who goes out with the equipment from this department knows exactly what to do with it. Previously, it was not always a nurse thoroughly familiar with the carriage and dressings who was asked to assist the doctor.

Now, when the call comes for the carriage, the nurse takes it to the appointed place, and having learned to handle sterile supplies, is ready to assist intelligently. A modern dressing carriage has a place for everything which will be needed and everything in its own place.

The call which the nurse receives may be for one dressing, for six or eight dressings in various parts of the hospital, or for dressings on the ward. The nurse is ready in any case. When the doctor has several dressings to do, he usually plans to do the "clean" ones first.

Procedure: Although the procedure for a dressing is always the same, it may be well to mention it. The patient is screened, made as comfortable as possible, a good light obtained (some carriages have their own lights which may be plugged in any socket), the bed adjusted, gown and covers folded neatly, binder removed or bandage cut, newspaper or paper bag on the foot of the bed, top dressing removed and placed on the paper or in the bag, glove case opened and put in a convenient place for the doctor, then the dressings and instruments which the doctor will need are placed on this towel. When a Mayo stand is used, the towel is placed on it and the dressings and instruments arranged.

When a wound is to be irrigated, a mackintosh is placed under the patient's side, and a kidney basin held in place. Solution basin, asepto syringe, and solution are carefully but quickly procured. The doctor removes the rest of the dressings with the forceps which have been placed on the towel. In taking sterile sponges from jars, the nurse must be careful not to strike the outside of the jar with the forceps; also, when holding forceps, she must remember to keep the point down, otherwise the solution will run up toward the handle, then down over the sterile end, and, be it ever such a small amount, the forceps are contaminated. It is safest to return the forceps to the container.

While the dressing progresses, the nurse must have everything ready as quickly as possible for whatever is to come next-the removal of sutures, cleansing of the wound, removal of drains, or irrigat- ing, etc. Dressings and adhesive are applied or tapes tied and bandage put on.

When the dressing is completed, soiled instruments are dropped in the container especially for them, and the gloves are put in their container. Soiled dressings are wrapped in the newspaper and tied with a string or, if a paper bag is used, the top of the bag is folded over and the package disposed of in the department. In this way it is possible to keep the carriage clean, and the soiled instruments and gloves are easily handled upon the return of the carriage to the Central Supply Room.

The Central Supply Room nurse will not always be able to replace the binder; therefore, the nurse on the ward follows to do this. It is to be hoped that the nurse assigned to each patient can be present for the dressing; otherwise, any nurse on the department may accompany the doctor and nurse with the carriage and record the changes in the dressing from day to day. If a ward nurse does not go with the carriage, the Central Supply Room nurse must make a note of the changes and give this note to the supervisor of the department.

Important points to be rememered by the nurse in order to assist with dressings are:

Fracture Carriage: A cart or carriage set up to carry ropes, pulleys, screws, adhesive, ace adherent, bandages, splints, and all other equipment necessary to put on a splint or Buck's extension is a very helpful service from this department. It may be adjusted as time and space permit so that much of the fracture work on any department may be done from this carriage. Painting Balkan frames different colors helps to keep them together and easy to assemble.

IV. Housekeeping and Supplies

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