By Mary Govoni, CDA, RDA, RDH, MBA
In my last column, I discussed organizing your information and inventory. In this issue, I’m going to focus on organizing “stuff.” Nothing is more frustrating that not knowing where things are - then trying to find them in a hurry. We all like to believe that we will remember where we put things when we need them again. But the reality is that we just have too many things to remember. Therefore, we need to have systems for organizing instruments, materials, equipment, etc. Using organization systems facilitates quick and easy retrieval of items. This increases efficiency and reduces stress. I know this firsthand. My close friends and colleagues know that I have spent the last several months on a mission to reorganize my office because the disorganization was having a negative impact on my productivity. Now that everything is labeled, categorized, filed, boxed, and purged, I feel liberated!
Yes, I did say purged. When was the last time you went through all the cupboards, drawers, and other storage areas in the office to get rid of things you no longer use or that might have significantly exceeded their expiration date? This is the first step toward organization and efficiency. If you’re short on storage space - and who isn’t - throwing or giving away unneeded items is a great way to create more space. Purge first, then organize the remainder.
I recommend focusing first on the areas where we spend the most time. I suspect in your offices that includes the treatment rooms, sterilization area, and lab. Let’s start with instrument management. How are your instruments organized? Are they grouped according to procedure? Are they stored by procedure in some type of container? Instrument cassettes or organizers, available from numerous manufacturers, are ideal for this task. I recommend using cassettes or organizers that can be used as delivery systems (in place of or on trays) and that can be placed in the ultrasonic unit for cleaning and then put into the sterilizer. These systems greatly enhance efficiency by eliminating the individual handling of items. When a procedure is completed, the instrument cassette is placed directly into the ultrasonic. Once the instruments are cleaned, they should be rinsed and inspected for any remaining debris. After the instruments are dry, they should be packaged and then sterilized. The cassettes or organizers can be color-coded to identify the procedure. If you wrap cassettes for sterilization, identification tape must be used on the outside of the wrap since the color-coding on the cassette will not be visible through the wrap. I prefer placing cassettes in pouches instead of wrapping the cassettes because it takes less time to load and seal the pouch as opposed to wrapping the cassette. Using the pouches also makes it easier to see the color-coding through the clear side of the pouch. It allows for easy reading of the CDC-recommended process indicator strip, which should be placed in the package to verify that the instruments have been exposed to the proper parameters for sterilization. (For more information on the use of process integrators, refer to the CDC Guidelines for Infection Control in Dental Health-Care Settings at www.cdc.gov.)
Standardization of procedures is the key to effective utilization of cassettes or instrument organization systems. Start by making a list of all the procedures that are performed, such as amalgam, composite, crown and bridge, etc. Then list the instruments needed for each procedure. The total number of instruments required for a procedure will determine the size of the cassette or organizer that is needed. Extra or nonstandard instruments can be individually packaged and stored in drawers in the treatment rooms. Once the procedure set-ups are standardized, you will need to determine the number of set-ups needed. To do this, determine the average number of times that each procedure is performed over a time span, typically two to four weeks. Add up the total number of times that each procedure is performed, and divide it by the number of days worked in that time period. Be sure that the schedule doesn’t have an unusual amount of unscheduled time, so that the time period averaged is representative of a typical patient load. Once you have the average number of times each procedure is performed, divide it in half. This is the minimum number of set-ups you will need for each procedure for one-half of the day’s patients. You may want to add one or two more, in cases where emergency patient visits are common. For orthodontic practices, you may want to divide it by four since patient turnover is higher in a typical day.
Utilizing instrument management systems is an investment in efficiency. There are many cassettes or systems from which to choose. Hu-Friedy IMS™, L&R IDC™, and SysTM™ by Sci-Can are several examples of high-quality, stainless steel cassettes. American Eagle Instruments, CT Med Systems, and Thompson Dental Manufacturing also offer high-quality stainless steel cassettes. Most cassettes come in a variety of sizes, including specialized cassettes for ultrasonic inserts, orthodontic instruments, and surgical instruments. If plastic is more appropriate for your budget, I would recommend the numerous instrument cassettes and organizers available from Zirc and Dux Dental. Although the stainless steel cassettes may last longer, plastic or resin cassettes are made from high-quality materials that can be used in heat sterilizers. For endodontic procedures, which utilize a large number of specialized instruments and other items, Dentsply has an extensive line of organizers designed specifically for endodontic procedures.
In addition to organizing instruments by procedure, burs can be organized in the same fashion. Burs fall into the category of items that must be heat-sterilized, if they are not disposable. Placing burs into individual bur blocks inside of instrument cassettes provides maximum efficiency, and discourages cross-contamination caused by retrieving burs from a common bur block during treatment. Dux Dental has a variety of magnetic bur blocks that are heat-sterilizable. Zirc offers many different types of bur blocks, too.
Next on the organization list is the myriad of materials that are used for both operative and hygiene procedures. I always recommend the use of tubs, organized by procedure, which can store all the items needed for a particular procedure. Each treatment room should have a tub for the most common procedures, stored in the treatment room. In the event that the procedure changes, the team members can easily retrieve any additional tubs necessary to complete the procedure without having to leave the treatment room. Dux Dental and Zirc have various sizes of tubs, dividers, and racks for storing the tubs. Consider purchasing optional covers for the tubs, to protect the contents from possible contamination during treatment. Some materials and equipment, such as automix devices (dispenser guns) and cartridges for impression materials, may be too large to place in tubs. Chipman Dental makes specially designed storage racks to organize guns and cartridges.
When researching organization systems, your dental supply representatives and the manufacturer’s representatives are excellent resources to assist you in determining what products are available and appropriate for your practice. All of the products mentioned in this column can be researched on the Internet as well. Spend time at the next dental convention you attend to learn about new products and devices.
Many of the clinical assistants reading this might be wondering where one can find the time to do this. As I learned while organizing my office, you must have regularly scheduled time blocked off for these types of projects. It may take a day to clean out the clutter, and additional time to plan and implement new organization systems. Take advantage of time when your doctor is attending meetings, continuing education courses, or on vacation. If there isn’t time blocked off in the schedule for your doctor to be out of the office, then get permission to block off time. Pick a nonprime appointment time, perhaps in the middle of the day. Don’t hesitate to discuss this with your doctor. It is very likely that he or she also could use some organizational time to catch up on those items piled up on his or her desk. Once you start the quest for improved organization, you’ll want to continue. I recommend that practices have at least two hours a month of unscheduled time for organization projects. When you experience the benefits of working more efficiently and having less stress during your workday, it will become addicting.
I would love to hear about the organization systems and tools you have found helpful. Please e-mail me your tips and tricks to [email protected] “organization” in the subject line. Don’t agonize - organize!
Mary Govoni is a Certified and Registered Dental Assistant and a Registered Dental Hygienist with more than 28 years of experience in the dental profession as a chairside assistant, office administrator, clinical hygienist, educator, consultant, and speaker. She is the owner of Clinical Dynamics, a consulting company dedicated to the enhancement of the clinical and communication skills of dental teams. She can be reached at [email protected].