INTERNal View

I am a 22-year-old MBA Student interning at Westchester Medical Center. I graduated in 2013 from Quinnipiac University with a Bachelors degree in Biomedical Marketing. I am currently pursuing a MBA with a concentration in Health Care Management.

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Once the sterilization process has been completed, the trays of equipment are then stored in inventory until they are ready to be used for a procedure.  The inventory is organized by service, so kits that are used for the same or similar procedures are grouped close to each other.  The physicians create the inventory makeup of the kits, so everything they need to complete the procedure is in the kit.  I even got to see some of the carts leaving the inventory and being taken up to the hospital for procedures.  

Above is a cart of sterilized equipment that will be used in an upcoming procedure.

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Aside from the tools like forceps, scissors and scalpels that are sterilized, there are some tools that can’t be put in the sterilization machines.  Special “scopes” that are used for different procedures, like endoscopes or colonoscopies, are too fragile to be put in the sterilization machines, as the steam can damage the equipment inside the scope.  In the prep and sterilization room, there is a separate room with specially designed machines to wash and sterilize these sensitive pieces of equipment.  I was able to go into the room and watch the scopes being placed in the machines and actually being washed.  As each piece of equipment is washed, it is recorded to ensure that the proper steps to sterilization have taken place and it is okay to be used in a procedure.

Above are scopes which have already been cleaned, and are waiting to be used in a procedure.

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As the tour moved out of the decontamination room, we made our way into the prep and sterilization room. Once the trays and carts are taken out of the washers, a technician then receives the trays they begin three main tasks; taking inventory, organizing and further cleaning of the equipment.  I saw the technicians go through every piece of equipment in the tray, taking inventory of the equipment and making sure the equipment is not damaged.  If the equipment is damaged, then the technician will repair the item, or will order a new piece to replace it.  Aside from inventory and repair, they also clean each piece of equipment by hand to ensure that it is sterile.  I got to see a technician cleaning out suction tubes used in surgery, using a wire brush to go inside the object and make sure there is no residue left over inside.  After all of the items are further inspected and put in the inventory list, the tools are grouped together in a size-order set.

Above is a workspace for a technician.  

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As a part of my tour through Central Sterile, I got to follow a set of equipment as it went through the process of being cleaned and sterilized.  As I began the tour, we started in the decontamination room. When a medical procedure is finished, the tools and equipment used are are sent down to the decontamination room in trays transported on carts.  When the decontamination technicians receive the equipment trays, they have to scrub all of the equipment down to remove what remained from the medical procedure.  After they are scrubbed down, they are placed in a machine, which washes them with a water and soap solution.  At this point, the trays and carts that hold the equipment are washed as well in the walk in dishwasher-like machines.  The washers that the trays and equipment are cleaned in are in the walls between the 2 rooms and can be accessed from each room so there is no direct contact between the rooms.  I was the only thing allowed to go to both rooms without being washed!

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For my most recent series of “INTERNal View” posts, I visited the Central Sterile Department at Westchester Medical Center.  At Central Sterile, they are responsible for making sure that all for the equipment used in hospital procedures are complete kits, and are sterile.  Prior to my internship, I had no idea that this was such a big department!  I knew that the equipment that the doctors use had to be cleaned; I was unaware of how large and important the entire department was, though.  They have a lot of work to do each day with over 9,000 instrument trays.  To ensure that items that have already been cleaned - stay clean, Central Sterile is broken up into 2 different rooms, decontamination and the prep room.  And they take their job seriously! I had to scrub up and put a cover over my beard even to be allowed in this place!

Above you can see a picture of me in scrubs and a picture of one of the machines used to sterilize equipment. 

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Staying On Top Of Inventory

Another responsibility of the pharmacy, which I did not immediately think of before my tour, is making sure that the inventory of medications keeps up with the constant needs of patients.   

Part of that process is keeping track of expired medications and taking care of them as necessary.  I saw that throughout the pharmacy all medications are labeled with their expiration date in clear site, to be sure that no expired medications are used. 

Some of the medications are stored on scales to measure how much of product has been used and when more needs to be ordered.  Others were temperature sensitive, so they are stored in huge walk in refrigerators that we were able to walk into.  The more dangerous drugs, like narcotics, are stored in locked vaults that are monitored 24/7 by cameras and can only be accessed by certain employees, in an effort to prevent theft or abuse.

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Seeing the amount of patients being treated at WMC, prior to my tour of the pharmacy, I thought that a pharmaceutical mistake could easily occur.  But I was able to see that the pharmacy has implemented multiple precautionary methods to cut out the chance of patients being administered the wrong drugs.

Nurses must scan both the bar codes on the medications and the patient’s wristband to ensure that the medication is appropriate for that patient.  By scanning the barcodes, patient needs are double checked in the database.  If the medicine does not match his or her needs, the nurse will be alerted so that the medication is not administered.

On my tour, I noticed that around the pharmacy there were posters on the wall with the term SALAD on them.  SALAD or Sound Alike Look Alike Drugs is a list of drugs that have names that sound similar or have similar packaging.  These drugs can easily be swapped, be put in the wrong bin or mistakenly be picked up and sent to the patient in haste.  For pharmacists, merely knowing that they need to be cautious with the medications on the list helps prevent errors and potential medical catastrophes.

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With hundreds of patients in the hospital needing medication at the same time, the pharmacy has to maintain an effective system to get the patients their medications in a timely manner. During my tour, I got to see first hand now this system works!

The process begins when a physician or nurse inputs the patient’s need for medication through a Computerized Physician Order Entry (CPOE system). I watched the pharmacy then receiving the orders, and preparing the appropriate meds. From there, the medications are then taken from the pharmacy and delivered to the nurse.  In order to administer the medication, the nurse must scan the barcodes on the patient’s wristband and the medication to ensure that the medication is right for that patient.  Since WMC is a level 1 trauma center, there are instances where medication is needed instantly.  I saw a wall completely filled with pre-loaded “crash cart trays” that can be delivered at a moment’s notice in the event of severe emergencies.  

Above is a picture of the machine that receives the orders, and helps prepare them. 

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Every trip I’ve made to my local pharmacy has been nothing short of slow, tedious, and frustrating.  From the time I walk in the door, wait in line at the pharmacy, hand over my prescription, and finally receive my medication, sometimes the process takes over an hour.

I was curious to know how my local pharmacy’s methods compare to that of a hospital pharmacy, considering the constant and often urgent need for medication.  Director of Pharmacy Services at Westchester Medical Center, Anthony County, showed me that process is much more quick and efficient during our tour of the hospital pharmacy.

At WMC, almost every admitted patient requires medication from the pharmacy, whether it may be in the form of an IV, a simple pill or a more complex pill.  Pharmacists are therefore responsible to maintain a large inventory of medication to keep up with the needs of hundreds of patients each day. 

They also need to take precautionary procedures to ensure to that no mistakes are made in the pharmacy-to-patient process.  In such a fast-paced environment, these precautions ensure safety to verify that the right medication always goes to the right patient, expired medications are never used, and narcotics are not easily attainable.  

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After visiting and spending time with the Hyperbaric Unit, I feel that I have learned a good amount about not only the process of hyperbaric therapy, but about how care should be provided as well.  After Seeing Dr. Kar going through a treatment with a patient, I began to notice that in every part of the procedure he was including the patient.  He would do this by asking for his or her input on topics, or making sure he or she was comfortable with the length of the treatment.  Patients are even able to choose to watch TV, a movie, or monitor their treatment.  The Doctors and technicians really care about the patient and want to work with him or her to provide a high level of care, which is one of the core values at Westchester Medical Center.

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The process of being treated in a hyperbaric chamber can be shown through 5 steps.  First, which I think is the most interesting, is when Dr. Kar works with the patient to customize a treatment plan by determining the time, frequency, and the air pressure to be used in the treatment.  Second, the patient enters the hyperbaric chamber, beginning the treatment.  Third, the technicians, to ensure the procedure stays in control, monitor the treatment.  Fourth if necessary, the patient gets an air break to ensure comfort, and to avoid oxygen poisoning.  The fifth and final step is to repeat the procedure again if it is required for the treatment.

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How It Works

You may be asking yourself, “What does a hyperbaric chamber actually do?” or “How does it work?”  From what I have learned, a hyperbaric chamber is filled with 100% oxygen, raised up to three times higher than normal air pressure, allowing the lungs to gather up to three times more oxygen than under normal conditions.  That’s the same amount of pressure as being 66 feet underwater.  In addition to the red blood cells, plasma also carries oxygen under these extreme conditions.  With more vessels carrying more oxygen than normal, the vessels allow oxygen to reach the limbs and parts of the body, which need healing, in turn speeding up the healing process.  Here is a selfie I took with a hyperbaric chamber.

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The Hyperbaric Unit

When most people hear the words “Hyperbaric Unit”, they think of Michael Phelps’ training regiment, or a deep-sea diver, or they go straight to Google.  What I did not know until my tour is that hyperbaric chambers are used to treat patients with life threatening conditions and ailments each day.  Hyperbaric chambers are large steel vessels with glass enclosures that are about 7 feet long, in which the patient can lay down, and have the pressure be raised or lowered for the treatment.  For 25 years, the Hyperbaric Unit at WMC has been treating patients with the highest level of care.  I met with Kausik Kar, M.D., Medical Director of The Hyperbaric Unit at Westchester Medical Center, and got to see how the Hyperbaric Unit personalizes the patient care, letting the patients make decisions about their care, rather than ordering them to undergo a procedure.  I found that typical patients who require treatment have carbon monoxide poisoning, have wounds that aren’t healing, or are trauma patients.

Click on the picture to view it in full size.

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INTERNal View

Hey everyone!  I’m Dan Roel, I’m an intern at Westchester Medical Center and I am going to be starting INTERNal View.  An INTERNal View of WMC is a series of posts showing the public what’s going on behind the scenes at WMC.  I will be highlighting functions of departments that are not always the face of patient care, but play a vital role in it.  I’m going to visit these departments, interview and shadow the employees to get a better idea of what they do, and then share it with you.  Let us know if you have a department you would like us to showcase in an upcoming post!  And keep an eye out for our first INTERNal View story on the Hyperbaric Unit!