By Marcia Frieze
It’s 10 o’clock. The patient is prepped; the doctor is ready for surgery. Do you know where your containers are?
Given the increasing complexity of surgical devices, increasing workloads and reduced staffing, there is no wonder that there has been a rise in equipment related issues leading to potential patient safety issues as well as a rise in surgical site infections and hospital-acquired infections.
To effectively manage surgical instrument sets, equipment usage and inventory; healthcare systems have employed various methods from pick lists and preference cards, to barcode scanning and now the use of radio frequency identification (RFID) tags to track mobile equipment and devices throughout the facility. Effectiveness of these asset management tools has already been demonstrated in many acute-care settings with improved efficiencies, automated data transfer, real time location and demonstrated cost savings. Today, standardization has proven to be a necessary goal to cut costs and improve efficiency. Instrument trays may be ordered in set configurations. Data is made available in count sheets and in electronic format using digital photographs to help with assembly of contents in prep and pack and improve the instrument count process.
In the past, most surgeons used to require their own instruments. Today, if a procedure is the same, a set of instruments can be standardized within the facility and even within a hospital system. What is critical is to locate each set, ensure that it is complete and properly processed, and that it reaches the correct location for a particular patient on time for the procedure.
Instruments and surgical devices are constantly moving between the sterile processing department and the operating room, creating a work flow that goes 360 degrees.
These processes include the need to capture data to determine:
o What devices, supplies and instrumentation are required
o When the procedure has been scheduled
o How the set is to be processed
o How often the devices have been used
o Which instruments need to be repaired or replaced
o How, when and where the container has been sterilized and stored in preparation for use in the operating room.
When it comes to asset tracking, there are both barcode tracking as well as RFID. Currently, for individual instrument and set tracking, bar code technology is used. This means that a specific technician in a specified location needs to scan the barcode manually. This method is time consuming and may be fraught with human error. Some barcode systems will not allow the instrument set to proceed further when a specific instrument is missing. In this case, the supervisor or technician must override the system in order to replace the missing device with a substitute. With critical specialty devices, this may be necessary. However, healthcare managers might want to consider whether it is necessary to scan every single item in the set when many can be easily replaced from inventory as needed.
RFID eliminates the human errors associated with manual scans and can greatly improve efficiency. Assets can be tracked as they move from room to room. Where tracking of individual instruments was seen as important in the past, many now view the scanning of the set itself, the container used for reusable packaging and the case cart used for transport to and from the operating room to be not only more practical, but also more efficient and necessary for infection control. In this way, the entire set, as it is processed and transferred to the operating suite and placed into use, will provide a full history from decontamination to point of use. As an example, CJD events can be recorded, sets isolated and the recent emergency situations avoided when real time data is available.
RFID is a wireless non-contact use of radio frequency electro-magnetic fields to transfer data from a tag to a receiver that decodes the data and relay that to a computerized system. Unlike the barcode, the tag does not necessarily need to be in sight of the reader and can be embedded in the tracked object. Some tags have stored information. Some can only be read in short ranges. Some use a local power source or battery and others have no battery at all, but collect energy from an antenna. RFID tags have been used in many industries such as super markets or large retailers like Walmart, or on production floors like in the automotive or pharmaceutical industries where items are tracked through warehouses. The RFID tag can be affixed to an object and used to track and manage assets, inventory items, even people. The tag may be used for tracking containers, medical assets or even monitoring environmental conditions such as temperature and humidity. In fact, RFID can manage the entire instrument process and provide alerts and even training tools wherever possible. RFID tags can be worn by personnel and patients as a safety measure allowing them to be located 24 hours a day and to be quickly found in emergencies.
Different applications have different performance characteristics. For example, a large hospital might need to locate a piece of equipment within a 10-foot radius, while an SPD technician may only need to scan an instrument a few inches away.
Here are some tips on choosing the right RFID system:
1. Decide whether you need RFID as a point solution or a multi-interface solution
2. Determine the distance or frequency needed
3. Determine the location where the items are to be tracked
4. Decide which items you need to track
5. Determine whether the tag has the durability to withstand the environmental conditions
6. Review the cost of the software and hardware needed
7. Consider how much the implementation will disrupt existing operational activities
8. Prioritize which items are most important to track first
9. Decide on the degree of data security needed
10. Importantly for instrument processing, determine whether the tag can be sterilized and cleaned in an automated washer
While many healthcare facilities have initiated RFID for asset management of mobile equipment and supplies, few, if any have found a way to secure RFID tags to sterilization containers and devices that must be decontaminated and sterilized for patient care. Recently, Grady Memorial Hospital took part in an enterprise initiative to make it easier to locate medical equipment in real time using active RFID technology. The Veterans Affairs system has initiated a similar RDIF tracking program as well for their equipment. RFID technology is a valuable tool for improving asset utilization, reducing the incidence of lost equipment and cutting the time required trying to find a device for patient care.
Most RFID chips were not designed to withstand the harsh environment of the autoclave. This has been a major issue when it comes to using RFID tags for devices requiring sterile processing. Until now, facilities that use RFID tags for mobile equipment use 1D or 2D barcode labels for tracking and managing their instrument sets. Nonetheless, hospitals in Europe and in Japan are trialing new systems that can potentially survive the decontamination and sterilization process with more robust RFID tags with greater frequency.
Kanto Medical Center in Tokyo has introduced an automatic identification system with data capture technology. In order to overcome a shortage of operating rooms caused by a substantial increase in surgeries they implemented a system that has met their needs for greater accuracy and improved turn-around times. The goals for data capture included information as to when the devices were needed for surgery, which instruments are in each container, how often the set is used and which patients they were used upon. For individual instruments, they applied a 2D bar code dot matrix to each device. Such barcodes can include more information than the original 1D dot matrix. However, for sterilization containers, they utilized RFID technology to retrieve sets and record the name of the set and the time when decontamination, assembly and sterilization were accomplished. Movement of the container is recorded as antennas are strategically placed in the doorways adjacent to each of the processing areas. Thus, the instrument set once assembled could be easily traced throughout the facility without the chance of human error.
Robust asset management can greatly reduce surgical instrument shrinkage and optimize inventory, increase staff productivity and ensure compliance. It can provide information on set usage and monitor the workflow process. However, healthcare facilities in the U.S. continue to track instrumentation and medical devices with barcode scanners with manual input. A few companies are developing new, innovative software technology utilizing real-time RFID technology for asset management of instrument sets. All container systems must include a labeling system to be able to identify the contents of the set. In addition, a count must be provided to ensure that the correct items and quantities have been included for the procedure. Nonetheless, where to place the count sheet, internally or externally to the container, has continued to be an ongoing issue. One suggestion would be to eliminate the paper entirely and apply an electronic coding system with automated readout.
ANSI/AAMI ST77:2013 Containment devices for reusable medical device sterilization.
GS1 Healthcare Reference Handbook 2009/2010
RFID Journal online
Ochiai C. RFID and Barcode Based Management of Surgical Instruments in a Theatre Sterile Supply Unit. Accessible at: http://www.gs1.org/docs/healthcare/case_studies/Case%20study_Kanto_Surgical%20instruments%20traceability.pdf