Computer Instrumentation Management Program
by Jim Heller
Instrument management systems have the capability to do most of the ordering for new instruments right from the computer.
Every hospital wants to get a handle on managing instrumentation. This is especially important in the OR because that's where most of the instruments are used. Several different instrument management programs that can help manage trays efficiently and accurately are on the market today.
Almost every major instrument company in the country has an instrument management program. Some basic programs to suggest are those offered by a facility's primary instrument vendor. The basic program should provide visualization of instruments plus help develop count sheets. The program should also be on a computer terminal in the processing area. This is the foundation of a basic management system.
One Hospital's Experience
Sarasota Memorial Hospital, an 845-bed regional medical center, is the second-largest public hospital in Florida. With about 3,000 full-time staff members and more than 1,000 volunteers, Sarasota Memorial is Sarasota County's second-largest employer. It is a full-service facility, providing acute care, a Level III Neonatal Intensive Care Unit, outpatient services, home health, and long-term care. The hospital, founded in 1925, is among the top 25 in the US for the number of open-heart surgeries performed annually. One of the first non-academic hospitals in the nation to develop a clinical research service, Sarasota Memorial has conducted almost 200 clinical trials during the past 10 years. With all of these commitments, the hospital needs an efficient and reliable instrument management system.
One thing to consider when designing the system is what you want to accomplish. Sarasota Memorial's first goal was to have sets complete with the correct instrumentation. The facility created count sheets and imported photos for each instrument into a computer, so the staff can see what every instrument looks like. Each instrument has a cost associated with it, providing the hospital with tray pricing. One report can detail the total cost of replacing a tray. The system has the capability to do most of the ordering right from the computer system. Sarasota Memorial also has an overall cost of its instrumentation inventory. This is the basic version of instrument inventory.
When deciding to implement such a system, the instrument company comes to the facility and spends a few days there conducting inventory on sets and ensuring that all instrument count sheets are right. Basically, they help set up the system, input all the data, create count sheets, and train staff.
After a case, instruments are brought to decontamination to begin the tracking process.
With any instrument management and computer tracking system, an important thing to do is have all the staff in the sterile processing area and OR approve of the program. In other words, these departments have to be involved in the functioning of the system and must believe that this system is something that is going to be helpful for them. Therefore, the system needs to be as user friendly as possible.
Sarasota Memorial has implemented the N-Compass system, which is the Pilling Weck instrument management system. The facility first created count sheets and started using N-Compass to get staff accustomed to using the computer and retrieving count sheets and printing them out at the point of use.
The second function of this system is to create an instrument maintenance program. The instrument maintenance program is important since it helps the facility send sets out for repair in a timely manner. As a result, repairs are under control because instruments are sharp and the needle holders hold sutures. Repairs do not wait to be done until one of the doctors are upset about a broken or dull instrument. Set management is under control.
The next thing that Sarasota Memorial looked at is a tracking system. The facility had all of its instrument sets programmed on N-Compass so that the staff could see what the set was and identify it easier. The next step was to track the instruments by seeing where they went. Sarasota Memorial implemented a Pilling Weck tracking system called Trakker Pro. Other tracking programs are on the market, but Sarasota Memorial chose this program because of its hand-held scanners. Using these scanners, staff is able to collect data and take them to a download station, which downloads the information into the computer. Staff felt this feature was convenient since the hand-held scanner has the ability to move around unlike scanners attached to a computer.
Instrument management systems help track instrument trays efficiently and accurately.
To implement this tracking system, the company came in to help create another database. One of the basic things Sarasota Memorial wanted to know was how long it took for a tray to come in the decontamination area and be returned to the core shelf for use again. Another advantage to the tracking system is that it allows staff to know at all times the location of a specific tray. By clicking one button, you have the information at your fingertips.
With this tracking system, a tray will come into the decontamination area where staff first scan it. Scanning creates a record that the tray is in the decontamination area. After it goes through the washer, the tray is scanned into a clean hold area and is placed on a shelf to be assembled in the processing area. When the technician pulls the tray for assembling, they scan it, assemble the set, and scan it again to show it has been assembled. Next, they scan the tray to the sterilization location. After a load is sterilized, staff scan the load to the core area where it is stored for use. In the core area, the tray will be scanned to the shelf on which it "lives." When it is used, the tray gets scanned to a case cart location and a room. After the case, the instruments and the case cart are brought to decontamination to begin the process again.
This system also tracks of all of the facility's loads and records. When the trays are scanned to the sterilizer location, a test pack or biological test is also scanned to show what kind of load it is. The technician then manually enters how long the exposure time was, the temperature, and whether the indicator was positive or negative. The system then generates a report showing the load's specifications. If a load needs to be recalled, the system will show exactly where each tray is in the OR.
A couple of other important issues need to be considered when deciding how to structure the system. First, you want to have the ability to review staff productivity. Establish this monitoring by running reports to see how many trays staff are doing, to get an average time on assembly, to see what types of trays they are doing, etc. Basically, this helps manage staff.
Whatever system is used, be sure it has a good instrument repair function. Each time a tray is scanned at Sarasota Memorial, the computer keeps track of every time it goes through decontamination. With the Trakker Pro, staff has the ability to set up a maintenance level, meaning they can program the system so that every 20 times a tray is used, it gets flagged and appears on a maintenance report, which indicates that the set needs to be repaired and sharpened. This process creates proactivity.
Every hospital should have some type of instrument system. If a hospital is using instruments from one primary vendor, there is no reason why a facility should not have at least a basic instrument management system in its facility. At that point, you can evaluate whether a more advanced instrument management system is needed. A more advanced tracking system follows productivity and tracks trays efficiently and quickly to meet the needs of the OR.
Jim Heller is the Director of Central Services at Sarasota Memorial Hospital (Sarasota, Fla).
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