Objective Decision-Making:

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Objective Decision-Making:
Using a Surgical Instrument/Mobile Equipment Tracking System

By Rose Seavey, RN, MBA, CNOR, ACSP


TCH employee Ann Harvey demonstrates scanning an instrument that has come from the sterilizer.

A surgical instrument/mobile equipment tracking system affords many benefits, including the opportunity to objectively analyze and improve or optimize a sterile processing department's (SPD) quality, productivity, set instrument inventories, and equipment rental practices.

After implementing a computerized sterile processing information system, The Children's Hospital (TCH) in Denver gained access to the data required to carry out such analyses. The employees use bar code scanners to record their activity and actions taken on sets and equipment. The resulting database provides the hospital with an objective means of monitoring individual and departmental quality and productivity, as well as instrument set and mobile patient equipment usage.

A variety of reports is generated to enable the SPD to review its current operation and level of service. Analysis of these reports resulted in objective steps that could be taken to improve quality and productivity, optimize set inventories, and make cost-effective decisions on rental equipment.

Improving Quality and Productivity

Some of the biggest frustrations facing SPD professionals is ensuring the operating room has complete and accurate instrument sets and the nursing care units have sufficient patient care equipment. Dependable and timely data can help to dramatically reduce these frustrations.

The computerized bar code system allows TCH to track the location of instrument sets and patient care equipment. Having the ability to locate any instrument set or piece of equipment at any given time, has not only helped to decrease wasted employee time looking for items, but also helped to increase its usage and ensure routine preventive maintenance is performed.


Author Rose Seavey says a tracking system improves department efficiency.

The information system helps to reduce human error associated with the sterilization process. Each instrument set or individual peel package item has a specific bar code which, when scanned, alerts the sterile processing staff of specifics such as, if a biological indicator or special sterilization parameters are needed. If a technician inadvertently puts an item needing low-temperature sterilization in a steam load, the system alerts them automatically so they can remove that item from the load before it is too late.

Sterilization-load record reports are automatically printed, resulting in accurate and legible records. Having all of the sterilization information in a database makes it easy to pull up reports at any time. This is a godsend when it comes time for a visit from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) or if you have a sterilization recall.

SPD employees scan all activities they perform including such tasks as cleaning, assembling instrument sets, running sterilizer loads, picking case carts, delivering items, attending meetings or education sessions, etc. Reports can be used to measure the productivity of the department for budgetary purposes or for individual employees, which can be used for the annual performance reviews. There is also the capability to run reports according to the areas of activity such as processing, decontamination or case carts, by the day of the week or the time of day. This has proven very helpful for TCH when it comes to creating the daily schedule.

Having the computerized bar code system has help tremendously with departmental orientation and training. With the use of a digital camera, pictures of instruments and equipment are loaded directly into the system allowing employees to look up items they are not sure of. These pictures can be helpful in identifying individual items and how sets are assembled. The use of bar codes results in consistency and uniformed standards. When technicians had to write things down it often resulted in inaccuracies or inconsistency. New employees catch on to how things are done at TCH much quicker than before the implementation of the barcode system. Individual orientation and educational activities can also be recorded and kept in the database. This can help the educator monitor the activities and needs of individual employees.

QA reports are another function that has proven very valuable. When the supervisor or manager is notified of an error, such as instruments missing for a set, it is entered into the database. This tool allows the manager to monitor the accuracy of the department or individual. It has also proved to be invaluable when comments are made such as "the sets are never put up correct." Instead of giving excuses for a few errors and focusing on the negative, it is great to be able to show the positive with an accuracy rate of 99.8%. Sharing this information with the staff is helpful when it come to quality improvement goals.

Optimizing Instrument Set Inventories


Georgia Vittum uses the bar code scanner to keep track of TCH's numerous pieces of equipment.

Reports provided by the information system allow the SPD staff to monitor the usage of each instrument set. This information can be used to justify purchases of additional sets that are used frequently, resulting in decreasing the need to do stat turnarounds or to flash sterilize sets. It also helps in determining those sets that do not get used. Unused instruments can be put into the system and used. There are reports that can do set comparison, which has proved helpful to decrease the number of different sets. For instance, if two instrument sets are similar except for a few items, those items can be wrapped separately and the hospital can get more productivity from each set. When a set is missing it is easy to look up where the set was last scanned. This helps to locate sets quickly; decreases frustration and time lost looking for sets, which helps to increase surgeon satisfaction.

Cost-effective Decisions on Rental Equipment

Due to the ability to track, rental equipment is returned earlier, thereby reducing rental expenses. In one year, TCH reduced its equipment rental cost by $60,000 directly related to the ability to track and return equipment to the rental company earlier. Before we had the ability to track each piece of equipment, after use, items would often remain on the nursing units. They would sometimes be hoarded. Staff members recall three years ago when they could not get a piece of equipment, so the nursing units would just choose to keep it until they needed it for another patient. This often resulted in lost charges that decreased hospital revenues. Inability to track all equipment was not only a problem for budget reasons, but also for infection control reasons. If the piece of equipment remained on the floor, it meant that it was not sent to SPD and we could not be sure it was properly decontaminated before being used on the next patient. Equipment usage reports can also help when it comes to ensuring the proper amount of equipment is purchased, resulting in decreasing the need to rent equipment.

Conclusion

Implementing a computerized sterile processing information system has resulted in a more efficient, accurate, and cost conscious department. The reports are powerful tools when it comes requesting more instruments, equipment or FTEs. As TCH continues to find ways to use the information stored in the database, the use of the system becomes infectious.

Rose Seavey, RN, MBA, CNOR, ACSP, is the director of central sterile processing at The Children's Hospital in Denver. She also is 2003 president-elect to the American Society for Healthcare Central Service Professionals (ASHCSP). The author acknowledges the assistance of Georgette King, marketing manager for Materials Management Microsystems in Milwaukee, WI.


Certification Exam for Sterile Processing Personnel Offered at ASHCSP Annual Meeting

The National Institute for the Certification of Healthcare Sterile Processing and Distribution Personnel (NICHSPDP) announces a new certification category for surgical instrument processors. The NICHSPDP exam for surgical instrument processors will be offered for the first time on Oct. 19 at the American Society for Healthcare Central Service Professionals (ASHCSP)'s annual conference in San Antonio, Texas. The exam will be administered on the same date at all test locations worldwide.

The new exam was based on a job analysis survey of surgical instrument processors last year. The job analysis survey received a 38% response rate that included all national geographic areas and international locations. Central service, sterile processing, and OR directors were included in the analysis, which surveyed hospitals and clinics, surgery centers, VA, and military facilities.

A study guide for the exam will be available by July 1, 2002. Candidate bulletins to register for the exam will also be available at that time. The fee is $115 for a five-year certification. Interested parties can call NICHSPDP at (800) 555-9765 and ask to be placed on the mailing list for the surgical instrument exam in October, or they can visit the NICHSPDP web site at www.sterileprocessing.org

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