Infection Control Today - 08/2004: OR Topics

Instrument Tracking Systems:
Exploring the Potential Benefits

By Kris Ellis

The flow of surgical instruments between the operating room (OR) and the sterile processing department (SPD) is a process that is in constant motion in most hospitals. In order to perform operations and procedures correctly and efficiently, OR nurses and surgeons must have the correct instruments. It is the job of the SPD to ensure these instruments are delivered in a timely manner and are ready and able to be used.

Following surgery, the dirty instruments must be returned for cleaning and sterilization. Sounds simple enough, but anyone involved in the process knows there are a number of ways in which the proverbial ball can be dropped. Inefficiencies, errors and miscommunication throughout the surgical instrument cycle can create a chain reaction leading to surgery delays and even cancellations, among other things. These situations can wreak havoc with OR and physician schedules, bog down the SPD and generally become a source of major headaches for any facility, in terms of both cost and patient care.

Although the OR and SPD share the common goal of contributing to positive patient outcomes, for all practical purposes they exist in two different worlds. The inherent physical obstacles and time constraints in each virtually guarantee that a chronic lack of communication and understanding exists between the departments in most facilities.

Carol Petersen, RN, BSN, MAOM, CNOR, perioperative nursing specialist for the Association of periOperative Registered Nurses (AORN), describes an example in which a doctor decides to make a change in a surgical instrument set and must notify the SPD of this change.

Getting that information communicated to another department can become an issue, she says. In healthcare, just as in other businesses, poor communication can often lead to serious consequences.

It is not difficult to imagine how a missing instrument can quickly create an atmosphere of tension and frustration during a surgical procedure. Likewise, sterile processing personnels duties and effectiveness can be severely compromised if they are forced to hunt for a cart that is urgently needed for an upcoming procedure, but has been missing in action for hours, for example. The stressful and chaotic environment that everyone must contend with can make it easy to point fingers without having a complete understanding of the larger picture.

You want to talk about lack of productivity, lack of communication it is a major issue, says Nancy Chobin, RN, AAS, CSPDT, CSPDS, CSPDM, CSIT, clinical director for Healthcare Systems Management, distributor of the Trilogy instrument tracking system. Quite frankly, today sterile processing is a manufacturing center. Weve got to stop this nonsense that we dont have enough money to spend in SPD. We are spending hundreds of thousands of dollars in the OR for all these devices youd better believe we need to know where those devices are, she continues.

Unfortunately, for some hospitals part of the big picture may also be a shortage of staff in the SPD. Sometimes there are too many cases going on and for cost purposes they may not have enough people on staff to keep those instruments washed, cleaned and set up again. That turn-around time is very important, says Peterson. An inadequate number of knowledgeable and experienced technicians can put further pressure on a department already under a great deal of strain.

The Systematic Approach

Given the numerous challenges and cost implications, some facilities are taking a new approach to instrument tracking by implementing automated software tracking systems. There are many such systems on the market that have the capability to help facilities get a handle on their instrument inventory and utilization, and can also help SPD managers measure employee productivity and train new employees. With new features and technologies being incorporated to these systems constantly, automated instrument tracking is a tool that is gaining notoriety, and its potential benefits extend beyond the SPD and the OR.

A move toward tracking software can be a step in the right direction for facilities looking to improve quality and efficiency. Its taking responsibility in a proactive way for putting measures in place to prevent certain non-conforming incidents from occurring that are preventable, says Clay Cannady, head of sales, marketing and business development for Mequon, Wis.-based Materials Management Microsystems. These incidents are numerous and can include everything from the aforementioned OR issues to delays in containing infection to heading off many unnecessary costs.

We are trying to provide the tools, methods and systems for safe, effective, consistent and compliant instrument processing outcomes, continues Cannady.

Many organizations are looking for ways to better manage and optimize their key resources, says Steffan Haithcox, product marketing manager for St. Paul, Minn.-based Lawson Software.

Haithcox explains that Lawsons system can also help to improve the relationship between the OR and the SPD. Working together effectively, these two departments will deliver better patient care nothing is more important, he says. Clear and reliable instrument and tray information can help prevent errors, heighten accountability quality and reduce service delays.

A tracking system is essential not only to know where instruments are, but to make sure we can account for them throughout the process, says Chobin. This can be the first step in identifying problem areas in a hospitals instrument flow.

Hard facts are a must for SPD managers who are looking to correct these problems and procure the resources they need.

I was tired of dealing with anecdotal information, says Rose Seavey, RN, MBA, CNOR, ACSP, immediate past president of the American Society for Healthcare Central Service Professionals (ASHCSP) and director of the sterile processing department at The Childrens Hospital in Denver. I wanted some real data to be able to state my case and its made all the difference in the world as far as getting what we need for the department.

Many systems use bar codes to mark trays and carts which are then scanned as they move from place to place. Information on trays whereabouts is then accessible via computer at any time. Electronic storage of this information can also facilitate the automation of count sheets.

Some even have the capability to scan and track individual instruments. InfoDot bar code technology, manufactured by Eden Prairie, Minn.-based Key Surgical, Inc., is a part of many tracking systems, and can easily be incorporated into a facilitys existing system. Users have the ability to apply the two-dimensional InfoDot label themselves.

These small (less than a quarter of an inch) labels usually last from one to two years, even through repeated sterilization cycles, according to Peter Huck, general manager of Key Surgical. When scanned, the InfoDot links the instrument to a data file containing detailed, useful information about that instrument, such as maintenance/ repair history and utilization by case.

The basic tray and instrument tracking function of software systems can show its value in many ways. Number one, a full system is going to cut down on room turnover in the OR because youre going to know where your items are now, according to Chobin. She goes on to say that the tense finger-pointing scenarios that can occur when an item is missing can be eliminated: Its going to put those fires out.

One of the biggest problems is that many of the interactions between the OR and sterile processing are reactive, says Cannady.

By implementing a tracking system, the dynamic between the departments can be fundamentally changed for the better. Now what we are moving toward is integrating the system into surgery scheduling. Orders will come in to the department that support this schedule and the processing techs have the tools and the means to consistently and reliably meet these requirements, Cannady continues. Its a totally different way of operating, and the efficiencies that are made available as a result are huge.

In the first six months we saved $65,000 without even trying, just finding lost equipment and not having to rent additional equipment, says Seavey. She has used Materials Management Microsystems Sterile Processing Microsystem (SPM) since 2000, when it was implemented at her facility.

These efficiencies can extend outside the SPD as well. The ability to track the history of a certain instrument set may be indispensable for infection control and risk management professionals in terms of tracking and isolating infection.

Systems can also act as a tool for establishing and fostering accountability in the SPD. When you consider the hundreds of thousands of instruments that a sterile processing department processes in a month, depending on their size, we need to have some kind of accountability, says Chobin.

Measurable accuracy in terms of providing service to the OR can be an important factor as well. I do quality improvement tracking on it (the system) and we run about a 99.87 percent accuracy rate. Now I can prove to the OR that we do it right 99.87 percent of the time, says Seavey.

The large volume of data that systems collect can be condensed and organized into a variety of reports. Reports can be generated to provide hard documentation of any number of things, including tray location and cart utilization. These reports can provide several mechanisms for the SPD to monitor its activities and resources. They can also be valuable sources of insight for identifying purchasing needs and overstock.

Cannady describes how utilization reports can identify potential savings on repair costs. Most of our customers repair their instruments based on time, but the problem is they dont use the instruments equally. If you have 10 major trays, three of those major trays probably do 75 percent of the work, he says. But if you just refurbish them, sharpen them, based on time as opposed to based on actual utilization rates, youre probably under-servicing some and over-servicing quite a few. Controlling these costs is a key element of system functionality.

By identifying actual repair needs, this type of report can show facilities how to manage their repair budgets much more effectively.

Customers can also create ad-hoc reports to suit their specific needs, says Haithcox.

Chobin agrees that report customization is a key feature. Whatever kind of report you want, we will put it in the system for you. It can be completely customized to the facilitys wishes, she says.

Tracking systems can be invaluable assets for monitoring employee productivity and training in the SPD as well.

The productivity piece has helped me justify the need for more fulltime employees, says Seavey.

Many systems feature digital images and video footage to help technicians identify and correctly assemble and prepare instrumentation. The Trilogy system also integrates specific training exercises.

We have a whole module on care, handling, testing and sterilization of basic surgical instruments with over 700 competency-based questions and 20 CEUs, all bookmarked so you can reach them any time, says Chobin.

Training and comprehension also can be established on the job. There are things our system can do to help people understand a lot more about the processing requirements, and we have an extensive messaging system to give people that kind of information, in real-time, at the point where its needed, says Cannady.

For example, Cannady describes the systems ability to prevent improper sterilization methods by alerting technicians if an instrument must be separated from a cart for special care.

We build instrument files so that we can tie the instrument, manufacturer, refurbishment/repair schedule based upon the number of uses, the kind of sterilization thats requiredwe build all of that into the database, Cannady continues.

In an environment where time set aside for orientation and training is virtually non-existent, a standard, reliable training method could be key in helping SPD managers handle the many demands of their department. Efforts to achieve a consistent level of knowledge and performance will also be appreciated by OR staff.

These efforts can be enhanced by the capacity of many tracking systems to interact directly with other hospital systems. One common example is OR scheduling systems.

The ability to integrate our system with some of the major surgery scheduling and perioperative automation systems means that you now have the ability to dial instrument issues into the conflict checking process that these scheduling systems perform, says Cannady. Improving the processes and outcomes of sterile processing and making the benefits of the system relevant facility-wide is the essential mission. if we had a device that went out for repair, the OR would know not to book that case if it was one-of-a-kind, Chobin says, emphasizing the importance of this interaction.

By cutting down on loss, waste and inefficiency throughout the surgical instrument cycle and increasing productivity in the SPD, a facility can, of course, stand to gain financially. This possibility provides another incentive for hospital administration to consider implementing tracking software.

Many believe that enabling improved quality of care, patient safety and clinician satisfaction is justification enough, Haithcox says. However, significant cost saving is possible as well. A good goal for a 300-bed hospital would be to save $500,000 annually from factors such as reducing instrument replacement and repair costs, increasing staff performance and preventing surgery delays.

These savings start in the SPD. I probably spend $100,000 less per year on rental equipment, says Seavey.

Facilities that decide to invest in instrument tracking systems can expect an initial period of adjustment and learning. The length of time can vary depending on the system and the goals of the facility, but most can be fully up and running in a few months.

We offer five days of on-site training and during that time we will certainly help with implementation, says Chobin. I would say in a 200- to 300-bed hospital you should be up and running in three months.

As far as training individual SPD personnel, the learning curve can also fluctuate. For instance, those with a high level of computer literacy may be more comfortable with the technology initially. Different users may also be introduced to different functions of the system.

User training depends on their role, says Haithcox. For example, it takes very little time to learn how to track a tray, but a little more to assemble trays and note exceptions.

Implementation of instrument tracking software will be a drastic change for SPDs in most facilities. For many, this change is one that warrants consideration in order to meet the continuous challenges in the SPD and OR, and to explore new options in controlling costs.

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