Sophisticated to Simple: ID Systems Keep Instrument Sets on Track
By Michael C. Murphy, ACSP
An identification (ID) system is a method or procedure used to identify a person or an object. More elaborate systems include those that identify via voice, fingerprint or retinal scan. In the healthcare arena, specifically in the central sterile processing department, ID systems help identify and classify instruments. They may not be as extravagant as a driver's license or something out of a James Bond movie, but they are ID systems nonetheless.
Several ID systems have been tried in the past. In the old days, everyone had a system unique to his or her situation. Pictures of instruments were filed according to the name vendors used for them. A picture of the instrument, its size, product number and other pertinent data was placed on an inventory list and an index card, thus allowing the central service professional to compare the picture and accompanying information with the instrument to determine the correct item was being ordered. When assembling trays, pictures listed in alphabetical order helped identify the proper instrument. When instruments or vendors changed, the picture books were updated.
As time went on these systems became cumbersome, since vendors changed constantly and the actual product number for items varied from vendor to vendor. In some cases, two completely different instruments manufactured by separate vendors were called by the same name. In the late 1990s, the University of Iowa Hospitals and Clinics had surgeons evaluate basic instruments and discovered that the type of surgery each physician performed had a lot to do with whether or not instruments were accepted. To a general surgeon, the instrument might be exactly the correct size, while an orthopedic surgeon found it much too small. On the other hand, an ophthalmology surgeon thought everything was quite large. Getting the correct item to a physician is a difficult task, and each time a change in vendors is made, the task becomes even more challenging. It gets increasingly complicated as new instrument systems are developed and brought to the marketplace.
Colored tape is another ID system that has been used to identify instrument sets; yellow tape for labor and delivery instruments, blue tape for orthopedics, etc. This allowed central sterile processing staff to easily identify instruments sent for processing from specific areas of the hospital, and facilitated the return of the correct instrument to the correct department. Some hospitals used different colored tape to identify certain instruments for certain trays; instruments with white tape went in a major tray, for example. Still others color coded instruments by service, such as orthopedics, neurology, CT, etc. Tape identification systems varied from institution to institution depending on the issues involved in instrument cleaning and assembly. Some institutions did not use tape because of concerns that the instruments could not be cleaned properly and that bacteria might not be completely removed from the nooks and crannies under the tape on the instrument.
In 1986, the University of Iowa Hospitals and Clinics developed its own method of identifying instruments using an alpha-numeric system to aid staff who were working with more than 12,000 unique items. When new instruments were entered into the computer, each was given a unique number; instruments were given a number beginning with the letter T, and implants were given a number beginning with the letter X. When instruments were ordered from vendors, vendors were instructed to send the instrument with its unique number permanently etched on its surface. Staff simply had to verify the correct number had been etched onto the instrument when it was received. Incorrectly marked items were sent back to the vendor.
Today, a technologically advanced bar code identification system is available, similar to what one sees in most retail shops. A small bar code placed on instruments identifies that item when it is run through a scanner. Anecdotal information suggests that this option, while convenient, can be rather costly (greater than $1.23 per bar code). Once implemented, however, this system is a great aid in instrument identification. The bar code system helps track instruments and provides useful information about how long the instrument was in service, when it needed repair etc.
In the future, an optimal ID system would identify instruments through a bar code that was implanted in instruments by the manufacturer and which could be read from the same scanner. It would help identify instruments and implants and make them unique by being able to track their use. It would aid in inventory control and generally simplify the process. As an ID system, it still may not live up to James Bond fame, but with this method each instrument would have its own driver's license, and who knows what inventions may revolutionize the future for central sterile processing.
Michael C. Murphy, ACSP, is director of central sterilizing services for the University of Iowa Hospitals and Clinics and is a past board member of the American Society for Healthcare Central Service Professionals (ASHCSP).