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Automating Central Sterile: Instrument Tracking Systems in Action
More and more healthcare facilities are realizing the many benefits ofsurgical instrument tracking systems. From increasing employee productivity todecreasing unnecessary expenditures, tracking systems are proving their worth incentral sterile (CS) and beyond.
Considering the millions of dollars that many facilities have invested intheir medical devices and surgical instruments, protecting that investment is asignificant concern. You talk to anybody in the industry and were losingthousands of dollars over months or years or what have you on all thesereplacement costs, says Richard Schule, BS, CST, CRCST, CHMMC, FEL, managerof the processing department at Cleveland Clinic Foundation.
Here we can narrow it down to who the victims are, or what services aremore problematic than others, or what particular devices are more problematicand need to be replaced because were capturing that data; were identifyingthat when were assembling the instruments, and on a daily or weekly ormonthly basis I can provide that information to our customers and show them thetrends.
When it comes to producing documentation on instruments, automation is theway to go. The documentation piece, for systems out there that are manual andlaborious and intensive as far as collecting data, people have to be responsiblefor collecting that data at the end of the day, and then at the end of the monththeyre always pulling stuff together, Schule says. Here its all scanned in by bar code, and its all realtime, so it just makes the process very efficient.
Nancy Chobin, RN, CSPDM, SPD/CS educator for Saint Barnabas Health CareSystem, explains that planning the implementation of the tracking system in herfacility gave CS personnel a renewed sense of confidence in executing theirduties and responsibilities. Most people in CS are always getting blamed foreverything, she says. Its so nice to have some accountability and be able to trackthings through your department and know who did it and when they did it and howthey did it, which was really something they were looking forward to and veryexcited about.
Chobin points out that her facilitys system, TRILOGY from HealthcareSystems Management, features an extensive training module that includes 700competency-based questions on the care, handling and identification of basicsurgical instruments. There are also crossword puzzles, theres a wordfind, theres parts of an instrument scattered all over and you have toconstruct the instrument, and if you come up with the wrong answer, it not onlytells you that the answer is wrong, but also what the correct answer should be,Chobin continues. The learning is reinforced at all times, and that training can bebookmarked at any time and it keeps track of where you were. The supervisor canprint out a report and you can get 20 CEUs for it.
Schule can also attest to the advantages of the computer-based training thatmany tracking systems can provide. Its huge, he says. We have atutorial that gets them through, and before they know it theyre online withina few days and then within a month they have no problems whatsoever.
Schule explains that the ability to customize the tutorial is particularlyhelpful in preserving valuable resources. Weve added pictures of instrumentation so when they bring up a countsheet and theyre not sure what the tray looks like, they can bring up apicture right there; the training modality is quickly expedited through visuals and pictures, sowe dont have to waste a second person shadowing them it tells youeverything you need to know, he says. You click on a product number andtheres the clamp or theres the knife handle. It cuts back on the labor youneed for training.
Chobin says basic features such as scanning instruments and dealing withcount sheets are quick and easy to learn and put into practice. Other options, such as adding custom instructional videos, may evolve moreslowly depending on the time CS staff can devote to the system.
You can download videos not only for training but also for refreshingsomeone, Chobin explains. So if I was doing a tray and it tells me thatthis particular device needs to be lubricated, and I havent done this in along time and I dont remember how to do it, I can click on the video icon andit will bring up the video of how to lubricate the drill.
Chobin explains that a streamlined system that is capable of being customizedcan be very attractive. One of the beautiful things about our system is itssimplicity, she says. We dont have a lot of bells and whistles. I likesimplicity; why give me 200 reports when theres only three or four that Imgoing to really use? Im wasting paper, Im wasting electricity, and no oneelse is going to read them either. It can be customized to give you any reportthat you want, but we try to keep the system very simple.
Another feature that has proved useful at Saint Barnabas is instantmessaging. Operating room (OR) personnel are able to send an instant message tothe CS supervisor, who then can send it to everyone in the department, or toindividual workstations. I can get an instant message up on my screen thatsays the OR needs a Metzenbaum scissor Room 7 STAT. I can either send it to thecase cart area, or I can send it to everybody and say Does anyone have onethats sterile? Let me know immediately, and they can respond back to me.The staff loves it because they dont even have to get up to answer the phone its right there on the screen. The instant messaging has really been ahit.
Chobin notes that the everyday interaction between the OR and CS can begreatly enhanced through the use of a tracking system. For example, one daylast summer I counted no less than 43 phone calls in an eight-hour shift, andthe majority of them were for devices that were already in the OR, she says.This is common all over; this is the way it is, she says. With thetracking system we can tell them exactly when it was sent up.
Schule explains that the uses and benefits of instrument tracking arecertainly not limited to the OR and CS. My colleagues and peers, the nursemanagers, managers in charge of the various services, they find this extremelybeneficial when theyre trying to plan capital budgets at the end of the yeargetting ready for the upcoming year, he says. I can show throughhistograms or usage reports on a particular tray of instruments where we spikedand if we have so many on hand. For example, say if we have 10 trays, andthroughout the year we had need on several occasions for 12 or 13, it gives themammunition to go and get $3,000 to add another tray to the inventory. On theflip side, it shows those trays that are just sitting stagnant on the shelf, andwe can pull those devices off, bring them down and build trays that we need, soits better utilization of the minor equipment or surgical instruments.
Most people just want to get a tracking system in to find out where theirinstruments are and where theyre going, says Chobin. However, shereiterates the fact that automated instrument tracking offers an array of usefulfeatures that should be taken advantage of. I get very frustrated because alot of people have spent this money on tracking systems and theyre really notutilizing them to their full potential, she explains. They scan a traywhen it comes into decontam, but it doesnt get scanned again until someonepicks it up to prep for packaging. I want to know not only when that tray cameinto decontam, but I also want to know how long it took for somebody to puttheir hands on it, because if the OR calls me, thats affecting my turnovertime. It may also be affecting my employee utilization they may need to putmore people in decontam. We can track station utilization, people utilization,tray utilization, and the more you scan, the more finite, the more real-timeyour information. Most people just want to scan to get their productivity andknow this tray went through here and thats it. I just feel that if youregoing to spend the money for a tracking system that you want to have reallydetailed information to know who did it, how they did it, when they did it,and why they did it.
Accounting for instrumentation can save countless hours of miscommunicationand searching, allowing clinicians to concentrate on what matters most. Herewe just push a couple buttons and find out where it was last scanned and nineout of 10 times, there it is, says Schule. So that offset in lost labor costs is also huge, which allowsthe perioperative staff to concentrate on patient care and not worry abouthaving to look for a device.
The surgical processing department at Schules facility has earned thedistinction of ISO (International Organization for Standardization) 9001:2000certification, thanks in part to effective utilization of its tracking system,Sterile Processing Microsystem (SPM) from Materials Management Microsystems.Several specific features of the system were key in making this effortsuccessful, according to Schule.
One such feature involves the creation of templates for sterilization ofcertain devices. When we build a template for a medical device, we add inthere that a biological is required, or a device needs to be exposed to acertain sterilant modality steam, gas, plasma or ozone, Schule explains.They asked what our preventative measures were, or what our quality was inensuring that happens. Based on that bar code, we showed them that you cantscan this device into any other modality than whats dictated by the computersystem, which was a huge piece.
Schule describes another example in which corrective action was put in placein response to an event in which unsterile instruments made their way to the OR.We rewrote a program, and now a device has to be mapped back to asterilization load. In other words what will happen is if you try and scan atray that hasnt been run through a sterilization load, it will come up on thescreen that the device is unsterile, preventing us from sending it upstairs.Those all triggered or helped support us going after the ISO certification.
As far as specific application to the infection control effort, Chobincontends that instrument tracking has much to offer. I think now with the newJoint Commission on Accreditation of Healthcare Organizations (JCAHO) tracermethodology, this is going to be really invaluable, although they haventrequired it, she says. I think with all of the issues weve had with CJD(Creutzfeldt-Jakob disease), even though its extremely rare, weve seenseveral instances of not screening patients appropriately or not having theinformation and then having to go back and follow up on 700 or 900 patients now youll know exactly which set was used on that patient and what patientsubsequently had that set. In my opinion, its going to be required in the next couple of years.