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By Marcia Frieze and Arlene Carlo, RN, BSN, FCSP
Healthcare workers (HCWs) are continually seeking ways to enhance service andquality, and improve the financial bottom line. An effective inventory controlmanagement system for surgical instruments in the healthcare setting is one wayto achieve this goal.
Why control surgical instrument inventories?
Every hospital wants to get a handle on managing instrumentation. Surgicalinstrumentation has become increasingly complex and expensive. The instrumentsrepresent a substantial financial investment for healthcare facilities. Money istight and HCWs do not have the luxury of buying excess inventory. This isespecially true of endoscopic instruments, which have become a costly andnecessary financial investment as HCWs increasingly utilize minimally invasivesurgical procedures.
In today's healthcare setting, there are hundreds of instrument setscontaining thousands of different types, designs, and sizes of instruments thatare used in surgical procedures. As the number and variety of instruments usedin surgery has increased throughout the years, so has the cost of theseinstruments. In addition, surgical cases and the need for rapid turnover of setshave contributed to the need for better organization and control. Remember, anorganized inventory management program keeps trays under control andcirculating. The volume of procedures can be better handled and tracked avoidingthe need to routinely flash instruments.
The volume, high cost of surgical instruments, increased turns, and limitedinventories make it essential that an effective management system for this assetbe in place to provide accurate control and timely data.
Instrument management systems
Every hospital sees the need to manage its instrument sets. Having anestablished written policy and procedure regarding instrument inventorymanagement is one step; having the cooperation of the staff to implement theseprocedures when overwhelmed by the increased volume of cases andresponsibilities is another. In other words, we need a team of dedicated stafftrained to utilize the system each and every step of the way. Training andcooperation are crucial in maintaining an inventory management system.Furthermore, the system must be consistent and easy to implement.
Healthcare facilities typically utilize a manual record-keeping system, or anautomated system, to document information. However, all healthcare facilitiesare not the same. The decision as to which system to utilize, whether manual orautomated, is based on several factors, including the size of the facility, thenumber of surgical instruments, procedures, staff compliance, and the financialresources of the institution. It is important to choose an instrument managementsystem that will best meet the healthcare facility's particular needs. Whateversystem is used, it should be efficient, cost-effective, and easy-to-use. It iscrucial for the staff to completely understand the system, be trained to use thesystem, and work together to achieve optimum results.
Manual inventory control systems
Manualinstrument management systems are certainly a way to start. In the past it wasthe only option and these may work for smaller healthcare facilities and surgerycenters. However, a manual inventory system takes a considerable amount of timeand effort to maintain. Keeping manual logbooks where all processed instrumenttrays are listed and tracked is time consuming and labor intensive. There is achance for error. Additionally, retrieving information from a manual system isdifficult, as there are volumes of paperwork to look through before data can becomplied and analyzed.
When there are many instruments, it is even more difficult to maintainaccurate control with the manual system. It is also a challenge to consolidateinformation from the records to generate needed and valuable reports that areuseful to enhance the operation of the department.
Organization and standardization of trays, color-coding, labeling, andinstrument count sheets are a few solutions that can help manage the process.There are products currently on the market such as sterilization containers thatprovide organization and secure containment of surgical instruments. Thesecontainer systems provide a location for the identification of set name orservice, load card information for the sterilization record, and options tocustomize and standardize sets.
Automated inventory control systems
Computer technology has provided opportunities for improving instrumentmanagement. Computerized inventory management systems have the capability tomanage and process large volumes of data quickly and provide reports that helpthe healthcare facility do a better job of managing its surgical instrumentinventory. It is important to be aware of which systems are currently availablein the marketplace and what they offer. Most computer management systems trackthe instrument set through all processes and services. Others have additionaloptions, such as instructional features on line, instrument preventivemaintenance reminders, and employee tracking for productivity.
Take time to review literature and assess different systems and costs.Although an automated system may require a substantial initial investment, ithas proven to be a cost effective instrument management program. According toValerie DeVries, RN, sterile processing manager at Lenox Hill Hospital in NewYork City, "It may cost thousands of dollars, but it's worth it. Now we canfind the trays. At Lenox Hill, we have an outrageous volume of instruments andnow we have a better handle on standardization and control over the instrumentinventory." However, the system requires maintenance, backup, and someoneto sit and input consistently.
When it comes to inputting data, bar coding is a valuable tool. Inputtingdata using a bar code system is a definite time saver over manual input as longas the information is recorded at time of use. Bar coded trays and a bar codescanner provide improved tracking of instrument sets. Using a tray system thatprovides a location for labeling as well as the ability to bar code is a clearadvantage.
Scanning ensures accuracy of data entry. Instrument sets are scanned atspecific workstations in order to know the location and status of any set at anytime. Surgical instrument sets can be identified with a bar code label thatidentifies each set.
Labels can be affixed to inner baskets and outside of containers and to theoutside of trays that are wrapped. Computers track the flow of sets through thedepartment and at each stage of the processing department.
Reviewing the process:
First, instrument sets are scanned when they enter the decontamination area.Scanning creates a record that the tray is there. The tray is scanned when theset arrives in the prep and pack area for assembly, when sterilized, and whendelivered to the operating room or storage area.
A count sheet for each set is printed when the set is scanned for assemblyand bar code labels are printed to affix to the outside of the container orpackage before the sterilization process. Additionally, a backup plan isnecessary as with all computerized systems. Implementation takes time andrequires a concerted effort. When all processes and documentation rely on anautomated system to function, if the system goes down, tracking documentationcannot be obtained. Therefore, service is an important feature of the system.
The system must be as user friendly as possible. At Sarasota MemorialHospital, an 845-bed regional medical center, an automated inventory managementsystem was approved by the staff in central processing and the OR, and put intouse. According to Jim Heller, director of central services, "SarasotaMemorial's first goal was to have sets complete with the correctinstrumentation. The facility created count sheets and imported photos for eachinstrument in the computer." Later they implemented an instrumentmaintenance program, a tracking system and standardized to a sealed containersystem to store and contain the instrument sets using bar code labeling.
In conclusion, choose an instrument management system that will work for you.Obtain consensus from everyone involved and do a step wise implementationprogram. Make it easy. Do a back-up and use trays that can be standardized andlabeled. In the end, whether the inventory management system is manual orautomated, what it comes down to are the people, their dedication, andcommitment.
Marcia Frieze, MS, is the CEO of Case Medical, located in Richfield, NJ.Arlene Carlo, RN, BSN, FCSP, is an experienced clinical manager, educator, andconsultant.
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