OR WAIT 15 SECS
by Jim Heller
Every hospital wants to get a handle on managing instrumentation. This is especiallyimportant in the OR because that's where most of the instruments are used. Severaldifferent instrument management programs that can help manage trays efficiently andaccurately are on the market today.
Almost every major instrument company in the country has an instrument managementprogram. Some basic programs to suggest are those offered by a facility's primaryinstrument vendor. The basic program should provide visualization of instruments plus helpdevelop count sheets. The program should also be on a computer terminal in the processingarea. This is the foundation of a basic management system.
Sarasota Memorial Hospital, an 845-bed regional medical center, is the second-largestpublic hospital in Florida. With about 3,000 full-time staff members and more than 1,000volunteers, Sarasota Memorial is Sarasota County's second-largest employer. It is afull-service facility, providing acute care, a Level III Neonatal Intensive Care Unit,outpatient services, home health, and long-term care. The hospital, founded in 1925, isamong the top 25 in the US for the number of open-heart surgeries performed annually. Oneof the first non-academic hospitals in the nation to develop a clinical research service,Sarasota Memorial has conducted almost 200 clinical trials during the past 10 years. Withall of these commitments, the hospital needs an efficient and reliable instrumentmanagement system.
One thing to consider when designing the system is what you want to accomplish.Sarasota Memorial's first goal was to have sets complete with the correct instrumentation.The facility created count sheets and imported photos for each instrument into a computer,so the staff can see what every instrument looks like. Each instrument has a costassociated with it, providing the hospital with tray pricing. One report can detail thetotal cost of replacing a tray. The system has the capability to do most of the orderingright from the computer system. Sarasota Memorial also has an overall cost of itsinstrumentation inventory. This is the basic version of instrument inventory.
When deciding to implement such a system, the instrument company comes to the facilityand spends a few days there conducting inventory on sets and ensuring that all instrumentcount sheets are right. Basically, they help set up the system, input all the data, createcount sheets, and train staff.
With any instrument management and computer tracking system, an important thing to dois have all the staff in the sterile processing area and OR approve of the program. Inother words, these departments have to be involved in the functioning of the system andmust believe that this system is something that is going to be helpful for them.Therefore, the system needs to be as user friendly as possible.
Sarasota Memorial has implemented the N-Compass system, which is the Pilling Weckinstrument management system. The facility first created count sheets and started usingN-Compass to get staff accustomed to using the computer and retrieving count sheets andprinting them out at the point of use.
The second function of this system is to create an instrument maintenance program. Theinstrument maintenance program is important since it helps the facility send sets out forrepair in a timely manner. As a result, repairs are under control because instruments aresharp and the needle holders hold sutures. Repairs do not wait to be done until one of thedoctors are upset about a broken or dull instrument. Set management is under control.
The next thing that Sarasota Memorial looked at is a tracking system. The facility hadall of its instrument sets programmed on N-Compass so that the staff could see what theset was and identify it easier. The next step was to track the instruments by seeing wherethey went. Sarasota Memorial implemented a Pilling Weck tracking system called TrakkerPro. Other tracking programs are on the market, but Sarasota Memorial chose this programbecause of its hand-held scanners. Using these scanners, staff is able to collect data andtake them to a download station, which downloads the information into the computer. Stafffelt this feature was convenient since the hand-held scanner has the ability to movearound unlike scanners attached to a computer.
To implement this tracking system, the company came in to help create another database.One of the basic things Sarasota Memorial wanted to know was how long it took for a trayto come in the decontamination area and be returned to the core shelf for use again.Another advantage to the tracking system is that it allows staff to know at all times thelocation of a specific tray. By clicking one button, you have the information at yourfingertips.
With this tracking system, a tray will come into the decontamination area where stafffirst scan it. Scanning creates a record that the tray is in the decontamination area.After it goes through the washer, the tray is scanned into a clean hold area and is placedon a shelf to be assembled in the processing area. When the technician pulls the tray forassembling, they scan it, assemble the set, and scan it again to show it has beenassembled. Next, they scan the tray to the sterilization location. After a load issterilized, staff scan the load to the core area where it is stored for use. In the corearea, the tray will be scanned to the shelf on which it "lives." When it isused, the tray gets scanned to a case cart location and a room. After the case, theinstruments and the case cart are brought to decontamination to begin the process again.
This system also tracks of all of the facility's loads and records. When the trays arescanned to the sterilizer location, a test pack or biological test is also scanned to showwhat kind of load it is. The technician then manually enters how long the exposure timewas, the temperature, and whether the indicator was positive or negative. The system thengenerates a report showing the load's specifications. If a load needs to be recalled, thesystem will show exactly where each tray is in the OR.
A couple of other important issues need to be considered when deciding how to structurethe system. First, you want to have the ability to review staff productivity. Establishthis monitoring by running reports to see how many trays staff are doing, to get anaverage time on assembly, to see what types of trays they are doing, etc. Basically, thishelps manage staff.
Whatever system is used, be sure it has a good instrument repair function. Each time atray is scanned at Sarasota Memorial, the computer keeps track of every time it goesthrough decontamination. With the Trakker Pro, staff has the ability to set up amaintenance level, meaning they can program the system so that every 20 times a tray isused, it gets flagged and appears on a maintenance report, which indicates that the setneeds to be repaired and sharpened. This process creates proactivity.
Every hospital should have some type of instrument system. If a hospital is usinginstruments from one primary vendor, there is no reason why a facility should not have atleast a basic instrument management system in its facility. At that point, you canevaluate whether a more advanced instrument management system is needed. A more advancedtracking system follows productivity and tracks trays efficiently and quickly to meet theneeds of the OR.
Jim Heller is the Director of Central Services at Sarasota Memorial Hospital(Sarasota, Fla).
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