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By Jan Pingel
In an ever-changing economy with resources becoming more and more limited, hospitalsare evaluating and reviewing systems and procedures in an effort to contain costs andstreamline processes. One idea that is taking the market by storm is the use of specialsoftware and inventory control programs to track instrumentation and mobile equipment.While many of the concepts of these systems are similar--not all are created equal.
An instrument tracking system should lay the foundation for all the activities in thecentral processing/central supply department of a hospital. It should be able to documentevery process in the department, providing staff with tracking and documentationcapabilities to create an efficient and cost-effective department. The best systems shouldmanage inventory, streamline processes, improve quality, and also be used as a decisionsupport system for managers of the central supply and operating room.
Caution should be taken when choosing an instrument tracking system. Some systems tendto be specialized to fit the vendor's instruments, mobile equipment, or processingequipment. Keep your options open. While you may be using a particular vendor exclusivelynow, you may not be in the future. You should select a system which can be used withinstruments and equipment from various manufacturers. The system selected should also havethe capability of connecting to any vendor's equipment or at least have the ability to logdata from that equipment. Because many hospitals process instrumentation and mobileequipment in the same area, the system should be able to document the process for both ofthese types of goods.
A computerized instrument tracking system can be intimidating to the staff in thecentral supply department. Typically, only administrators and supervisors use thecomputers in central supply. With a tracking system, everybody has to be able to use thesystem. The easier a system is to use--the better for all. Simple tasks such as loggingonto the system and viewing pictures can become complicated tasks for users who lackcomputer knowledge. Technologies like barcode scanners, touch screens, and voice controlsmake instrument-tracking systems easier to use. A system where the user is not confrontedwith a computer/PC interface will be the easiest to use.
Tracking systems can have a dual purpose since they can also be used as a training toolfor new employees and as a reinforcement tool for the current employees. The pictures showthe correct instruments, sets, or equipment that is being handled or packed. Manyhospitals use several pictures at various angles to help identify correctly the items inthe set. The system chosen should also store procedure descriptions to help the usersprocess the items so they are readily accessible. Ultimately, the system should be able tohold all of the departmental procedures and be used as a training and quality assurancesystem.
A major part of compliance in central supply is the maintenance of sterilizationrecords to include information on sterilizer loads, biological indicators, and sterilizerperformance. Some tracking systems will allow a user to document cycles, the content ofthe load, and the processing of the biological indicator. However, most systems do notrecord the actual sterilizer performance. The sterilizer strip or sterilizer chart stillhas to be saved for complete documentation for most systems. Normally, only the sterilizermanufacturers offer some kind of system that will electronically document the actualsterilizer performance and tie that documentation to the sterilizer load documentation.
There is no standard on how instrument-tracking systems connect to sterilizers.However, this connection allows the user to have a truly paperless systems-instrumenttracking system. All the information that is needed and required by regulatory is storedwithin the system and is easily retrievable. Both sterilization and instrument/equipmentdata can be archived on a CD and retrieved easily when needed. All of the processinginformation for an entire year could be archived on one CD, eliminating enormous amountsof paperwork and filing.
An instrument tracking system can also have a major impact on the Operating Room.Therefore, when selecting a system, select one that can be used in both the CS and the OR.Because these two departments work so closely together, they will both benefit from thechange a tracking and documentation system provides. Overall, the system you select shouldhave the capability to connect directly to the OR scheduling system and communicate databack and forth between the OR and the CS. With such a connection, specific goods can betracked to actual patients for billing purposes or instrument recall.
The OR can also realize other benefits from a tracking system. Some tracking systemsprovide the user with instrument preventive maintenance reminders when instruments need tobe sharpened or serviced. By using these reminders, the OR is guaranteed to receive sharpand well-maintained instruments, providing better quality of care and oftentimes extendinginstrument life. Furthermore, well-maintained instruments do not need to be replaced asoften, saving both departments time and money.
In today's healthcare environment, it is common for hospitals to workinterdepartmentally as well as within their network or hospital affiliation, sharinginformation and equipment. Thus, the tracking and documentation system selected needs toprovide sufficient flexibility, as well as scalability, to connect various sites. Thesystem should also be a part of the total hospital information system. It is alsoimportant that their system is Health Level 7 compliant. Health Level 7 is an organizationthat works to standardize the computing environment in the healthcare field. This isbeneficial when connecting to systems in Materials Management, OR Scheduling, PatientCensus, Patient Billing, and other related areas.
Benefits are often realized quickly with tracking systems and range from time and costsaving to accurate reports and quality assurance. Realizing the time that is saved eachday by these systems becomes an easy task. Add up the time it takes to search for a set orcheck sterilization records and the minutes easily become hours. Now, since you have thelocation of every set or the sterilization records at your fingertips, that time isreduced significantly.
Cost savings can be seen with a decline in instrument replacement and mobile equipmentrentals. Other areas that benefit include better staff appropriation and instrument lossand/or theft. And when it comes time to reorder instruments, you will have informationbased upon actual usage, therefore, gaining leverage on contract negotiations.
Another major benefit to both CS and OR management is report generation. Reports arenormally standard with tracking systems and can be generated on almost any subject fromemployee productivity to sterilization cycles. The best systems on the market use reportwriters that allow for a wider range of customizable reports. Many of these systemsincrease quality assurance for the hospital. With scheduled reminders, sets are wellmaintained and instruments are sharp and ready for use. The best system on the market willnot allow goods to be sterilized unless certain criteria are met or dispatched to the ORwhen they have not been sterilized.
When deciding on an instrument tracking system, a key element to consider should beservice. When switching from a manual system to an automated processing system, allprocesses and documentation rely on the automated system to function. If the system goesdown, tracking documentation cannot be obtained, goods cannot be returned, the sterilizerdocumentation is not saved, etc. It is important that the supplier of the system beavailable to get it back up and running as soon as possible to maximize uptime. Serviceoffered might even be in the form of remote support, allowing the service organization toaccess the system remotely. If remote support is available, the time from service call toidentifying the problem is almost instant.
Another important aspect of service to consider is spare parts. If a computer breaksdown, it should be easy to replace with a spare or temporarily move an existing computerin its place. All critical parts of the system such as connection to sterilizers, speciallabel printers, and scanners should have at minimum of two spares on hand. Non-criticalhardware such as laser printers, keyboards, and monitors are typically found within thehospital and can be easy to replace.
In case a critical problem that cannot be fixed immediately or remotely arises, acontingency/backup plan is a necessity. If, for example, the server breaks down or thenetwork is inoperable, pre-printed labels should be available to identify packs normallyreceiving freshly printed barcodes. A logbook where all the processed units are registeredand tracked should also be available to maintain records of sterilized goods. Thisinformation can be added into the system after it is repaired, so no documentation islost.
The last and very important part of service is the vendor's service organization. Thecustomer should review the size and location of the service organization. Service callresponse time is equally important with the actual time needed prior to the on-site visit.Many vendors of tracking systems rely on the sales organization or local distributor toresolve problems on-site. Equipment manufacturers typically have local servicerepresentatives who can respond to a service call within hours.
Overall, it is important to choose a system that meets all of your needs--whether it isinstrumentation and equipment tracking to sterilization documentation and qualityassurance. The system purchased will be at the facility for many years to come, and itneeds to be adaptable to a changing environment.
Jan Pingel is now the Senior Market Manager, Integrated Processing Systems forLunatronic at Getinge/Castle, Inc. (Rochester, NY) where he promotes the T-DOC system fortracking, quality assurance, and asset management for sterile goods in hospitals acrossthe US and Canada. For more information about T-DOC, visit
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