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By Kris Ellis
The flow of surgical instruments betweenthe operating room (OR) and the sterile processing department (SPD) is a processthat is in constant motion in most hospitals. In order to perform operations andprocedures correctly and efficiently, OR nurses and surgeons must have thecorrect instruments. It is the job of the SPD to ensure these instruments aredelivered in a timely manner and are ready and able to be used.
Following surgery, the dirty instruments must be returned forcleaning and sterilization. Sounds simple enough, but anyone involved in theprocess knows there are a number of ways in which the proverbial ball can bedropped. Inefficiencies, errors and miscommunication throughout the surgicalinstrument cycle can create a chain reaction leading to surgery delays and evencancellations, among other things. These situations can wreak havoc with OR and physicianschedules, bog down the SPD and generally become a source of major headaches forany facility, in terms of both cost and patient care.
Although the OR and SPD share the common goal of contributingto positive patient outcomes, for all practical purposes they exist in twodifferent worlds. The inherent physical obstacles and time constraints in eachvirtually guarantee that a chronic lack of communication and understandingexists between the departments in most facilities.
Carol Petersen, RN, BSN, MAOM, CNOR, perioperative nursingspecialist for the Association of periOperative Registered Nurses (AORN),describes an example in which a doctor decides to make a change in a surgicalinstrument set and must notify the SPD of this change.
Getting that information communicated to another departmentcan become an issue, she says. In healthcare, just as in other businesses,poor communication can often lead to serious consequences.
It is not difficult to imagine how a missing instrument canquickly create an atmosphere of tension and frustration during a surgicalprocedure. Likewise, sterile processing personnels duties and effectivenesscan be severely compromised if they are forced to hunt for a cart that isurgently needed for an upcoming procedure, but has been missing in action forhours, for example. The stressful and chaotic environment that everyone mustcontend with can make it easy to point fingers without having a completeunderstanding of the larger picture.
You want to talk about lack of productivity, lack ofcommunication it is a major issue, says Nancy Chobin, RN, AAS, CSPDT,CSPDS, CSPDM, CSIT, clinical director for Healthcare Systems Management,distributor of the Trilogy instrument tracking system. Quite frankly,today sterile processing is a manufacturing center. Weve got to stop thisnonsense that we dont have enough money to spend in SPD. We are spendinghundreds of thousands of dollars in the OR for all these devices youdbetter believe we need to know where those devices are, she continues.
Unfortunately, for some hospitals part of the big picture mayalso be a shortage of staff in the SPD. Sometimes there are too many casesgoing on and for cost purposes they may not have enough people on staff to keepthose instruments washed, cleaned and set up again. That turn-around time is very important, says Peterson. Aninadequate number of knowledgeable and experienced technicians can put furtherpressure on a department already under a great deal of strain.
The Systematic Approach
Given the numerous challenges and cost implications, somefacilities are taking a new approach to instrument tracking by implementingautomated software tracking systems. There are many such systems on the marketthat have the capability to help facilities get a handle on their instrumentinventory and utilization, and can also help SPD managers measure employeeproductivity and train new employees. With new features and technologies beingincorporated to these systems constantly, automated instrument tracking is atool that is gaining notoriety, and its potential benefits extend beyond the SPDand the OR.
A move toward tracking software can be a step in the rightdirection for facilities looking to improve quality and efficiency. Itstaking responsibility in a proactive way for putting measures in place toprevent certain non-conforming incidents from occurring that are preventable,says Clay Cannady, head of sales, marketing and business development for Mequon,Wis.-based Materials Management Microsystems. These incidents are numerous andcan include everything from the aforementioned OR issues to delays in containinginfection to heading off many unnecessary costs.
We are trying to provide the tools, methods and systems forsafe, effective, consistent and compliant instrument processing outcomes, continues Cannady.
Many organizations are looking for ways to better manageand optimize their key resources, says Steffan Haithcox, product marketingmanager for St. Paul, Minn.-based Lawson Software.
Haithcox explains that Lawsons system can also help toimprove the relationship between the OR and the SPD. Working togethereffectively, these two departments will deliver better patient care nothingis more important, he says. Clear and reliable instrument and trayinformation can help prevent errors, heighten accountability quality and reduceservice delays.
A tracking system is essential not only to know whereinstruments are, but to make sure we can account for them throughout theprocess, says Chobin. This can be the first step in identifying problem areasin a hospitals instrument flow.
Hard facts are a must for SPD managers who are looking tocorrect these problems and procure the resources they need.
I was tired of dealing with anecdotal information, saysRose Seavey, RN, MBA, CNOR, ACSP, immediate past president of the AmericanSociety for Healthcare Central Service Professionals (ASHCSP) and director ofthe sterile processing department at The Childrens Hospital in Denver. Iwanted some real data to be able to state my case and its made all thedifference in the world as far as getting what we need for the department.
Many systems use bar codes to mark trays and cartswhich are then scanned as they move from place to place. Information on trayswhereabouts is then accessible via computer at any time. Electronic storage of this information can also facilitate theautomation of count sheets.
Some even have the capability to scan and track individualinstruments. InfoDot bar code technology, manufactured by Eden Prairie,Minn.-based Key Surgical, Inc., is a part of many tracking systems, and caneasily be incorporated into a facilitys existing system. Users have theability to apply the two-dimensional InfoDot label themselves.
These small (less than a quarter of an inch) labels usuallylast from one to two years, even through repeated sterilization cycles,according to Peter Huck, general manager of Key Surgical. When scanned, the InfoDot links the instrument to a data filecontaining detailed, useful information about that instrument, such asmaintenance/ repair history and utilization by case.
The basic tray and instrument tracking function of softwaresystems can show its value in many ways. Number one, a full system is goingto cut down on room turnover in the OR because youre going to know where youritems are now, according to Chobin. She goes on to say that the tense finger-pointingscenarios that can occur when an item is missing can be eliminated: Itsgoing to put those fires out.
One of the biggest problems is that many of theinteractions between the OR and sterile processing are reactive, saysCannady.
By implementing a tracking system, the dynamic between thedepartments can be fundamentally changed for the better. Now what we aremoving toward is integrating the system into surgery scheduling. Orders willcome in to the department that support this schedule and the processing techshave the tools and the means to consistently and reliably meet theserequirements, Cannady continues. Its a totally different way of operating, and the efficienciesthat are made available as a result are huge.
In the first six months we saved $65,000 without eventrying, just finding lost equipment and not having to rent additional equipment, says Seavey. She has used Materials Management MicrosystemsSterile Processing Microsystem (SPM) since 2000, when it was implemented at herfacility.
These efficiencies can extend outside the SPD as well. Theability to track the history of a certain instrument set may be indispensablefor infection control and risk management professionals in terms of tracking andisolating infection.
Systems can also act as a tool for establishing and fosteringaccountability in the SPD. When you consider the hundreds of thousands ofinstruments that a sterile processing department processes in a month, dependingon their size, we need to have some kind of accountability, says Chobin.
Measurable accuracy in terms of providing service to the ORcan be an important factor as well. I do quality improvement tracking on it(the system) and we run about a 99.87 percent accuracy rate. Now I can prove tothe OR that we do it right 99.87 percent of the time, says Seavey.
The large volume of data that systems collect can be condensedand organized into a variety of reports. Reports can be generated to providehard documentation of any number of things, including tray location and cartutilization. These reports can provide several mechanisms for the SPD to monitorits activities and resources. They can also be valuable sources of insight for identifyingpurchasing needs and overstock.
Cannady describes how utilization reports can identifypotential savings on repair costs. Most of our customers repair their instruments based ontime, but the problem is they dont use the instruments equally. If you have10 major trays, three of those major trays probably do 75 percent of the work,he says. But if you just refurbish them, sharpen them, based on time asopposed to based on actual utilization rates, youre probably under-servicingsome and over-servicing quite a few. Controlling these costs is a keyelement of system functionality.
By identifying actual repair needs, this type of report canshow facilities how to manage their repair budgets much more effectively.
Customers can also create ad-hoc reports to suit theirspecific needs, says Haithcox.
Chobin agrees that report customization is a key feature. Whatever kind of report you want, we will put it in thesystem for you. It can be completely customized to the facilitys wishes,she says.
Tracking systems can be invaluable assets for monitoringemployee productivity and training in the SPD as well.
The productivity piece has helped me justify the need formore fulltime employees, says Seavey.
Many systems feature digital images and video footage to helptechnicians identify and correctly assemble and prepare instrumentation. The Trilogy system also integrates specific trainingexercises.
We have a whole module on care, handling, testing andsterilization of basic surgical instruments with over 700 competency-basedquestions and 20 CEUs, all bookmarked so you can reach them any time, saysChobin.
Training and comprehension also can be established on the job. There are things our system can do to help peopleunderstand a lot more about the processing requirements, and we have anextensive messaging system to give people that kind of information, inreal-time, at the point where its needed, says Cannady.
For example, Cannady describes the systems ability toprevent improper sterilization methods by alerting technicians if an instrumentmust be separated from a cart for special care.
We build instrument files so that we can tie theinstrument, manufacturer, refurbishment/repair schedule based upon the number ofuses, the kind of sterilization thats requiredwe build all of that intothe database, Cannady continues.
In an environment where time set aside for orientation andtraining is virtually non-existent, a standard, reliable training method couldbe key in helping SPD managers handle the many demands of their department.Efforts to achieve a consistent level of knowledge and performance will also beappreciated by OR staff.
These efforts can be enhanced by the capacity of many trackingsystems to interact directly with other hospital systems. One common example isOR scheduling systems.
The ability to integrate our system with some of the majorsurgery scheduling and perioperative automation systems means that you now havethe ability to dial instrument issues into the conflict checking process thatthese scheduling systems perform, says Cannady. Improving the processesand outcomes of sterile processing and making the benefits of the systemrelevant facility-wide is the essential mission. if we had a device that went out for repair, the ORwould know not to book that case if it was one-of-a-kind, Chobin says,emphasizing the importance of this interaction.
By cutting down on loss, waste and inefficiency throughout thesurgical instrument cycle and increasing productivity in the SPD, a facilitycan, of course, stand to gain financially. This possibility provides anotherincentive for hospital administration to consider implementing trackingsoftware.
Many believe that enabling improved quality of care,patient safety and clinician satisfaction is justification enough, Haithcoxsays. However, significant cost saving is possible as well. Agood goal for a 300-bed hospital would be to save $500,000 annually from factorssuch as reducing instrument replacement and repair costs, increasing staffperformance and preventing surgery delays.
These savings start in the SPD. I probably spend $100,000less per year on rental equipment, says Seavey.
Facilities that decide to invest in instrument trackingsystems can expect an initial period of adjustment and learning. The length oftime can vary depending on the system and the goals of the facility, but mostcan be fully up and running in a few months.
We offer five days of on-site training and during that timewe will certainly help with implementation, says Chobin. I would say in a200- to 300-bed hospital you should be up and running in three months.
As far as training individual SPD personnel, the learningcurve can also fluctuate. For instance, those with a high level of computerliteracy may be more comfortable with the technology initially. Different usersmay also be introduced to different functions of the system.
User training depends on their role, says Haithcox. Forexample, it takes very little time to learn how to track a tray, but a littlemore to assemble trays and note exceptions.
Implementation of instrument tracking software will be adrastic change for SPDs in most facilities. For many, this change is one thatwarrants consideration in order to meet the continuous challenges in the SPD andOR, and to explore new options in controlling costs.