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By Rose Seavey, RN, MBA, CNOR, ACSP
A surgical instrument/mobile equipment tracking system affords many benefits,including the opportunity to objectively analyze and improve or optimize asterile processing department's (SPD) quality, productivity, set instrumentinventories, and equipment rental practices.
After implementing a computerized sterile processing information system, TheChildren's Hospital (TCH) in Denver gained access to the data required to carryout such analyses. The employees use bar code scanners to record their activityand actions taken on sets and equipment. The resulting database provides thehospital with an objective means of monitoring individual and departmentalquality and productivity, as well as instrument set and mobile patient equipmentusage.
A variety of reports is generated to enable the SPD to review its currentoperation and level of service. Analysis of these reports resulted in objectivesteps that could be taken to improve quality and productivity, optimize setinventories, and make cost-effective decisions on rental equipment.
Improving Quality and Productivity
Some of the biggest frustrations facing SPD professionals is ensuring theoperating room has complete and accurate instrument sets and the nursing careunits have sufficient patient care equipment. Dependable and timely data canhelp to dramatically reduce these frustrations.
The computerized bar code system allows TCH to track the location ofinstrument sets and patient care equipment. Having the ability to locate anyinstrument set or piece of equipment at any given time, has not only helped todecrease wasted employee time looking for items, but also helped to increase itsusage and ensure routine preventive maintenance is performed.
The information system helps to reduce human error associated with thesterilization process. Each instrument set or individual peel package item has aspecific bar code which, when scanned, alerts the sterile processing staff ofspecifics such as, if a biological indicator or special sterilization parametersare needed. If a technician inadvertently puts an item needing low-temperaturesterilization in a steam load, the system alerts them automatically so they canremove that item from the load before it is too late.
Sterilization-load record reports are automatically printed, resulting inaccurate and legible records. Having all of the sterilization information in adatabase makes it easy to pull up reports at any time. This is a godsend when itcomes time for a visit from the Joint Commission on the Accreditation ofHealthcare Organizations (JCAHO) or if you have a sterilization recall.
SPD employees scan all activities they perform including such tasks ascleaning, assembling instrument sets, running sterilizer loads, picking casecarts, delivering items, attending meetings or education sessions, etc. Reportscan be used to measure the productivity of the department for budgetary purposesor for individual employees, which can be used for the annual performancereviews. There is also the capability to run reports according to the areas ofactivity such as processing, decontamination or case carts, by the day of theweek or the time of day. This has proven very helpful for TCH when it comes tocreating the daily schedule.
Having the computerized bar code system has help tremendously withdepartmental orientation and training. With the use of a digital camera,pictures of instruments and equipment are loaded directly into the systemallowing employees to look up items they are not sure of. These pictures can behelpful in identifying individual items and how sets are assembled. The use ofbar codes results in consistency and uniformed standards. When technicians hadto write things down it often resulted in inaccuracies or inconsistency. Newemployees catch on to how things are done at TCH much quicker than before theimplementation of the barcode system. Individual orientation and educationalactivities can also be recorded and kept in the database. This can help theeducator monitor the activities and needs of individual employees.
QA reports are another function that has proven very valuable. When thesupervisor or manager is notified of an error, such as instruments missing for aset, it is entered into the database. This tool allows the manager to monitorthe accuracy of the department or individual. It has also proved to beinvaluable when comments are made such as "the sets are never put upcorrect." Instead of giving excuses for a few errors and focusing on thenegative, it is great to be able to show the positive with an accuracy rate of99.8%. Sharing this information with the staff is helpful when it come toquality improvement goals.
Optimizing Instrument Set Inventories
Reports provided by the information system allow the SPD staff to monitor theusage of each instrument set. This information can be used to justify purchasesof additional sets that are used frequently, resulting in decreasing the need todo stat turnarounds or to flash sterilize sets. It also helps in determiningthose sets that do not get used. Unused instruments can be put into the systemand used. There are reports that can do set comparison, which has proved helpfulto decrease the number of different sets. For instance, if two instrument setsare similar except for a few items, those items can be wrapped separately andthe hospital can get more productivity from each set. When a set is missing itis easy to look up where the set was last scanned. This helps to locate setsquickly; decreases frustration and time lost looking for sets, which helps toincrease surgeon satisfaction.
Cost-effective Decisions on Rental Equipment
Due to the ability to track, rental equipment is returned earlier, therebyreducing rental expenses. In one year, TCH reduced its equipment rental cost by$60,000 directly related to the ability to track and return equipment to therental company earlier. Before we had the ability to track each piece ofequipment, after use, items would often remain on the nursing units. They wouldsometimes be hoarded. Staff members recall three years ago when they could notget a piece of equipment, so the nursing units would just choose to keep ituntil they needed it for another patient. This often resulted in lost chargesthat decreased hospital revenues. Inability to track all equipment was not onlya problem for budget reasons, but also for infection control reasons. If thepiece of equipment remained on the floor, it meant that it was not sent to SPDand we could not be sure it was properly decontaminated before being used on thenext patient. Equipment usage reports can also help when it comes to ensuringthe proper amount of equipment is purchased, resulting in decreasing the need torent equipment.
Implementing a computerized sterile processing information system hasresulted in a more efficient, accurate, and cost conscious department. Thereports are powerful tools when it comes requesting more instruments, equipmentor FTEs. As TCH continues to find ways to use the information stored in thedatabase, the use of the system becomes infectious.
Rose Seavey, RN, MBA, CNOR, ACSP, is the director of central sterileprocessing at The Children's Hospital in Denver. She also is 2003president-elect to the American Society for Healthcare Central ServiceProfessionals (ASHCSP). The author acknowledges the assistance of GeorgetteKing, marketing manager for Materials Management Microsystems in Milwaukee, WI.
The National Institute for the Certification of Healthcare Sterile Processingand Distribution Personnel (NICHSPDP) announces a new certification category forsurgical instrument processors. The NICHSPDP exam for surgical instrumentprocessors will be offered for the first time on Oct. 19 at the American Societyfor Healthcare Central Service Professionals (ASHCSP)'s annual conference in SanAntonio, Texas. The exam will be administered on the same date at all testlocations worldwide.
The new exam was based on a job analysis survey of surgical instrumentprocessors last year. The job analysis survey received a 38% response rate thatincluded all national geographic areas and international locations. Centralservice, sterile processing, and OR directors were included in the analysis,which surveyed hospitals and clinics, surgery centers, VA, and militaryfacilities.
A study guide for the exam will be available by July 1, 2002. Candidatebulletins to register for the exam will also be available at that time. The feeis $115 for a five-year certification. Interested parties can call NICHSPDP at(800) 555-9765 and ask to be placed on the mailing list for the surgicalinstrument exam in October, or they can visit the NICHSPDP web site at www.sterileprocessing.org.