Marked improvement:
Surgical instrument tracking evolves into high-tech tool for process change
by Jeannie Akridge
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Cardinal Health IMPRESS
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O ne
day we’ll look back on the "old days"of Central Sterile and Sterile Processing.
Much like grandpa’s legendary ten-mile walk both ways in bare-feet in the snow
to school, seasoned veterans will tell tall — but terribly true — tales of
downtrodden colleagues who searched through piles and piles of records,
or searched high and low for hours on end for that one darned instrument
or tray.
But that was before
there were automated instrument management programs. That was before we could
scan, point and click our way to a highly-efficient, smooth-running CS/SPD
operation of the highest caliber.
Instrument tracking is
nothing new, but today’s instrument management programs provide deeper and
deeper levels of functionality and integration, with multiple layers of value
and big payoffs. From tracking trays, building sets and automating count sheets,
to instrument-level tracking with connectivity to sterilization equipment and
surgery suite scheduling programs – instrument management programs are giving
CS/SPD managers the tools they need to survive – and thrive – in an increasingly
more complex and automated world.
Clay Cannady, vice
president, sales, marketing and business development for Materials Management
Microsystems (Mequon, WI), describes the evolution of programs from "Instrument
Tracking" systems to what would be better described as "Sterile Processing
Management" tools. "Instrument assets are a key piece, but the importance of
machine and human processes are realized as increasingly important as well," he
said.
"When you look back ten
years ago, what used to frustrate people is the amount of time they would waste
looking for what they needed. But if you look at the environment in which our
clients operate today – issues of process design, staff training and proficiency
as a function of quality, and compliance with respect to AAMI – those are really
some of the major drivers for the use of these systems in departments today,"
said Cannady.
"With the majority of
cost components in SPD either fixed or pre-determined, process design, staff
proficiency and consistent quality are the primary means by which managers can
reduce costs and improve outcomes. This moves well beyond the traditional count
sheet and tray location tool," he added.
Companies like Materials
Management Microsystems, TGX Medical, STERIS, Cardinal Health, GETINGE, Rosebud
Solutions, Integrated Medical Systems (IMS), Lawson Software, just to name a
few, are responding to advanced sterile processing and inventory management
needs with approachable, tiered solutions that provide immediate payoff for even
the most basic applications but can grow as quickly as the facility or health
system demands. This new breed of sterile processing management software
solutions follow instruments from receipt in Decontam, through Prep and Pack, on
into Sterilization, Storage, Case Cart and back to the O.R. suite for use,
capturing critical data along the way. Even instrument vendors such as Olympus
are providing programs that allow facilities to proactively manage repairs and
maintenance.
Many of these systems
will integrate with manufacturers’ sterile processing machines either through a
direct connection with the machine, or through vendor "interface" programs.
Integration with sterilization equipment will be a godsend to the entire SPD. No
more writing out load logs, attaching sterilizer tapes, and manually capturing
BI results – such systems automatically record all reprocessing activity, and
provide alerts for workers with specific reprocessing instructions.
On yet another level,
some of them will direct-connect with O.R. management programs providing the
ultimate in productivity benefits. Integration with these scheduling and patient
management programs is a key distinguishing factor among surgical instrument
tracking programs.
"The question is, does
your software integrate into these other software systems that the hospital
might be using? That’s what really sets some of these programs apart," said Dan
Woodcock, sales representative for Key Surgical (Eden Prairie, MN).
"When STERIS set out to
develop an instrument management solution, we quickly found that a
one-size-fits-all offering wouldn’t work," said Mike Duckett, director of
strategic initiatives, SterilTek Inc., a wholly owned subsidiary of STERIS
Corporation (Mentor, OH). "So we looked at the solution from a tiered
perspective, knowing that some customers want to effectively manage their count
sheets and inventory and needed a training tool for new hires and complex trays,
but didn’t need tracking," said Duckett.
"Some customer scenarios
are more complex with more O.R.s, instrument trays and SPD technicians, so they
need a system that can track their trays, case carts and all of their mobile
equipment. Lastly, some customers’ needs for accountability extend into the area
of instrument-specific management. Their inventories are quite substantial and
valuable and they want the ability to manage instrument maintenance and recalls
down to the specific item," Duckett added.
Systems also allow
facilities to customize tracking needs for various applications.
"Lawson Surgical
Instrument Management (SIM) provides the flexibility for the customer to
determine, for each tray type, whether they want to track specific individual
instruments or just track the tray," said Marc Delurgio, supply chain product
manager, Lawson Software (St. Paul, MN). "Many customers have found that for
many tray types, there is just one particular instrument, such as a scope, that
they need to track individually. In this case, at the time of tray assembly the
scope’s unique identifier is scanned, but no scanning is required for the rest
of the items on the tray."
Productivity gains
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Rosebud Solutions Tray Controller |
A reduction in
labor-intensive searches for lost trays is just the beginning of what an
instrument tracking program can do for CS/SPD productivity and efficiency.
In fact, "once a
hospital decides to acquire a system, and uses a system, the individuals working
there wonder how they got their jobs done before the system," suggested Michael
Good, senior vice president, TGX Medical Systems (Carmel, IN).
Compounding the issue,
said Delurgio is that "often customers are asked to ‘do more with less,’ such as
pick up sterile processing services for a new surgi-center, but also trim
staff."
That’s where an
automated instrument management programs can be of particular help. For
starters, such programs can be a tremendous boost for training efforts and
quality control. From helping workers identify instruments to providing
processing instructions and enabling set building, instrument management
programs are driving improvements in quality of work – as well as helping to
bridge the gap between CS and O.R. departments. With touch screens and alerts to
guide technicians through reprocessing, instruments are more likely to be ready
on time and processed correctly, which will go a long way towards reducing
frustration between O.R. and CS staff.
"When the O.R. sees SPD
as a reliable and responsive supplier of critical items mutual respect and
cooperation are no longer pipe dreams," said Cannady.
"CS and O.R. want the
same thing but rarely work together to achieve it," said Good. "An instrument
tracking system makes everyone accountable. This is not to be used as a finger
pointing tool, but as a tool to take away the guess work," he emphasized.
Designed for users with
little or no computer experience, TGX Medical’s Alex Gold central service
management software has alerts related to the proper cleaning, assembly,
sterilization, storage and overall care and maintenance for a specific
instrument or tray. These are forced pop-ups that will be triggered upon the
item being scanned in the related department.
Tray Controller,
developed by Rosebud Solutions and distributed exclusively by Stryker
Corporation, includes Rosebud Alerts, automatic e-mail or pager alerts that can
be generated for any management-defined event. These alerts can be triggered
from scanners or workstations and sent to any number of pre-designated
recipients.
"Tray Controller uses a
combination of touch screen technology and wireless pocket PC scanners to reduce
the probability of human error, ensure real-time documentation and reduce the
time required to complete each task," said Alicia Torres, president and CEO,
Rosebud Solutions (Ann Arbor, MI). "Touch screen technology increases the speed
and accuracy of the packing process. Technicians simply touch the screen to
document the contents of a tray. In addition, productivity reporting allows
managers to identify staff members who may need further training on a specific
task," she said.
"Proactive prompts,
alerts and an array of reports to arm sterile processing department management
with the tools they need to establish an efficient workflow," Torres continued.
"Tray Controller does not change the workflow process; it simply make the
process more efficient, accurate and easier to manage. We customize the format
of the count sheets to match the hospital’s current or preferred format and
train all users on site."
Tray Controller also
allows technicians to click onto short training videos that demonstrate the
various steps of the process or view pictures of specific instruments or trays.
Cardinal Health updated
its IMPRESS instrument management program last year so that it is now a
web-based hosted application that utilizes simple, visual prompts, tracks all
sterilization loads and includes an enhanced assembly module that provides the
capability to perform on-line assembly of surgical sets with additional quality
checks.
"IMPRESS improves the
communication lines between the O.R. and CS because the system holds people
accountable for their work and, whether you are a technician assembling a set or
an O.R. nurse scanning a case cart into the O.R. IMPRESS keeps track of each
transaction and provides visibility to historical transactions," said Flavio
Marin, senior manager, V. Mueller, Cardinal Health (Dublin, OH).
"These systems include
an element of change management to proactively keep the count sheets accurate,"
said Duckett. "When the SPD techs scan a tray they’re assured that what comes up
on their screen is the most recent and accurate version of the count sheet. When
they assemble the tray, they know that it’s meeting the expectations of their
biggest customer, the O.R."
"The natural result of
these improvements is an improved relationship between the O.R. and the SPD.
Conflict resolution is also assured because the objective data provided by the
instrument management system can help resolve conflicts based on facts and
without any harmful finger-pointing," he said.
Integration with surgery
scheduling software can also help change the SPD from a reactionary to a
proactive department, taking efficiency to new levels and allowing the SPD to
actually plan ahead versus simply responding to trays as they show up at the
door.
Cannady explained: "If
you’re really going to manage your inventory and capacity, you’ve got to use
your resources to build trays according to user demand. That’s a totally
different concept. Now the sterile processing department can take orders and
fill orders, they don’t just take what comes in the door. And the way that we do
that is we have a bi-directional interface with the surgery scheduling system,"
he said of Materials Management Microsystems’ Sterile Processing Microsystem (SPM).
"Our system will take
the demands from the preference card from the surgery scheduling program and
conflict-check against the actual inventory levels. What it allows you to do is
gear the consumption of your resources around the demand – to take all of those
exceptional, expedited scenarios and have a dedicated process for dealing with
them and for allowing the manager of the department to know where they stand at
any given time in terms of the work that is being done relative to the demand
which is dictating the priority of that work and how it gets done." SPM alerts
can be targeted or global such as "set expedite requests" from the O.R. or
staff-specific notifcation, said Cannady.
"The sterile processing
department can proactively prioritize trays, based on the upcoming needs of the
O.R.," said Rosebud’s Torres. "This is accomplished through an interface between
Tray Controller and the surgery scheduling software."
Getinge’s T-DOC (Total
Documentation) productivity management system tracks instrument location along
with processing and maintenance status, for example, whether the instrument is
sharp, or the batteries need changing. T-DOC integrates in real-time with
washer-disinfectors and sterilizers archiving data for future reference.
Integrated Medical
Systems (IMS) uses its instrumentReady platform of teams, processes, services,
technology and infrastructure to help healthcare facilities ensure that
instruments are ready when the surgical team is ready. With origins as an
instrument maintenance and repair company, IMS now offers ReadyTracker - Tray
and ReadyTracker - Tissue, web-based software programs that use bar-code
technology to track instrument trays and/or implants and support staff training
and education through electronic count sheets and digital instrument images.
The Milestone process
from IMS helps maximize instrument performance through education, proactive
maintenance, and trend analysis. A more comprehensive approach is available with
IMS on-location surgical endoscopy solutions and central sterile process
management and coaching, designed to help strengthen the bridge between CS and
O.R. According to IMS, having instruments ready on time can help facilities
increase the number of surgical cases that can be performed in a day – which can
quickly help to pad the bottom line. The company estimates that one additional
procedure per day can generate $4 - $7 million of revenue in an average sized
facility (i.e., 250 beds) in one year.
TGX Medical’s Alex Gold
The patient safety advantage
Even if there were no
financial or productivity benefits to be had, there’s still one extremely
important reason to consider instrument-level tracking – and that’s patient
safety.
The ability to link
instruments directly to the patient they were used on is a critical aspect of
instrument management that will be needed for JCAHO audits or in recall
situations.
For example, when a
facility finds a case of Creutzfeldt-Jakob disease (CJD) and they have to
contact everyone who might have been exposed to those instruments, "it could
mean the difference between contacting 1,000 people or contacting ten people if
you can directly trace back which patients those surgical instruments were used
on," said Woodcock.
"Instrument management
systems are very effective when it comes to improving patient safety," confirmed
Duckett. For example, "it’s alarming to see the number of loaner/vendor and
short inventory trays that are flash-sterilized each day. A good information
management system can help the SPD proactively manage loaners and quick-turn
items by applying an interface to the hospital’s O.R. scheduling system. The
STERIS IMS system has the ability to receive information from the O.R. schedule
and prioritize the SPD work flow. Everyone using the system is alerted when
trays are needed, based on their need throughout the day. This function reduces
the dependency on flash sterilization, which in turn improves patient safety."
"A sterile processing
management system has implications on not only the operational efficiency, but
the sterile processing function also has a significant impact on infection
control, patient liability and risk management. And that’s huge," said Cannady.
"With visibility into
the history of an instrument and warning when users scan a tray to an incorrect
sterilization type, Lawson Surgical Instrument Management can help prevent
patient safety problems, and provide information that can be used to improve
safety for future patients in the event of an infection control incident. With
this level of information, as well as the ability to quickly find trays and
instruments in the event of an emergency, service to the O.R. can be
substantially improved," said Delurgio.
For a low-tech,
low-cost, easy-to-implement aid for tying sterilized items directly to the
patient they were used on, SPSmedical provides the Patient Record Card. Simply
tape a card to the outside of every package and apply a lot control sticker to
the card. The O.R. then separates it at the perforation and places the card on
the patient’s chart. This is an economical means of complying with AAMI ST79
regarding traceability of all items used in a procedure.
Inventory aids
A key functionality of
many automated instrument management programs is the ability to generate
utilization reports that can ultimately lead to a reduction in unnecessary
surgical instrument inventory, among other benefits.
"Utilization reports
allow the hospitals to quantify exactly how many trays and instruments they
actually need, and what they don’t need," said Rosebud’s Torres. "These reports
can be generated quickly and can be sorted by user defined parameters. Examples
of these parameters include tray type, department, owner, time frame, etc.
Excess trays can be broken down and the instruments redeployed. Conversely, when
more trays and instruments are needed, it can be quantified. This ultimately
leads to more effective capital deployment," said Torres.
Keeping track of repairs
and maintenance is yet another benefit of an automated instrument management
program that can lead to cost savings.
"We work with clients to
move from time-based refurbishment/repair to a schedule tied directly to the
utilization rates of the specific device or instrument set," said Cannady. "This
will ensure the client is spending money on the items that need it when it is
needed. Not only does this optimize repair budgets but eliminates premature
sharpening that can shorten the useful lifespan of instrumentation.
Additionally, the ability to document repair work and expense to the specific
asset increases the accountability on users for proper use and care."
"When you only track to
the tray level, you interpret that everything that happens to that tray is
happening to every instrument," explained Woodcock. "For example, if you’re
tracking a certain tray you could have it flagged so that every 10 or 20 uses
you need to pull the set for servicing sharpening, repair, etc. In any given
set, you might only use 60 to 70 percent of those instruments, on any given
procedure. If you can actually track individual items, you know which of those
instruments really need to have servicing and which ones are just getting passed
through without being used every time. You can really save money on repair and
refurbishing costs."
Good relates an example
of a facility that was able to cut yearly repair expenses by $80,000 using TGX
Medical’s Alex Gold Central Service Management program. "One of our facilities
was spending over $120,000 a year on repairs. With Alex Gold and its repair
module they were able to identify that most of that money was being spent on
Linvatec Reciprocating Saws.
"Using Alex Gold, they
identified that the saws were being damaged on Tuesday and Thursday cases. The
manager observed the surgeons that were using the drill and noticed that in
order to achieve the power and speed the surgeon wanted the PSI would be cranked
to over 90psi. The drill could only handle 40 psi. By simply providing this
surgeon with an electric alternate, they have cut the repair budget from
$120,000 a year to $40,000 a year," said Good.
To help its customers
track repairs, Olympus has developed a 24/7-service portal. The repair and
service tool allows customers to electronically submit service orders and track
instruments in real-time through the Olympus Service Network.
"With an established
account and password, customers can securely submit and approve orders, access
repair history and pinpoint where a device is in the repair process. Beyond
repairs, the service portal gives Olympus customers enhanced inventory and
purchasing visibility," said Alec Weiss, product manager with Olympus.
"I believe that the
opportunity to have greater visibility of the repair status of a product can
greatly benefit our customers in scheduling procedures, as well as in balancing
workloads. Furthermore, our customers will have the ability to submit and
approve repairs via the service portal, and in this way minimize the repair
downtime of their products," said Eddie Garces, vice president, Olympus Medical
Equipment Services America.
The Olympus Repair
module includes value-added customer features and services like reporting
mechanisms, details regarding customer Olympus assets including model, serial
number, purchase date, real-time service contract information such as
consumption and balance, and any repairs performed in the past 120 days. "These
additional features as well as those already contained in the service portal,
will provide our customers the opportunity to more efficiently manage the
tracking of repairs, repair cost, trends, etc. Knowing and understanding this
information will enable customers to maximize the efficiencies and performance
of their assets. Olympus customer solutions representatives can be contacted to
get repair histories longer than 120 days for the life of the product," said
Joel Munar, senior manager, Olympus.
Rapid ROIs
The really good news for
any department needing to take the plunge and implement an automated instrument
management program is that many companies are now offering guaranteed results.
Some are so certain of their program’s ability to save facilities money, that
they’re sticking their necks out and offering a guaranteed Return on Investment.
"It is critical that
senior management be able to justify the capital dollars for an instrument
management system for their SPD. To help them, we’ve created a tool that shows
how this technology will pay for itself in a relatively short period of time,"
said Duckett. "A healthcare system’s biggest short-term gains are going to come
from two areas; staff productivity and instrument repair and procurement
savings," he adds.
Materials Management
Microsystems provides clients with a guaranteed ROI equal to the customers’
investment in the system, typically within 12 months, explained Cannady. ROI for
the SPM program is predicated on productivity, quality, the benefits of going to
utilization based repair schedules, and AAMI documentation and compliance.
"Those are the four primary areas where we will use our financial model to
project savings," said Cannady.
TGX Medical Systems
guarantees any new client that they will receive a full ROI from their Alex Gold
system within 24 months. "Efficiencies are gained throughout the lifecycle
process," said Good. These include reduced repair and maintenance dollars,
increase in productivity, proper instrument utilization, an increase in
communication, decreased down time in O.R., proper cleaning instructions that
allow instrumentation to be better maintained adding to the life of the
particular item.
Rosebud Solutions claims
ROI results for its TrayController solution of up to 57 percent increased
productivity in preparing trays at the packing station; up to a 95 percent
increased productivity at the sterilization area; a reduction in SPD time
responding to calls and inquiries by nearly 5 hours per day; up to a 140 percent
reduction in time required for new hire orientation and training; a projected
5-8 percent reduction in annual expenditures for surgical instruments.
Marking methods
Whatever the
functionality of your instrument management program, it all starts with marking
the instruments or trays for tracking. This can be in the form of a barcode
that’s permanent laser-etched directly on to the instrument, called Direct Parts
Marking, or, another option is a tiny label containing a barcode that’s affixed
to the instrument.
Key Surgical provides an
alternative to laser etching with its KeyDot (previously called InfoDot). Sold
in sheets of 100, KeyDot is meant to be an easy, efficient, and economical
solution for facilities to quickly implement individual instrument tracking
in-house. KeyDots each have a unique barcode number associated with them.
Scanning the dot, with its data matrix bar code links that instrument to a
datafile within the tracking software system. KeyDot is made from a durable
material that can last through multiple sterilization process cycles. This year,
Key Surgical has introduced a warranty that guarantees the KeyDot to last two
years or 200 cycles, whichever comes first, said Woodcock.
When it comes to asset
tracking there are both radio-frequency identification (RFID) and barcode
specific applications. Currently, instrument-level tracking requires the use of
barcode technology which is scanned by a technician at specified check points.
RFID on the other hand uses strategically placed readers that automatically
register items as they pass through. RFID eliminates the human factor error
associated with manual scans, and can track assets as they move from room to
room, but it can’t trace to the level of detail required within the SPD itself.
"RFID will greatly
improve efficiency and will be able to account for instruments that move quickly
in emergency situations and are not always scanned in today’s barcoded
environment. However, RFID technology needs to progress from a reliability and
cost perspective before customers will rely on it for their instrument tracking
needs," said Lawson’s Delurgio. "Lawson has investigated RFID technology for
instrument tracking, but Lawson will not directly support RFID in Lawson
Surgical Instrument Management until the technology is more reliable in a
sterile processing environment and less expensive to implement."
"The problem with RFID
in tracking individual instruments is that most instruments are stainless steel
(metal) and they’re usually contained within metal trays on a metal case cart on
wheels, for example," explained Woodcock. "The idea behind RFID would be that
you wouldn’t have to actually scan an instrument; as soon as that instrument
went through a portal it would just pick up the RFID signal and register where
that item is. When you have metal instruments inside metal trays, that really
interferes with the signal. That’s one obstacle with RFID for individual
surgical instrument tracking at this point."
Cannady says Materials
Management Microsystems envisions a symbiotic environment where RFID and
barcoding work in tandem to provide the ultimate instrument tracking method.
"RFID has, in our view
of the world, sort of limited value within the department where we deal with so
many SPD function-specific activities and requirements. But where it becomes
pretty powerful is when you create the handshake so that items going to sterile
storage, case carts, O.R. suite, etc. are tracked via the RFID system, and then
we take ownership and control back from the RFID system at the point of Decontam."
"While the asset is in
the SPD it rightly belongs with a system that brings all of those human touch
points and machine touch points and asset management capabilities together so
that you have that full-traceabilty documentation trail. But once the instrument
is sterile and ready to be issued for use, if the RFID system is capable, that’s
clearly the efficient answer because…all of that manual scanning goes away,"
said Cannady.
With its wireless
real-time location system (RTLS) called SPOT, InnerWireless provides the ability
to track assets as they move throughout a facility. While they’re currently able
to tag and trace to the tray level, the company is investigating the use of
technology to track down to the instrument level.
InnerWireless uses a
software program, completely sealed ridge-free tags, and beacons that reads the
tag as they move throughout the enterprise then sends those signals to the asset
location engine, SPOT. SPOT will then tell the end-user where that asset is
within the enterprise through a set of maps and GPS-type functions. Alerts can
be provided if a product is moving into a location that it shouldn’t go into or
out of.
"What we have been asked
to supply, and what our customers have been talking about using SPOT for is to
tag that whole tray, not at the instrument level but whole tray itself, and so
when that tray leaves CS or a request comes down for that tray from the O.R.,
then they can track that tray as it moves throughout the hospital up to the O.R.
suite and now they have kind of a closed-end process. Yes the Dr. requested the
tray, it was the right tray, and it did leave CS at this time, we tracked it
throughout the floor, and it arrived into the O.R. suite at "X" time. So that
there is a complete history of what happened to that tray as it left CS and
wound up in the O.R. suite," said Chris Click, vice president, marketing,
InnerWireless.
STERIS’ Duckett suggests
that the industry address the possibility of a uniform marking system applied at
the time of manufacture. "A simple serial number is all that’s needed. A uniform
system has many advantages. For example, by simply scanning the instrument, the
tech could pull up assembly instructions, decontamination instructions,
sterilization parameters, purchasing history, reprocessing history, maintenance
requirements and more.
"Think about the
ramifications of trying to recall instruments used for a CJD case. By having a
unique serial number on each instrument, we would be able to know instantly
where, when and how every instrument was used. The future is very exciting for
this technology. We envision taking information management systems into the O.R.
and out onto the patient floors with the objective of proactively managing the
entire instrument process and providing training tools to the end users wherever
possible."
No doubt, instrument
management programs will continue to expand its capabilities as more facilities
realize the need and the potential opportunities.
"We are constantly
presenting to healthcare facilities, and attend almost every national show and
have yet to come across an individual or facility that does not have a need for
instrument tracking," said Good.
For those facilities
that are just "getting their feet wet" with a surgical instrument management
program and what to start with a simple count sheet program, Cannady advises,
"That’s fine. Just make sure the runway is long enough for the next size plane
that you want to fly."
"The greatest success
comes from clients that use all of the system, and pull reports that help them
model the department like a business. The facility will benefit greatly if it
has by-in from all of the stakeholders; this includes O.R., IT, CS and upper
management," said Good. "Instrument Tracking empowers individuals with
information and knowledge of what is truly going on in their world. Once
implemented you have the ability to know when and where you need your staff to
be the most efficient and productive."
|
Key Surgical’s KeyDot |
"The question is, does your software integrate into these other
software systems that the hospital might be using? That’s what really sets some
of these programs apart," said Dan Woodcock, sales representative for Key
Surgical, Eden Prairie, MN.
"When STERIS set out to develop an instrument management
solution, we quickly found that a one-size-fits-all offering wouldn’t work,"
said Mike Duckett, director of strategic initiatives for SterilTek Inc., a
wholly owned subsidiary of STERIS Corp, Mentor, OH. "So we looked at the
solution from a tiered perspective, knowing that some customers want to
effectively manage their count sheets and inventory and needed a training tool
for new hires and complex trays, but didn’t need tracking. Some customer
scenarios are more complex with more ORs, instrument trays and SPD technicians,
so they need a system that can track their trays, case carts and all of their
mobile equipment. Lastly, some customers’ needs for accountability extend into
the area of instrument-specific management. Their inventories are quite
substantial and valuable and they want the ability to manage instrument
maintenance and recalls down to the specific item."
Systems also allow facilities to customize tracking needs for
various applications. "Lawson Surgical Instrument Management (SIM) provides the
flexibility for the customer to determine, for each tray type, whether they want
to track specific individual instruments or just track the tray," said Marc
Delurgio, supply chain product manager, Lawson Software, St. Paul, MN.
Productivity gains
|
STERIS instrument management software uses a
laser-bonded marking process |
A reduction in labor-intensive searches for lost trays is just
the beginning of what an instrument tracking program can do for CS/SPD
productivity and efficiency.
In fact, "once a hospital decides to acquire a system, and uses
a system, the individuals working there wonder how they got their jobs done
before the system," said Michael Good, senior vice president, TGX Medical
Systems, Carmel, IN.
For starters, such
programs can be a tremendous boost for training efforts and quality control.
From helping workers identify instruments to providing processing instructions
and enabling set building, instrument management programs are driving
improvements in quality of work. With touch screens and alerts to guide
technicians, instruments are more likely to be ready on time and processed
correctly
"When the OR sees SPD as a reliable and responsive supplier of
critical items mutual respect and cooperation are no longer pipe dreams," said
Cannady.
"CS and OR want the same thing but rarely work together to
achieve it," said Good. "An instrument tracking system makes everyone
accountable. This is not to be used as a finger pointing tool, but as a tool to
take away the guess work."
Designed for users with little or no computer experience, TGX
Medical’s Alex Gold software has forced pop-up alerts related to the proper
cleaning, assembly, sterilization, storage and overall care and maintenance for
a specific instrument or tray, that are triggered when an item is scanned in the
related department.
Tray Controller, developed by Rosebud Solutions and distributed
by Stryker Corp., offers Rosebud Alerts, automatic e-mail or pager alerts that
can be generated for any management-defined event, triggered from scanners or
workstations and sent to pre-designated recipients.
"Tray Controller uses a combination of touch screen technology
and wireless pocket PC scanners to reduce the probability of human error, ensure
real-time documentation and reduce the time required to complete each task,"
said Alicia Torres, president and CEO, Rosebud Solutions, Ann Arbor, MI. "Touch
screen technology increases the speed and accuracy of the packing process.
Technicians simply touch the screen to document the contents of a tray. In
addition, productivity reporting allows managers to identify staff members who
may need further training on a specific task."
"Proactive prompts, alerts and an array of reports arm sterile
processing department management with the tools they need to establish an
efficient workflow," she continued. "Tray Controller does not change the
workflow process; it simply make the process more efficient, accurate and easier
to manage."
Cardinal Health updated its IMPRESS instrument management
program last year so that it is now a web-based hosted application that utilizes
simple, visual prompts, tracks sterilization loads and includes an enhanced
assembly module that provides the capability to perform on-line assembly of
surgical sets with additional quality checks.
"IMPRESS improves the communication lines between the OR and CS
because the system holds people accountable for their work and, whether you are
a technician assembling a set or an OR nurse scanning a case cart into the OR,
IMPRESS keeps track of each transaction and provides visibility to historical
transactions," said Flavio Marin, senior manager, V. Mueller, Cardinal Health,
Dublin, OH.
"When the SPD techs scan a tray they’re assured that what comes
up on their screen is the most recent and accurate version of the count sheet.
When they assemble the tray, they know that it’s meeting the expectations of
their biggest customer, the OR," said Duckett.
Integration with surgery scheduling software can also help
change the SPD from a reactionary to a proactive department, taking efficiency
to new levels.
"If you’re really going to manage your inventory and capacity,
you’ve got to use your resources to build trays according to user demand. That’s
a totally different concept. Now the SPD can take orders and fill orders, they
don’t just take what comes in the door. The way that we do that is we have a
bi-directional interface with the surgery scheduling system," Cannady said of
the Sterile Processing Microsystem (SPM).
"Our system will take the demands from the preference card from
the surgery scheduling program and conflict-check against the actual inventory
levels. What it allows you to do is gear the consumption of your resources
around the demand – to take all of those exceptional, expedited scenarios and
have a dedicated process for dealing with them and for allowing the manager of
the department to know where they stand at any given time in terms of the work
that is being done relative to the demand, which is dictating the priority of
that work and how it gets done." SPM alerts can be targeted or global such as
"set expedite requests" from the OR or staff-specific notifcation.
"The sterile processing department can proactively prioritize
trays, based on the upcoming needs of the OR," said Torres of Tray Controller’s
interface with surgery scheduling software.
Getinge’s T-DOC (Total Documentation) productivity management
system tracks instrument location, processing and maintenance status, for
example, whether the instrument is sharp, or batteries need changing. T-DOC
integrates in real-time with washer-disinfectors and sterilizers.
IMS (Integrated Medical Systems International) uses its
InstrumentReady platform of people, teams, processes, services, technology and
infrastructure to help facilities ensure that instruments are ready when the
surgical team is ready to operate. One way IMS helps facilities is through its
ReadyTracker Software Suite. The instrument-set tracking software solution
within this suite is called ReadyTracker-Tray. Using bar code technology, this
web-based software tracks instrument trays, maximizes tray performance, and
supports staff training and education.
Also, the Milestone process from IMS helps to maximize
instrument performance through education, Proactive Maintenance, and trend
analysis. A more comprehensive approach is available with IMS’ on-location
Surgical Endoscopy Solutions and Central Sterile Process Management and
coaching, designed to help strengthen the bridge between CS and OR. According to
IMS, having instruments ready on time can help facilities increase the number of
surgical cases that can be performed in a day, which should, in turn, increase
revenue. The company cites a study that estimates one additional procedure per
day can generate $4 - $7 million of revenue in an average sized facility (i.e.,
250 beds) in one year.1
Patient safety
Linking instruments directly to the patient they were used on
via instrument-level tracking will be critical for JCAHO audits or recalls.
For example, if a facility finds a case of CJD, "it could mean
the difference between contacting 1,000 people or contacting ten people if you
can directly trace back which patients those surgical instruments were used on,"
said Woodcock.
Key Surgical provides one of several individual instrument
identifier methods, with its barcoded KeyDot (formerly Info-Dot). Sold in sheets
of 100, KeyDot is meant to be an easy, efficient, and economical solution for
facilities to quickly implement individual instrument tracking in-house.
Key-Dots each have a unique barcode number associated with them. Scanning the
dot, with its data matrix bar code, links that instrument to a datafile within
the tracking software system. KeyDot is made from a durable material that can
last through multiple sterilization process cycles. This year, Key Surgical has
introduced a warranty that guarantees the KeyDot to last two years or 200
cycles, whichever comes first.
Duckett explains another patient safety advantage of STERIS’
(Instrument Management Solution) IMS: "It’s alarming to see the number of
loaner/vendor and short inventory trays that are flash-sterilized each day. A
good IMS system can help the SPD proactively manage loaners and quick-turn items
by applying an interface to the hospital’s OR scheduling system. The STERIS IMS
system has the ability to receive information from the OR schedule and
prioritize the SPD work flow. Everyone using the system is alerted when trays
are needed, based on their need throughout the day. This function reduces the
dependency on flash sterilization, which in turn improves patient safety."
Inventory control
Utilization reports generated by instrument management programs
can lead to a reduction in unnecessary surgical instrument inventory, among
other benefits. "Utilization reports can be generated quickly and can be sorted
by user defined parameters," said Rosebud’s Torres. "Excess trays can be broken
down and the instruments redeployed. Conversely, when more trays and instruments
are needed, it can be quantified. This ultimately leads to more effective
capital deployment."
Keeping track of repairs and maintenance is another benefit. "We
work with clients to move from time-based refurbishment/repair to a schedule
tied directly to the utilization rates of the specific device or instrument
set," said Cannady. "This will ensure the client is spending money on the items
that need it when it is needed. Not only does this optimize repair budgets but
eliminates premature sharpening that can shorten the useful lifespan of
instrumentation. Additionally, the ability to document repair work and expense
to the specific asset increases the accountability on users for proper use and
care."
"When you only track to the tray level, you interpret that
everything that happens to that tray is happening to every instrument,"
explained Woodcock. "For example, if you’re tracking a certain tray you could
have it flagged so that every 10 or 20 uses you need to pull the set for
servicing - sharpening, repair, etc. In any given set, you might only use 60 to
70% of those instruments, on any given procedure. If you can actually track
individual items, you know which of those instruments really need to have
servicing and which ones are just getting passed through without being used
every time. You can really save money on repair and refurbishing costs."
Photos courtesy of Microsystems
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Hand Held Products 6300 reads
laser-applied direct parts mark
deemed safe & effective for instruments
and implants by FDA. |
Good relates an example of a facility that was able to
drastically cut repair expenses using TGX Medical’s Alex Gold. "One of our
facilities was spending over $120,000 a year on repairs. With Alex Gold and its
repair module they were able to identify that most of that money was being spent
on Linvatec Reciprocating Saws, and they identified that the saws were being
damaged on Tuesday and Thursday cases. The manager observed the surgeons that
were using the drill and noticed that in order to achieve the power and speed
the surgeon wanted the PSI would be cranked to over 90psi. The drill could only
handle 40 psi. By simply providing this surgeon with an electric alternate, they
have cut the repair budget from $120,000 a year to $40,000 a year," said Good.
Lawson SIM integrates with the Lawson Procurement application
for better item standardization and cost analytics.
To help its customers track repairs, Olympus has developed a
24/7-service portal. The repair and service tool allows customers to
electronically submit service orders and track instruments in real-time through
the Olympus service network.
"With an established account and password, customers can
securely submit and approve orders, access repair history and pinpoint where a
device is in the repair process," said Alec Weiss, Olympus product manager. The
Olympus service portal provides customers with reporting mechanisms; details
regarding Olympus assets (model, serial#, purchase date); real-time service
contract information (consumption & balance) and repair history.
"I believe that the opportunity to have greater visibility of
the repair status of a product can greatly benefit our customers in scheduling
procedures, as well as in balancing workloads. Furthermore, our customers will
have the ability to submit and approve repairs via the service portal, and in
this way minimize the repair downtime of their products," said Eddie Garces,
vice president, Olympus Medical Equipment Services America.
No doubt use of instrument management programs will
continue to expand as more facilities realize the opportunities. Some companies
such as Microsystems and TGX Medical offer a guaranteed Return on Investment (ROI),
based on efficiencies gained through productivity, reduced repair and
maintenance costs, quality and compliance among other benefits. Rosebud
Solutions claims ROI results for its TrayController solution of up to 95%
increased productivity at the sterilization area; 5-hr. per day reduction in SPD
time responding to calls and inquiries; and up to 140% reduction in new-hire
orientation and training time.
"The greatest success comes from clients that use all of the
system, and pull reports that help them model the department like a business,"
said Good.
For those facilities that are just "getting their feet wet" with
a surgical instrument management program and what to start with a simple count
sheet program, Cannady advises, "That’s fine. Just make sure the runway is long
enough for the next size plane that you want to fly."
REFERENCE
1. Bragg, Krista, RN, MSN, CRNA, VanBalen, Nancy, RN, and Cook,
Nathaniel. "Home Study Program: Future Trends in Minimally Invasive Surgery."
AORN Journal. Dec. 2005; 82(6): 1006-1018.
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