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Instrument tracking solutions offer
far-reaching benefits

To be clear, that’s not to say that locating an instrument, tray or cart’s whereabouts is neither beneficial nor a solid reason to embrace the technology. The difference between today’s thoughts surrounding instrument tracking and that of years past, however, is that the value of a tracking solution lies in its ability to stretch the boundary of benefits.

"It may be known as instrument tracking, but it’s so much more than that. It really is a Central Service management tool that can help manage all steps of the process – from staffing and instrument repairs and replacements to decontamination, sterilization, and other aspects of the instrument management process," said Michael Mancebo, CRCST, director of sales, TGX Medical Systems LLC, Carmel, IN.

As a former CS manager of 12 years and one who actively embraced instrument tracking during his tenure at Richmond, IN-based Reid Hospital (incidentally, under Mancebo’s direction, the department was awarded the 2005 CS/SPD Department of the Year Award), Mancebo certainly speaks from experience.

"When you think about it, instrument tracking is really the least of the issues facing CS. It’s less about the instruments themselves and more about what staff is doing with those instruments that matter most. That’s why the solutions they [adopt] need to offer so much more."

Indeed, they are. More than ever, vendors are pushing the limits of their instrument tracking capabilities – offering a far greater degree of functionality and integration, and a greater degree of flexibility and scalability that essentially offers a "sky’s the limit" approach to supporting the management of the entire sterile processing function.

The apparent shift away from individual count sheet management and tray tracking products and more toward a comprehensive information system has perpetuated the fundamental expectation of system integration with other applications in the facility, according to Clay Cannady, vice president of sales, marketing and business development for Materials Management Microsystems, Mequon, WI.

Along with that, Cannady explained, came "the need to satisfy the networking, security and stability, and support expectations from the sophisticated IT function hospitals rely on."

Enhanced system capabilities have also brought about a stronger focus in areas that were previously difficult to quantify, such as the complexity of missing instrumentation and the difficulty of managing loaner equipment, added Hana Scheichenost, T-DOC product manager, Getinge Infection Control, Getinge USA, Rochester, NY.

More specifically, she explained that the comprehensive CS management solution process "starts with a patient’s arrival to the preparation and processing of instruments, complex materials management, the operation itself, and lastly, to the patient’s departure. Having a high level of consolidated and accurate information at each stage is crucial to ensure patient safety." Getinge’s T-DOC Asset Management Systems can track instrumentation in real time throughout the processing cycle and even to the patient while also managing real-time sterile and non-sterile inventory, providing real-time sterilization and washing documentation, helping identify and manage instrumentation, capture accurate production costs, and provide real-time reporting statistics.

Cardinal Health IMPRESS

While, certainly, not every facility is currently embracing automated instrument tracking/CS information management solutions, there’s no question that the technology is becoming more mainstream and more widely accepted as an integral tool for success.

"Over time, the awareness of tracking and the number of facilities looking at adopting it has increased," confirmed Dan Woodcock, a sales representative for Eden Prairie, MN-based Key Surgical.

Cardinal Health reports that while approximately ten to 15 percent of U.S. acute care hospitals currently have instrument management systems in place an additional 30 percent are planning on investing in such systems in coming years.

Some credit that growth to a more educated healthcare community and the desire to better manage costly assets, the mounting concern over the potential for spreading Creutzfeldt-Jakob Disease and other diseases to patients via contaminated instruments, and less cost-prohibitive tracking technology.

That’s especially apparent with tracking to the individual instrument level. Hospitals that may have wanted to perform unit-based tracking were often hamstrung by costly scanners and technology that couldn’t adapt to every type of instrument in their inventory.

"The biggest leap [in the instrument tracking] process is the ability to track at the instrument level," confirmed Whitney Ligon, director of corporate software for Integrated Medical Systems International Inc. (IMS), Birmingham, AL, adding that technology now allows everything from a GPS-type system to an infrared "dot" system that allows the SPD to put together trays by scanning instruments. "This technology, when used appropriately, also allows instruments to be tracked and retrieved in the instance that they are accidentally discarded at any point in the usage cycle."

Despite the benefits, the vast majority of healthcare organizations aren’t tracking to this detailed level – at least not across the board. Upon taking a closer look at the process, the reasons become clearer. Even vendors and CS professionals who tout the benefits of instrument tracking acknowledge that doing so presents some challenges. For starters, it’s time-consuming and labor-intensive, which can, in some cases, decrease productivity and increase the burden of responsibility for already time- and resource-constrained CS
departments.

"While the ability to track individual instruments provides many benefits, including exact knowledge of item usage, item maintenance and doctor preference for particular items, if the system is not easy to use, its chances of being misused or not used at all increase significantly," stressed Ligon.

That in itself could explain why some CS departments haven’t rallied behind automated instrument tracking solutions. Many, having repeatedly heard about the need to track to this detailed level, were scared off by the implementation challenges – with the solution, in some cases, being to simply stick with the processes they had grown accustomed to, however inefficient they may have been.

If instrument tracking is a process that has continued to elude – or even scare off — CS departments, perhaps it’s time they take a closer look.

With the average U.S. hospital having surgical instrumentation inventories in the $2-4 million range and groups such as The Joint Commission and Association for the Advancement of Medical Instrumentation advocating the adoption and implementation of instrument tracking, it’s becoming increasingly important for facilities to protect their inventory investment — and reputation — and most importantly, the patients on the receiving end of the devices.

What CS staff should realize is that they don’t have to tackle unit-based tracking right out of the gate. In fact, even vendors that initially built their business around individual instrument tracking capabilities are now beginning to soften their stance – encouraging end users to start slowly before pushing their capabilities to that more detailed level.

"The fact is not every hospital wants to track individual instruments, and even if they do, that doesn’t mean they’re going to be prepared to tackle that right from the start," acknowledged Jim Creason, senior vice president of business development for Censis Technologies Inc., Franklin, TN. "One of the biggest hurdles at getting instrument level functionality is the perception that you have to do it all at once. You don’t."

Lawson’s SIM instrument tracking

Although Creason – and a number of other vendor executives and industry experts – still see tremendous value in tracking to that instrument level, there’s a growing consensus that hospitals should start slowly, doing so by partnering with a vendor that offers flexible, scalable solutions that can allow facilities to expand their instrument management capabilities as they see fit.

"We try and encourage customers to evolve. Basically, that means learning to crawl and walk before attempting to run with the process," explained Creason.

Facilities in the market for automated instrument management solutions should first have a solid understanding of what it is they hope to accomplish. Prospective vendor partners should play an integral role in helping hospitals weigh their options and understand the pros and cons of each level of functionality.

"Our experience indicates the need for a detailed and thoughtful conversation with the client on specific objectives and requirements," added Cannady. "This will ensure the inherent tradeoffs between control and flexibility are clearly understood." An appropriate balance can be found for any facility, he assured, but it must be understood on the front end to prevent frustration later on. Additionally, it is essential that requirements for proper database build be understood as well. "Anything else seems to guarantee problems later on."

While the early implementation phase will vary from facility to facility – after all, automated instrument tracking isn’t one-size-fits-all and different organizations are better poised to adopt higher-level functionality – at the most basic level, facilities may want to consider embracing an electronic count sheet capability.

"It’s a pretty simple concept and a good place to start," Creason explained, adding that the key benefit lies in having a central repository that automatically updates and manages all changes to the count sheet. A database of instrument and tray assembly photos is also available at that entry-point level. "From there, customers can then build their level of functionality to meet their changing needs in the future."

Tray tracking is what some consider a middle-of-the-road approach to automated instrument management. Such a solution can help ensure that the right instruments were packed in the right trays, while also improving staff productivity and allowing staff to pinpoint a tray’s location in the facility via real-time tracking capabilities. And that’s not all.

Other benefits include the reduction of lost or stolen instruments and the ability to help eliminate unnecessary trays and redeploy instruments to service areas where they would be put to better use, explained Alicia Torres, president, Rosebud Solutions, Ann Arbor, MI. "Knowing instrument utilization can dramatically reduce capital costs." Torres pointed out that Rosebud Solutions’ Tray Controller solution, distributed by Stryker Corp., also serves as a productivity tool that can track how long it takes staff to pack certain trays and a training tool that can instruct staff via pop-up instructions, while also providing prompts, alerts and an array of reports to give management the necessary information to guide behavior and enhance workflow.

Tray tracking solutions can also allow sterilization loads to be traced back to individual trays by scanning the sterilizer and the load. Allowing staff to have such data at their fingertips can prove invaluable in the event of an infection-related incident or when auditors pay a visit and request detailed information about a particular load, Torres stressed. Case cart tracking is another function that can help facilities identify which trays were used on which patients, and when, and which equipment processed those trays.

"If there’s a CJD situation, you can see which washer those trays were washed in and any other trays that may have been washed with them, for example," said Mancebo. "Facilities are able to track to that level to include everything that was processed that day, by which person and on which particular equipment, and so on. It isn’t tracking to the individual instrument level, but having even that kind of data can be invaluable."

Once facilities realize the benefits and master the process of tray- or cart-level management, sources said it can then be an easier decision to adopt instrument-level tracking. Because most of today’s leading instrument management vendors offer scalable solutions their customers have the option of pushing their instrument management process to the level and detail that best suits their needs.

While some facilities that understand the degree of commitment that’s involved with instrument-level tracking will opt for more widespread tracking of individual instruments – and may benefit greatly as a result – vendors seem to agree that this high-level, detailed tracking functionality may be better suited (at least initially) to specific devices, such as scopes and other low-inventory, high-dollar instruments.

"That expensive bookwalter ring or ratchet that gets thrown out every other weekend? That’s an example of something you might want to track," pointed out Mancebo.

Facilities may also opt to track instruments within a full service specialty. "It may be that a hospital will want to track every Labor & Delivery instrument, for example, and then expand from there," said Woodcock. "Again, it’s about having the flexibility to accomplish what they want right now, with the option to broaden their capabilities in the future as needed."

Rosebud Solutions Tray Controller

Consistent upgrades and feature enhancements that up the quotient for user-friendliness are an added bonus provided by many of today’s instrument tracking solution vendors – from improved marking (either by etch or dot) to far-reaching integration capabilities and strategic partnerships with equipment manufacturers.

Flexibility and ease of use are at the heart of the IMPRESS Inventory Management System from Cardinal Health’s V. Mueller business. A fully integrated Web-based hosting solution, it features the latest technology and simple, visual prompts in real-time. IMPRESS uses barcode technology to track sets and peel packs. For added functionality, IMPRESS customers can assemble their sets via an onscreen assembly mode. The solution also allows for sending instruments and sets out for repair, logging missing or broken instruments and reconciling from a back-up location where PAR levels can be set. Users can also access photos of instruments and image-based instructions for proper tray assembly.

As for developments on the marking side, Censis is in the process of beta-testing its fourth generation marking technology. According to Creason, the next-generation mark will have an even longer lifespan and will provide for more efficient instrument recording. "Marking an instrument has always been a challenge, whether it’s marked with a dot or laser, but we’re committed to staying at the cutting edge of the marking process."

Key Surgical is so confident about the performance of its KeyDot that the company offer a warranty that guarantees the tiny barcode label will last 200 cycles or two years, whichever comes first.

In the absence of a standardized marking method (the jury’s still out on which technology – the dot, the etch or otherwise – is best, so at this point it often boils down to a hospital’s personal preference), some instrument management solutions providers, such as Getinge, Cardinal Health and TGX Medical, have built their systems to accommodate both. According to Mancebo, such an approach makes sense because "not every device is able to accept a [direct parts mark]. The same can be said for the dot, so having the option to do both is good."

Getinge also does not endorse one method of marking, or even one specific code.

"Even the most common code, data matrix, has its limitations and marking methods vary greatly," explained Scheichenost, adding that often codes are unique to a specific company or require proprietary scanners, thus eliminating the needed flexibility and increasing the reliability on a specific vendor.

Marks aside, customers will likely find that enhanced integration capabilities are among the key benefits of today’s instrument tracking solutions – whether via direct equipment connection or vendor interface programs. Lawson’s SIM, like other Lawson mobile applications, combines Web-based, handheld, wireless and barcode scanning technology to optimize each step in the process. And because SIM is designed to work with Lawson Procurement, it allows facilities to link instruments and supplies in SIM to their item master.

"By doing all of this, SIM can help maintain the highest level of service to the OR, while helping to reduce operating costs," said Keith Lohkamp, product strategist, Supply Chain Management, Lawson Software, St. Paul, MN. What’s more, SIM helps provide consistent, quality instrument sets while safeguarding against instrument damage by automatically alerting staff to incorrect sterilization procedures. "Most importantly, SIM helps improve patient care by ensuring the right instruments are available when and where they are needed most."

T-DOC has the ability to interface with OR, materials management and finance systems, for example, which, according to Getinge, makes the solution an essential part of the communication process between these key departments. Scheichenost encourages customers to look closely at a system’s growth potential within the SPD, OR, other departments, and even sister SPDs. "The best systems should reach far beyond one SPD and have the ability to fully integrate [with] other systems to capture the entire process. This simple extension can significantly improve communication in these very demanding areas."

To help bridge communication gaps between CS and the OR, IMS’ ReadyTracker-Tray software application is used as a key component to the company’s Central Sterile Process Management and Surgical Endoscopy Support services. These services assist client facilities with the development of a cohesive communication and workflow, building relationships and creating two-way communication that IMS says is a requirement for success. ReadyTracker-Tray can locate and track trays and their usage, provide maintenance and sterilization reports, allow users to print count sheets, reports and barcode labels, manage inventory, identify missing items, and store and display digital images of individual instruments and trays.

Cannady pointed to the benefits of bi-directional interface and integration capabilities with other systems in the OR and elsewhere in the hospital. "The operational, financial and decision-support benefits from this are compelling and there remains room for continued enhancement in this area."

Another key development for Materials Management Microsystems’ Sterile Procssing Microsystem has been in the area of electronic load control documentation. This has recently expanded to include the integration capabilities with incubators used in the biological monitoring process. "Similar to certain types of washers and sterilizers that connect directly to the hospital’s network and make for simple and efficient connectivity, Cannady explained that certain incubators have been designed to connect to computer workstations running Microsystems’ software application.

TGX Medical’s Alex Gold sterilizer monitor screen (LEFT) and washer load screen (RIGHT)

"The facility-wide, real-time availability of critical information, the availability of organized, structured and accurate historical pack, load and machine control information, the reduction in labor committed to sterility assurance documentation, and the removal of possible human error make this a key ingredient in any responsible approach to sterility assurance compliance, infection control and risk management," Cannady said.

TGX, through its Web-based Alex Gold solution, offers sterilization integration with virtually any sterilizer, regardless of manufacturer. Being able to track various factors related to sterilization, including results from Bowie Dick tests and biological indicators and integrators, can go a long way in verifying cycle success and protecting the hospital and its patients in the event of a potential process failure.

As of 2006, an exclusive distribution agreement has integrated Censis’ Censitrac technology with STERIS products to provide an end-to-end solution for both STERIS and Censitrac customers. Through this agreement, customers have the ability to more effectively manage the entire sterilization process. The electronic interface to STERIS sterilization equipment is available even for customers currently only involved in entry-level instrument tracking/management functionality, assured Creason.

Hospitals can expect even greater integration, inclusiveness and functionality in the near future.

"I’d say 2008 will be the year for us to see technology bring materials management, CS and the OR together as one seamless function," predicted Mancebo.

While such high-level functionality is undoubtedly an enormous leap forward, sources stressed that facilities that haven’t yet adopted an effective instrument tracking/CS management solution should make a commitment to doing so - in at least some capacity. For facilities that haven’t been able to adopt a successful instrument tracking because of budgetary restrictions, there are low- or no-cost options.

As an alternative to automated sterilization tracking, SPSmedical offers simple patient record cards that can be taped – prior to sterilization – to the outside of every package. A lot control sticker is applied to the sticker. The OR separates the card at its perforated edge and places the card on the patient’s chart. A Tray Record Card with Class 5 integrator is also available, allowing for documentation of every flash load to the patient for whom the instruments were used.

"Many facilities don’t have the resources available for an automated tracking system," said Mariann Pierce, director of sales and marketing, SPSmedical Supply Corp., Rush, NY. "SPSmedical offers a solution for these facilities with a low cost, manual system." SPSmedical also offers a universal system for facilities with STERRAD sterilizers. "This can be used in steam, EO, gas and STERRAD sterilizers."

Even those who are implementing automated instrument tracking solutions can find cost-effective ways to keep expenses down, while preparing to increase tracking capabilities in the future.

Mancebo recommends facilities ask their repair vendors to purchase an etcher, for example (if the vendor hasn’t already), so the hospital doesn’t have to make the investment – which can run upward of $40,000 – on its own.

"A repair vendor will charge [a nominal fee] and for that vendor, the ROI on the purchase of that etcher will be much more rapid. Rather than trying to mark every instrument at once, you can gradually add an etch when an instrument is repaired," he said. "It’s a cost-effective way to building that level of tracking functionality."

Innovative, high-level tracking capabilities aside, sources agreed that even the best solutions will fall flat if they don’t first have the buy-in from those who are expected to use them.