Sharpest instrument maintenance programs use multi-pronged approach

That same logic certainly applies to healthcare purchases, where equipment and instrumentation play a direct role in quality patient care and outcomes, and physician satisfaction. Certainly, routine maintenance offers some significant benefits, beginning with enabling healthcare organizations to extend the life of their instrument sets by preventing severe damage that can jeopardize the quality of a procedure and lead to costly repairs and premature replacement.

While a growing number of facilities are indeed making preventive maintenance a priority, it appears there’s still room for improvement.

"Significant progress is being made by some healthcare organizations in educating and training their employees about the proper care and maintenance of their medical instrumentation. On the other hand, we still come across products with avoidable repairs from some facilities," noted Eddie Garces, president of Olympus Medical Equipment Services/MPRG and Olympus’ vice president and chief quality improvement officer.

While instilling the importance of proactive instrument maintenance remains a challenge, some experts reason that the recession and subsequent penny pinching has further delayed acceptance in some facilities.

"A common mistake made by healthcare facilities during times of cost reduction is to eliminate or drastically reduce dollars allocated toward instrument repair," explained Matt Rudolph, senior corporate trainer for Spectrum Surgical Instruments Corp., Stow, OH. "If an instrument maintenance program is not in place and no budget exists, it may be challenging for the sterile processing and surgical departments to convince administration of the need for this new program."

Further compounding the problem is that budget-focused executives may be reluctant to allocate capital to build their instrumentation cache, which puts a greater strain on existing devices, keeps them in almost constant service and makes routine maintenance all but impossible.

Turnover in the SPD is also adding to preventive maintenance shortcomings. After all, trained technicians are the first line of defense for pinpointing minor problems and malfunctions before they become bigger issues, and keeping instruments in good working order. A steady rotation of new hires in the SPD often translates into knowledge gaps and added pressure being placed on technicians to complete their processing tasks quickly – two key factors that can promote bad habits and fuel reactive, rather than proactive, approaches to instrumentation management.

Beyond that, larger facilities often have such an enormous amount of instruments to track that it can be a daunting task to not only keep a precise inventory, but also ensure that all instruments are being maintained as necessary, added Robert Purtell, director of business development for Mobile Instrument Service & Repair, Bellefontaine, OH.

"Partnering with a reputable repair company [that] can work in conjunction with the clinical personnel is an effective way to tackle some of these problems," he assured.

Moving from a largely reactive instrument repair mindset to a proactive instrument maintenance program requires a multi-faceted approach — one that begins with ongoing education of virtually all parties involved, from SPD and surgical services professionals to C-level executives and the vendor partner itself.

"At facilities where we see considerable improvements, they have implemented focused efforts on staff education and repair prevention, and have taken advantage of ongoing training opportunities for their employees," Garces said. "Since proper protocols for cleaning, disinfection and sterilization have a huge impact on both patient safety and repair prevention, ongoing training in this area is vital."

Photo Courtesy Olympus

For optimal success, Garces suggests facilities have a formal, competency-based reprocessing training plan that includes in-services. Original equipment manufacturers should be able to provide the facility with ample training and educational resources, such as instruction manuals for reprocessing, guidelines, checklists, wall charts, and training videos, he said. "There are also OEMs that offer onsite endoscopy support specialists [whom] provide hands-on and online scope care and maintenance education." Olympus University provides customers with access to an extensive selection of formal educational programs.

One instrument maintenance vendor contends a strong education program should begin with a thorough assessment of current hospital procedures for the handling and management of instruments. "Assessment emphasis should include identification of process and logistic inefficiencies, regulatory or patient safety risks, and improper care and handling techniques," said Susan Williams, marketing manager, OnSite Services, CareFusion Corp., a unit of Cardinal Health based in McGaw Park, IL.

Targeted education at the executive level is often necessary for driving widespread, focused improvements, sources explained. While SPD and OR staff may recognize the value of proactive instrument maintenance, executives – whom are ultimately in charge of allocating funds – need to have a firm grip on the need and the soaring costs associated with reactive repairs and premature instrument replacement. While such a discussion may not always be an easy one, particularly during a recession, it’s one that nonetheless must happen if positive change is going to occur, experts contend. Fortunately, it’s a conversation that savvy instrument maintenance and repair vendors are well equipped to handle – and, by now, enough quantifiable data has been captured to show the financial and functional benefits of such a well-implemented program.

"When there is little money to invest in new instruments, the existing inventory must be maintained," reasoned Rudolph, adding that it is significantly less expensive to maintain instruments than it is to buy new ones. He noted that alignment of a laparascopic grasper might cost $15-$20, yet if the decision was made to purchase a new one it would cost $450-$650. While instrument maintenance programs can initially be viewed as an added expense, he assured that the right instrument vendor partner will help the facility reduce costs. Again, the best way to accomplish that is through education.

"Many instrument repair companies offer free programs which are pre-approved for continuing education credits," Rudolph said. "These programs will teach the processing staff how to identify minor repair problems before they turn into costly ones." One example: a hands-on flexible scope inspection lab can teach processing staff the importance of leak testing, proper handling and storage, and how to inspect the bending portion of the scope. "A simple leak test on a flexible scope may prevent a $5,000-$7,000 overhaul repair."

Staff input is another core element of successful preventive maintenance training programs. Facilities should make a point of gathering feedback from departments and inquiring about what staff is seeing and what they might need, according to Al Beverage, project manager for Stryker Instruments, Kalamazoo, MI. "This information can be used with your instrument maintenance partner to provide regular training with your departments and develop plans to meet your instrument needs."

Of course, ongoing education of vendor partner personnel is also critical. Not all instrument maintenance vendors are created equal, after all, and sources agreed that hospitals will be doing themselves a disservice if they simply assume their vendor – or prospective vendor partner – is staying ahead of the technological and educational curve.

"A repair vendor should have technical expertise and experience specific to surgical instruments. With tens of thousands of instrument patterns available in the market – and additional equipment – experience is essential," Williams stressed. "Repair technicians should pass knowledge testing, as well as recurrent hands-on training. New technicians should work with multiple senior technicians to observe and train under the supervision of experts." Further, computer technology today provides the opportunity for online annual renewals and a method to introduce and test on new topics, she said.

Of course, experience is critical when it comes to properly maintaining surgical instruments. Repairing instruments is a craft that can’t be learned overnight – and improper repairs can shorten the life of instruments significantly, according to Purtell. "Working with an experienced partner who can pinpoint areas of concern, as well as have a firm understanding of the needs of the surgeons is important," he said.

Consistency counts

If education is the vehicle for driving quality instrument handling and securing proactive preventive maintenance programs then consistency is the engine that keeps it running smoothly.

Unfortunately, hit-or-miss maintenance remains a pervasive problem in many facilities. Part of the problem is facilities may not realize that establishing a successful program takes work, commitment and a concerted effort from all parties involved.

"Adding an instrument maintenance program requires extra time for pulling the trays to be serviced, communication throughout the day with the repair vendor and reprocessing the surgical sets," Rudolph confirmed. In light of those challenges, he stressed the importance of partnering with a vendor that will work around the hospital’s surgery schedule.

The key to establishing a long-term, successful instrument maintenance program is ensuring that all sets are put on a regular rotation. After all, long spans between servicing will lead to a worsening condition of devices and costlier repairs. Another piece of advice: Don’t overlook specialty equipment. Items, such as power equipment and flexible scopes, must be included in the hospital’s preventive maintenance plan, pointed out Rudolph, adding that if a drill, for example, goes two or three years without being serviced, facilities face a greater risk of motor failure during the surgical procedure.

"Instead of spending $200 on an annual basis to have a drill disassembled, cleaned and lubricated, a facility may spend $800-$1,000 for a motor replacement – or worse yet, it may have to purchase a new [drill]."

Olympus’ Garces recommends daily and periodic maintenance to prevent costly repairs. The equipment should be evaluated prior to each procedure "to inspect and test functions, and [ensure] that the equipment is ready for the patient."

Facilities looking to become more proactive with their preventive maintenance, but concerned about where and how to begin may be relieved to know that it’s not an all or nothing proposition. One approach may be to focus on a particular instrument type and really get in-depth on not only the inspection of that device, but also why the instrument needs to function in a particular manner.

"In a clinician satisfaction survey, surgeons reported that they consider ‘quality’ to be a properly functioning device," said Williams. "If the [sterile processing] technicians better understand the end use of the equipment, they are more likely to identify issues during inspection." Some SPDs participate in cross-training programs that allow technicians to spend time in the OR to observe the instruments at point of use. On the flip side, OR personnel are also able to observe instrument processing in the SPD. "While it can be easy to point fingers when we are in silos, once we have walked in another’s shoes a sense of empathy is present."

Keeping a close eye on repair and maintenance expenditures will go a long way toward tracking trends and pinpointing areas of opportunity regarding staff education – and, perhaps, identifying the need for more instrument sets. Fortunately, leading instrument maintenance and repair vendors are offering their customers detailed reports that clearly outline such patterns, while also providing a snapshot of expenditures.

"The days of having ‘the sharpening guy’ coming to visit a hospital are over," said Rudolph. To effectively partner with the hospital, he said the vendor must provide value-added items, such as detailed service reports that show before and after images of a device, and outline the diagnostic tests and inspection that was performed. Reports should also detail categories of expenditures on a quarterly basis. "The customer should be able to view where the dollars are being spent. For example, if 60 percent of the repair budget is being utilized on flexible scopes, then that would be an area to focus on."

Because each healthcare facility’s needs are unique, CareFusion’s Williams advocates that each facility begin carefully tracking its own metrics to track trends, identify instrumentation and educational shortcomings, and pinpoint potential savings associated with a proactive preventive instrument maintenance program. Some key metrics that may justify new instrument expenditure, for example, include set utilization, which can provide an overview of the use of capital; percentage of complete sets and percentage of sets with missing instruments; corrective action; and return on investment on new technology. Instrument maintenance software programs can help facilities capture and track such data.

"Today, many hospitals understand the usage of their instrument sets much better through instrument maintenance software programs that provide reminders when preventive maintenance is due," said Williams. Although documentation is essential, she stressed that to be meaningful and beneficial it must be clearly presented and understood. While that may seem obvious, it’s a point that can easily be lost on some facilities.

"Implement a quality tracking method. Quality issues are largely under-reported," she continued. "No effective corrective actions can be placed until trends are understood and root causes identified."