For those not familiar with why tracking surgical instruments is absolutely necessary, you may want to click here,Tagging And Tracking Surgical-Instruments, About.com, and then return to this post.
In the Intelligent Hospital Today, I wrote of creating visibility through Fiscal and Physical Asset Management. This blog post follows
up on 2 of the 4 points in that article:
-Developing data quality
through simple everyday practices
-Empowering people to
improve performance and make processes better
Why only these 2
points? Mostly, because associating an
asset to revenue generation and developing decision-making tools are matters of
understanding how to pull comprehensive information from applications. Haldor Advanced Technologies allowed me to look
at their system, ORLocate®, under this perspective. They promote ORLocate® as a “surgical
instrument tracking and management system” that captures the complete life-cycle
of surgical instruments from sterile processing to the operating room and back
to sterile processing.
Starting with developing
data quality in and through simple everyday practices:
In CoveringYour Asset by Exposing the Butt-Ugly Truth, the acquisition process
led to the work center embracing the solution because managers and technicians
drove the process toward the leadership goal.
They saw the solution well… as a solution, an
assistant to help get the job done better. Asset Management looked at reports. The work
center cared for the equipment and simply looked at the monitor when needed.
They looked at date time stamps and locations for a specific device or
categories. I looked at categorized and
departmental utilization - the same data, different reasons. The system reinforced their chosen
process. Compliance was much less of an issue.
With Haldor, 2 key
components to simplicity are the ease of
use through an intuitive user interface and the variety of components. Intuitive applications together with the variety of components reinforce the significance of physical tasks in an end-to-end process.
The picture below is of an RFID tagged instrument and a tag reader. Haldor advertises that its RFID tags are
capable of withstanding sterilization, liquid and the mechanical vibrations
generated by ultrasound. The scan time for one of their reader-enabled surfaces is estimated at “8 seconds per 50 instruments as compared to 2-3 seconds for each instrument
with a 2D matrix”.
Tagged Instrument and Reader
The tagged instrument
and a tag reader (RFID Reader) serve as a simple way to capture the data from daily
processes.
- Haldor attaches the tag firmly to the surgical
instruments.
- The tag stores information - Unique
identification code of type and serial number.
- The reader sends a message asking the tag for this
information.
- The tag responds.
- The reader receives the information and passes
it toward the software application.
For example, the reader may ask the tag, “What are you?”
The tag responds with categorical and unique
information, “Forceps, Number 12345.”
More information on this pair of forceps can be tied to this record. This may include manufacturer, part number or a further description. The tag could have responded, “Kelly forceps, curved 5½ inch.” This step is more about ensuring data is captured easily in each step. The process for data quality does not really start here.
Data quality starts with Haldor helping clients load information about each instrument and building the inventory. Haldor offers help by advising on best practices concerning names, categories, descriptions, etc. They will:
- attach the tags to most
standard instruments
- associate the
appropriate information to the tag
- load the initial
inventory
A word of caution about any initiative
toward data quality: it has been my experience that some hospitals disengage
from the process during this initial period.
The vendor is pushed to become responsible for decisions organizations
should retain. Whatever goes wrong,
blame the vendor. This goes the same when a solution provider
can build best practices into workflow and guides. From my perspective, disengagement is a serious
mistake. Users who depend upon a vendor's application to provide reports and manage an area really need to
understand the data fields and how to access that data in the new
application. Honestly, it may take a
while. But, in every case, my time was
well spent going through this process beforehand because I have seen the
results of not doing so. Avoid the Dive
Weights! If you have read Covering Your Assets byExposing the Butt-Ugly Truth, that means something to you.
Once quality data is associated to the tags
and uploaded to the software application, the daily tasks involve placing
multiple instruments in front of a reader and touching a button once.
Haldor RFID Scanner Reading Multiple Instruments
The reader sends the
information to the software application.
The application dates and time stamps each transaction and assigns that
scan to a step in the instrument care process.
This is performed in each step from collection to dispatch. The system will alert if any instrument misses
a step. The records are maintained every
day throughout the entire life cycle of each tagged instrument.
Haldor offers a variety of components to keep tasks simple and to optimize workflow.
This leads to implications for the operating room as well. These are Reader-Enabled surfaces and bins.
Reader-Enabled Surface (Can be configured for Back Table or Mayo Tray Setup)
The surfaces provide tracking
for SPD, and counting for Back Tray and Mayo Tray setups. Haldor states that current covers and bags can
be used with their hardware. The surfaces
reconcile instruments going in and out of the surgical field as well, preventing
tools from being left inside a patient’s body (Retained Surgical Items).
They offer 2 devices to ensure all sponges, used and unused, are reconciled to the total count brought into the operating room. The Sponge Tray and the Sponge Bucket provide this capability.
- Haldor tags the sponges.
- The tray counts unused
sponges.
- The bucket counts used
sponges.
- The software application reconciles the unused sponges in the tray and the used
sponges in the bucket to the total count brought into the OR suite.
- There is a method of adding to the total
sponge count as well.
Tagged
Sponge
Locator: detects hidden or covered items
-Empower people to improve
performance and make the processes better
When I asked Haldor about this
particular criteria, they showed me the guidelines and practices built within their
software: AORN recommended practices (updated July 2010); The Joint Commission
standards and Patient Safety Goals-CAMH Update 2 (September 2010). In other words, Haldor’s approach is to simply,
reinforce, and educate users by integrating international best practices within
the daily workflow of technicians. If
the technician encounters an instrument care process in which the local
guidelines are not in compliance with internationally recognized practices, the
technician or manager can request a change and have hard reference material to
support it.
In this example, Haldor shows how integrating ORLocate® into a hospital wireless network can electronically connect instrument management in the OR and SPD with other platforms.
On the patient treatment side,
this allows assigning sets and instruments to a patient. The result is auditing for each tagged
instrument that entered into an operating room and the sterile field for a
particular patient. I did want to touch
on integration for another reason too. It can directly relate instruments and
sets to a revenue generating person (the surgeon), and the revenue’s paying person, (the patient). Overtime, the utilization,
maintenance cost, and inventory, etc. can be compared directly to revenue. And maybe… just maybe, this will answer the
long term issue of excess equipment inventory.
To close, one final word of advice, when acquiring any technology, write an acquisition plan that returns distinguishable vendor proposals in regards to strategic and operational goals. For example, if your goal is to electronically track 100% compliance in all steps in the surgical instrument care process for each instrument and use on each patient, put that upfront, even in the first paragraph. That will help guide an acquisition plan and process capable of keeping every stakeholder in the game.
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