Do You Know Where Your Instruments Are?

Healthcare IT

By: William DeLuca

Published: 4/9/2021

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Tracking software boosts productivity by keeping close tabs on trays and tools.


ZEROING IN Sterile processing managers can pinpoint the location of scanned instrument sets in seconds.   |  William DeLuca

My hospital's sterile processing department is a constant buzz of activity. We manage 2,000 instrument sets and 47 techs work around the clock to reprocess more than 300 trays — from basic laparoscopy equipment to complex orthopedic instrumentation — each day. As one of the department's directors, it's my job to make sure instruments are cleaned, sterilized and sent back to the ORs as quickly as possible. I know all too well that busy central sterile departments and high-volume ORs are dynamic environments where the best laid plans can change in an instant.

We once received a call from an OR where the surgeon was about to perform a total knee replacement and needed a Hohmann retractor, which was missing from the instrument tray. It was the only retractor we had in stock. Or so I thought. I punched the tool's serial number into our hospital's instrument tracking system — the Google of sterile processing — and discovered we had another retractor in a tray that'd been sitting in storage for months. One of our reprocessing techs ran it up to the OR so the case could start on time. Crisis averted.

Locating specific instruments such as the retractor without the benefit of tracking software would be like finding a suture needle in a haystack, so the tracking technology can help you get out of the occasional jam. But a more practical benefit is what it does for you on a day-to-day basis: It records how long it takes to clean, sterilize and reassemble instrument sets, and provides the information you need to increase efficiencies in sterile processing and improve collaboration between reprocessing techs and members of your surgical team.

  • Real-time adjustments. In our hospital, trays full of soiled instruments are scanned when they arrive in decontamination, after they've been passed through an automated washer, after reassembly for sterilization and before they're placed in storage. The tracking system populates a digital count sheet of items that are supposed to be in individual trays, giving reprocessing techs a reference to work from while they're confirming sets are complete before they're sent to ORs. It also pinpoints specific shelves and racks on which trays are stored, a significant benefit in a high-volume sterile processing department.

At any given time, our department is managing more than 200 trays that are at various stages of the reprocessing process. Keeping tabs on the status of each tray lets me recognize potential bottlenecks before they happen and shift resources on the fly to make sure instruments are sterilized as efficiently as possible.

  • Process enhancements. Tracking systems let you identify specific trays that have been reprocessed, the techs who handled the cleaning and sterilizing, what time the tray was sterilized and which sterilizer it was run through. That information can prove invaluable when analyzing the performance of your sterile processing department and figuring out how to run it more efficiently. I'm able to generate monthly reports on how many trays are reprocessed during specific shifts, how many sterilizer loads are run and which techs handle the highest number of trays. That lets me know exactly how much work is being done during each shift and gives me the analytics I need to adjust staffing levels as needed. It also creates a sense of informal competition among the reprocessing techs, who like to see their names at the top of the productivity list.
  • Vendor accountability. We also scan instruments before they're sent out for general maintenance or repair, and the tracking system keeps a running list of each tray's maintenance status. If trays were repaired on a Monday, and a surgeon complains about the set's scissors being dull the following Friday, we know to address the issue with our maintenance provider.

TECH CHECK
Sponges Have Nowhere Left to Hide
RETAINED OBJECTS Sponges continue to be left in patients after surgery because of the inherent risks involved in the post-procedure accounting process.

Manual counts are an imperfect solution for the prevention of retained surgical sponges, according to Victoria Steelman, PhD, RN, CNOR, FAAN, an associate professor at the University of Iowa in Iowa City. “Sponges are often still in use, or at least on the surgical field, when counts are conducted,” she says.

The inevitable distractions of a busy OR can play a role. “Surgical team members are multitasking or mentally preparing for the next steps of the procedure and the patient’s care,” explains Dr. Steelman. “This is a function of the constant time pressure in surgery, and very difficult to eliminate.”

Confirmation bias — providers making incorrect counts based on the number of sponges they expect to be present, not the number that are actually there — can also result in incorrect counts. There are two main types of technologies that address these issues:

  • Barcode scanning. Surgical team members scan sponges before they’re placed in the patient and again when they’re removed. The system displays and documents the “count in” and “count out” — and won’t close out the case’s record until used sponges are scanned back into the system.
  • Radiofrequency detection. RFID tags are affixed to individual sponges, which are detectable by an underbody mat placed on the OR table or a wand swept over the patient. This solution also lets staff detect sponges that were accidentally tossed into the garbage can during post-procedure cleanup.

“Use of either system improves patient care,” says Dr. Steelman.

“However, relying on technology alone to prevent retained objects is not enough. Using it in place of the manual count would require years of substantial evidence proving its effectiveness and consistent staff compliance with its use. Until then, technological solutions should be used as an adjunct to manual counting.” Dr. Steelman believes retained objects remain an issue in part because of a misperception of the cost of the technology designed to decrease the risks. She says a robust cost analysis should include not only the purchase price of the technology and soft goods, but also the potential cost avoidance associated with treating patients with retained sponges, as well as defense and litigation expenses. “This level of thinking provides a broader, more comprehensive picture of the actual impact of investing in the technology,” says Dr. Steelman.

— Dan Cook

Our department also manages about 110 loaner trays. The trays are scanned into the tracking system when they're brought in by instrument vendors, who are supposed to deliver the sets 48 hours before the cases in which they're needed. That rarely happens, however, and the tracking system captures the drop-off data we need to address the issue. We also know exactly how many trays vendors provide, information that has come in handy when discrepancies occur between the number they claim and what's documented in our electronic records.

Clear-cut expectations

Data captured by our instrument tracking systems has improved communication between the sterile processing team and surgical leaders. The two departments don't always see eye to eye, with one side wondering why it takes so long to reprocess instruments and the other side frustrated with the lack of appreciation for the multiple steps involved in ensuring tools are properly cleaned and sterilized. Instrument tracking provides the information and insights leaders from both departments use to improve the flow of instruments through the reprocessing circuit. Basing those efforts on hard data instead of soft opinions leads to increased collaboration and better instrument care. OSM

Clear-cut expectations

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