THIS WEEK'S ARTICLES
The Value of Routine Preventive Maintenance Practices for Your Instruments - Sponsored Content
Instrument Quality Is a Key Safety Issue
Tools that break during surgery can lead to significant patient harm.
Surgical instruments that are of poor quality or improperly maintained can fail during procedures, an alarming occurrence that jeopardizes outcomes and the well-being of patients, according to research published in the Cureus Journal of Medical Science.
The study analyzed 161 patient safety incidents involving broken surgical tools that occurred between August 2004 and December 2010. Burrs, retractors, snares, clamps, suction catheters and saws were among the most frequently broken items recorded in the database.
Of the 161 incidents, metal was left in 77 patients. Broken fragments were removed in only 57 cases, and 27 reports did not state whether instrument pieces had been removed. Among the incidents, five resulted in reoperations to remove device fragments, six caused moderate patient harm, 35 caused low harm and 119 resulted in no harm.
Surgeons and surgical teams assume instruments purchased from reputable suppliers will perform to the highest standard, but tools sometimes don't live up to those expectations. "Poor-quality instruments fail and break and, when used in an operation, the consequences to the patient can be disastrous," write the researchers, who note the FDA published an alert about 1,000 incidents of retained pieces of broken instruments occurring annually that led to tissue reactions, infections, disability and even death.
"The results of our report are likely to only be the tip of the iceberg," say the researchers. "Poor reporting of patient safety incidents means there may be as many as 1,500 incidents a year of poor-quality surgical instruments causing harm."
Remote Instrument Care Opens Up Space and Opportunities
Moving sterile processing offsite can help facilities gain space to boost patient volume or introduce new service lines.
As more procedures move to the outpatient setting, concerns over the instrument care necessary to keep case volumes running smoothly and efficiently is causing many facility leaders to look for outside-the-box solutions to the logistical problems inherent in sterile processing — or more accurately, outside-the-facility solutions.
Offsite and third-party instrument care facilities are gaining traction throughout the country, and even more ASCs and HOPDs are expected to give the concept a try in the near future. Why are more facilities choosing to outsource or create their own offsite location for their sterile processing and instrument maintenance needs rather than keeping the service line in-house where it traditionally resides?
One huge benefit is the extra space offsite reprocessing provides. Penn Medicine in Philadelphia provides an eye-opening example. It recently opened the Interventional Support Center (ISC), one of the largest instrument reprocessing facilities in the country, with 80 reprocessing techs working in a 110,000-square-foot space to sterilize thousands of instruments each day. Back at the hospital, there is now more space to expand clinical services. "Sending instruments to a centralized facility provides the breathing room hospital departments need to expand their services," says Chris Pastore, managing director of the ISC.
Most facilities, particularly smaller freestanding ASCs, don't have the resources to create a top-of-the-line, offsite sterile processing facility of their own. To serve smaller centers, third-party vendors offer offsite reprocessing options. For example, OrthoIllinois Surgery Center in Rockford, Ill., recently partnered with an offsite reprocessing service and, as a direct result of the move, the ortho center increased its surgical capacity and reduced instrument backlogs for total joint replacements. "We had reached capacity in our sterile processing department and needed to get creative if we were going to process instrument trays quickly enough to accommodate more cases," says Leanne Brennan, the center's business manager.
Facilities that are interested in such an arrangement should first perform a thorough analysis of the pros and cons, as well as confirm that any third-party vendor they use is also capable of handling the regular maintenance and repair services of the instruments it reprocesses.
The Value of Routine Preventive Maintenance Practices for Your Instruments
A PM program can identify instrument issues before they affect patient care and outcomes.
The cost of healthcare has skyrocketed in the past decade and is increased by each surgical case that has an adverse outcome because of a broken, non-functioning or dirty instrument. The National Center for Biotechnology Information reports, "There may be as many as 1,500 incidents a year of poor-quality surgical instruments causing harm."1 In 2008, the FDA published an alert that stated, "Nearly 1,000 incidents of retained pieces of broken instruments (unretrieved device fragments) occur each year, leading to a range of problems including local tissue reactions, infections, disability, and even death."2
Maintaining your instruments is critical for the safety of your patients and staff and should be a regular part of your workflow. Medical equipment maintenance is a set of activities conducted to keep a medical device in good working condition. It consists of inspection, preventative maintenance and corrective maintenance and involves regular routine testing, calibrating and adjusting of equipment. These activities help identify wear and tear and eventually may lead to replacement of components or the product to avoid breakdown.
Surgical Services typically account for 40% of a hospital's operating expenses and generate about 70% of its revenue.3 A significant portion of an operating room budget is allocated to cleaning, maintaining and repairing surgical instruments. To keep ORs running efficiently, it is important to have a plan for ensuring that all surgical instrumentation is functioning safely and effectively and is procedure-ready.
There are direct and in-direct costs associated with instrument maintenance. Not having functioning equipment ready for surgical procedures can result in delayed starts and cancellations, thus directly affecting costs. Indirectly, using non-functioning, broken or improperly cleaned instruments can lead to surgical site infections and other adverse patient events. Patient safety is the priority and removing these risks and costs must also be a primary goal.
A Preventive Maintenance (PM) program can identify instrument issues before they affect patient care and outcomes. Functionality of surgical instruments is a critical factor in ensuring the highest standards and best patient outcomes. By establishing a comprehensive, thorough PM routine, a hospital or outpatient surgery center can mitigate much of the risk of adverse events related to broken devices or retained bioburden. Additionally, such a program will increase the lifespan of the instrumentation, lead to a higher level of surgeon and staff satisfaction and eliminate costly weekly visits from the instrument repair company.
KARL STORZ recognizes that your staff is caring for patients in a new and increasingly challenging environment. Let us lift your team by doing the heavy lifting in managing your equipment needs. Our On-Site Endoscopic Specialist (OES) is a dedicated, full-time resource to your team, providing daily face-to-face support in the perioperative space. The OES keeps your equipment functioning like new and provides expert troubleshooting, education and problem prevention.
Our OES program helps you ensure safety and compliance with the support of full-time subject matter experts, save time with right and ready equipment for your MIS procedures, and save dollars by maximizing the life of your equipment and minimizing repairs. Overall, you will increase the satisfaction of your clinicians and staff as they focus on patient care. The On-Site Endoscopic Specialist program has been shown to have significant clinical, operational and financial benefits such as increased overall satisfaction, decreased downtime and reduced costs.
1. Dominguez E, Rocos B. Patient safety incidents caused by poor quality surgical instruments. Cureus 2019 11(6): e4877. doi:10.7759/cureus.4877
3. Open Anesthesia. OR Costs: Labor vs Materials, Open Anesthesia. https://www.openanesthesia.org/or_costs_labor_vs_materials
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Tech Helps With Instrument Tune-Ups and Tracking
Software platforms allow facilities to pinpoint the location of instruments while ensuring they stay in top condition.
Although patient safety is always the primary goal when surgical facilities decide to purchase instrument tracking technology, they derive another benefit from consistently scanning individual trays and case carts: the ability to track individual instruments.
Tracking software provides data that surgical facilities need to determine when instruments require preventive maintenance or repair, according to Jon Kraft, BSN, RN, CNOR, a central sterile leader for ENT and neurologic surgery at Vanderbilt Children's Hospital in Nashville, Tenn. "Tracking and monitoring tray usage and wear and tear ensures instruments are sent out for regular maintenance and repair, which increases their longevity," he says.
The software can be particularly helpful to hospital outpatient departments that occasionally lend instruments to nearby ORs that are then not returned. "The instrument scanning technology lets us pinpoint the locations of specific trays and ensures instruments that belong in our inventory are returned," says Mr. Kraft. "We've found that fewer instruments go missing, so we've spent less money on purchasing replacement items."
Tracking scanned instruments also improves tray accuracy and helps to ensure instrument sets will arrive in ORs with no missing items. This can result in fewer costly case delays and makes for improved relationships between members of the surgical team and sterile processing department.
Tracking software also provides a clearer picture of which instruments are being used and which are not. For example, at some facilities, certain items or even complete trays too frequently are returned to sterile processing unopened. Tracking can allow trays to be "rightsized" for specific cases or service lines, meaning resources are better allocated and sterilization costs wasted on unused instruments go down.
Mr. Kraft says surgical facilities that buy instrument tracking software, educate staff on its use, ensure it is used consistently, and regularly audit their process and results likely will save money over time.
Outside Service and Repair Keeps Instruments in Shape
High-volume center benefits from working with a same-day third-party provider.
At the eight-OR Knoxville (Tenn.) Orthopaedic Surgery Center, surgeons perform 30 to 80 procedures every weekday. They need a steady supply of instruments throughout those fast-paced days that aren't dull or damaged. The solution for the facility has been to contract with a third-party company that offers same-day, on-site instrument repair and service.
"Twice a month, technicians arrive in a service van, retrieve clean instrument sets and take them to the van to perform minor repairs," says Jennifer Parrott, RN, OR clinical manager. "The van pulls into our parking lot around 6:30 a.m. and a crew of two to three technicians work until about 2 p.m." The techs typically care for about 11 trays of instruments during that time. Each visit includes routine upkeep such as alignments, adjustments, sharpening, screw and spring replacements, lubrication and ultrasonic cleaning.
The company provides capped pricing with an agreed-upon fee per visit, and the center spends a contracted amount with the service each month. Ms. Parrott says the center has found the firm to be reputable and transparent, and the relationship has extended for two years running.
Ms. Parrott says facilities who wish to emulate this setup should maintain high standards. "Find a firm that is upfront and honest and makes your facility a priority," she says. "I, along with our sterile processing staff, was able to tour the main facility of our service repair company, which I highly recommend. If they open their doors to you, they have nothing to hide. You want to work with a service repair team who is happy and upbeat about their work, because that often translates into successful production. Let them know what you want and what you expect, and do not settle for less."
The service provides the center with a detailed activity report after every visit that reviews the major and minor repairs the techs performed. It also provides a detailed list of which instruments are due for service. Through a website, Ms. Parrott can track instruments that needed to be taken off-site for repair. If a tool cannot be repaired, the service van also carries an array of new instruments for purchase to complete the tray. "It's very convenient to have the option to purchase an instrument on the spot when one is unable to be fixed," says Ms. Parrott.
She adds that her four-person reprocessing staff also benefits from the on-site service. "Instead of having surgical techs bring us instruments that are damaged or dull right before a surgery is about to begin, the imperfections have already been addressed by the third-party repair staff," says Ms. Parrott. "That means our hardworking reprocessing techs don't waste time sterilizing instruments that might end up unsuitable for use during a case."
Now, rather than spending large amounts of money on new instruments, the center spends a more reasonable amount on routine repairs and maintenance. "We're saving money by maintaining the life of instruments, rather than always being forced to purchase new tools when something breaks and needs to be replaced," says Ms. Parrott.