Tagging and Tracking Surgical Instruments

Surgical Tray and Tools for RFID and RTLS. Copyright (c) Public Domain

Based in the Savannah, Georgia area, but with clients across the United States, Al Hardy is a writer and consultant with expertise in Enterprise Asset Management, Real-Time Location Systems, Technology and Capital Planning. He is the author of the book, Covering Your Assets By Exposing the Butt-Ugly Truth. Mr. Hardy has been a long-time reader of our About.com Medical Supplies Site. Since he is particularly passionate about one of this site's prominent themes, advising healthcare organizations on the various ways to achieve both quality improvement and cost reduction, I've asked him to offer his insight and perspective.

From Al Hardy

Inspector General and the General Accounting Office reports from 1985 to 2012 show written procedures and policy were not followed in some Veterans Healthcare facilities. Veterans were infected with disease, a problem Brian Carmody has written about many times called "healthcare acquired infections". It happens in every hospital, not just Veterans Administration hospitals.

Many infections are contagious, so when a patient acquires one while in the hospital, they will either be detained in the hospital for a longer stay, or they may be discharged if the infection does not reveal itself right away. At that point, the infection is "brought home" and the public health, especially the people with whom the infected patient lives with, becomes threatened.

The Veterans Health Administration’s (VHA) protocols for notifying beneficiaries of possible infections led to press reports that revealed infections passed to veterans.

Poor compliance, no one monitoring compliance: time, distractions, lack of a systematic approach, staff turnover, any of these could’ve been a factor. Any patient, regardless of the continent, could suffer these events. Consider if every hospital had the openness policies of VHA instead of a gang of attorneys waving nondisclosure agreements.

Surgical instruments hold, cut, or scrape skin, bone, nerves, and organs. Body fluids, bone fragments, and soft tissue adhere to these instruments. Cleaning and sterilization for the next patient is tough but absolutely critical.

The VHA is on a mission to fix the problems by transforming medical care for veterans. The overall goal for their healthcare efficiency initiative is very clear: improve quality, reduce costs – a commonality with most hospitals, globally.

Real-Time Location System (RTLS)

The VHA describes a Real-Time Location System as “... to provide an integrated solution for locating assets, monitoring temperature, tracking instrument and supply workflows, surgical flow, emergency department flow, hand hygiene compliance, staff tracking, and patient tracking.”

A similar example is the navigation application (app) on your mobile phone. The app shows your progress towards a destination by tracking what you should be doing versus what you are doing while in progress to a destination.

Make a wrong turn, it tells how to get back on course. Upon approach, it tells you where to look: left, right, or straight ahead. If the destination is your home, it’s not a stretch to make your phone open the garage door automatically. The app can send a message to a loved one and a security desk simultaneously. The objective of the navigation app is to keep you moving (flowing) safely and smoothly to your destination in the best time possible. The message helps provide oversight.

Sterile processing Departments manage collection, washing, inspecting, packing, sterilization, storage, and issuing surgical tools and tool trays. The plan calls for staff to track each instrument (there can be thousands of them) and each tray as each staff member flows through each of these steps. This can occur in the operating room too.

Tracking Methods: Costs and Variable to Consider

Methods of tracking must be simple, a single transaction or the push of one button. RTLS tags must be durable. The instruments, trays and tracking method must survive washing, chemicals, ultrasonic waves, heat, and vacuum.

Physical marking and Radio Frequency Identification(RFID) are 2 methods of tracking. Physical marking means a pattern is placed on a label or directly on each instrument. In contrast, RFID/RTLS tracking is done by attaching a small computer chip.

Physical coding with labels requires repeated replacement of labels. Positioning the instrument to read the label can be a problem.

Permanent marking is relatively inexpensive. It requires handling as well. Seconds matter when handling thousands of instruments daily.

RTLS tags cost more than labels or permanent markings. The upside is one can read multiple tags in an instant, reducing the handling time over the long run.

Embedding a RFID reader into a pad allows the reconciliation of instruments in the operating room. One simply removes or puts it back on the pad. This very important reconciliation can dramatically reduce the need for intraoperative X-Ray scans to ensure an instrument is not left inside a patient.

Connecting and pushing both the entire sterile and use cycles down to each instrument level can provide the multi-level continuous monitoring that hospitals need. The objective is to ensure that every instrument goes through the proper steps in sterile processing and is accounted for in the operating room.

Patient safety and disease prevention from infectious diseases like hepatitis, rare diseases like Creutzfeldt-Jakob disease, and other hospital acquired infections from bacteria, are among the most important goals hospital leaders face. RFID, to the instrument level, can provide an effective solution to reinforce those processes used to prevent these dangerous incidents.

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