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Advanced instrument tracking paves the way for quality [Healthcare Purchasing News](Healthcare Purchasing News Via Acquire Media NewsEdge) Instrument tracking is certainly not a new concept, but some new developments are taking shape that are making the function even more valuable - and making more sterile processing professionals and even C-suite executives stand up and take notice. That's certainly good news for resourcestrapped SPDs that have struggled to get their facilities to even consider building instrument tracking solutions into the budget. And it's also good news for the operating room and other hospital customers served by the SPD, not to mention, the patient on the receiving end of the instruments (and processes) being tracked. Today, the capabilities of instrument tracking systems go far beyond what the name implies. While tracking instruments undoubtedly remains a critical core function, vendors are building in a multitude of other functions and benefits that, if fully tapped by the end user, can further enhance quality in the SPD, offer a better return on investment, and provide even greater peace of mind. The bottom line, sources told Healthcare Purchasing News, is that today's instrument tracking solutions have evolved into true instrument management solutions that allow for effective data capture and dissemination that can greatly improve department-wide (and even facility-wide) quality and efficiency. "While asset management tools can be the most immediate and significant areas of impact for SPDs following implementation, that can really be just the start," stressed Clay Cannady, vice president of sales, marketing and business development for Mequon, ILbased Materials Management Microsystems. "There are a number of ways for robust systems to impact productivity. Training aids, competency measurement methods, tools for LEAN process design, and a broad range of integration capabilities represent a pretty sizable runway for ongoing performance improvement year after year." Integration boosts value More than ever, facilities are beginning to embrace comprehensive instrument tracking solutions. A number of vendors reported significant customer growth over the past year or two, which some attributed to a heightened focus on patient safety and quality improvement, and standards and regulations, such as GSl and Unique Device Identification, that are pushing accountability and device traceabüity to the forefront. According to Michael Mancebo, director of sales for TGX Medical Systems, Carmel, IN, business is accelerating as more facilities try to rise above the pressure of meeting these standards and staying one step ahead of surveyors who are becoming more keenly focused on patient safety and traceabinty. "It wasn't long ago when having an instrument tracking system was considered 'pie in the sky/ Now, we see more facilities seeing it as a real necessity," he said. "And for many facilities that did have instrument tracking in place, we're now seeing them want to really push their systems beyond the basics. They're now coming to us and saying, 'We're ready to do more. Show me everything.'" While exact features and functions will, of course, differ from one system to the next, some notable trends have surfaced -with advanced equipment connectivity capabilities ranking high on the list. "The greatest advancement is the increased interface capabilities to multiple types of equipment and technology applications," confirmed Mike Patterson, senior vice president of sales and marketing for Censis Technologies Inc., Franklin, TN. He noted that systems can now interface with various manufacturers of washers and sterilizers, OR scheduling systems, materials management procurement systems, online sterilization and reprocessing guidelines, while also integrating with RFID/ RTLS, vision scanning systems, voice recognition, and robotics. "These interfaces to equipment and having information readily available help support the overall objective of having the right instruments in the right place at the right time, thus, positively enhancing patient safety." No question, this heightened degree of connectivity allows for improved documentation, operational efficiency and clinical outcomes. "Interfaces allow the hospital to automatically link data between different software solutions, providing a more efficient and error-free process," assured Jamie Molina, product manager, services marketing, Aesculap Inc. Throughout the tracking process, Aesculap's Instacount PLUS captures data on staff productivity, sterilization, maintenance, missing instruments, quality assurance, and more - all of which can be easily summarized in reports that allow managers to make better business decisions based on accurate, realtime data. In SPD environments with washer and sterilizer interfaces, electronic documentation of results serves to streamline work, eliminate opportunities for human error and improve the ability to handle internal Joint Commission audits, Cannady added. "With a biological monitoring interface, you get real-time status information, tools for managing recall down to the individual device, and the means for providing notifications to surgeons and infection control in the event that unfit instrumentation comes into contact with patients. Operationally for the department and clinically for the hospital, this continues to be huge." And the benefits don't end there. Connectivity with other software applications in the OR further enhance operational efficiency and clinical outcomes, Cannady continued, noting that capabilities that eliminate the need for manual tray scanning, while preserving the traceability of the uniquely identified instrumentation to the patient or procedure, continue to demonstrate significant benefits to all involved. System integration could come in other innovative ways, as well. Patterson predicts that hardware technology advancements will push tracking system functionality, capabilities and ease of use even higher. "As tablet utilization, such as the iPad, increases, we believe tracking solutions will be required to function on these hardware devices in the near future," he reasoned, adding that as access to applications through this type of hardware increases, utilization will increase as the electronic medical record initiatives advance. "Integration with EMR data will become a requirement for the instrument tracking process. Also, data mining and utilization analysis will become easier and more prevalent." The move to improve SPD professionals from all different backgrounds, locations and facility sizes are finding that stepping up their instrument tracking capabilities can pay off handsomely. When Carmen Ferriero III, MBA, sterile processing manager for Albany Medical Center in New York, assumed his position roughly three and a half years ago, he quickly determined that the instrument tracking system in use, Getinge's T-DOC, wasn't being tapped to its fullest potential. In fact, he estimated that only 20 percent of the system was being implemented. Fortunately, shortly after his start date, he was able to travel to Rochester to attend a T-DOC user training group to familiarize himself with all that the system could offer and formulate a strategy for bringing his department up to speed. In short order, virtually all features of the system were implemented and the benefits began rolling in. "We have been able to increase overall process efficiency and improve instrument set accuracy, which has led to greater overall product quality," Ferriero said, adding that the ability to quickly locate instruments throughout the entire process, while also greatly reducing time and headaches associated with product recalls, has helped significantly improve customer service. Prior to assuming his role as the SPD's manager, the staff would scan the barcode and then print off a component list. "I turned to the pack on-screen function where a component screen pops up and staff now have to actually click through each one before the barcode is given. It's about improving quality and accuracy." Photos and notes are also being incorporated into the system to help technicians ensure instrument and process accuracy, and promote staff education. Currently, more than half of all instruments in the facility's inventory have an accompanying photo incorporated into T-DOC. Ferriero also plans to work with a training specialist to develop videos that can pop up for certain instruments or sets, and steer technicians to proper practices. "I might be on the video saying, 'Remember, this is how you do this/ or 'don't forget this step/ I've found that instrument tracking systems can serve as a valuable training tool - you just have to be willing to be creative and take the time to explore the various features." The scores of data collected by the system can also prove invaluable for creating productivity reports and even justifying staffing levels. Ferriero creates monthly productivity and quality reports, and individual productivity reports - and he also posts errors to serve another educational purpose. "Everyone in my department knows where they stand. They know that quality and accuracy is the focus here, not how fast they can get something done. Using our tracking system in so many different ways has helped keep everyone focused on quality and following good practices." Even smaller facilities are reaping the benefits of instrument tracking systems. When Valley View Hospital in Glenwood Springs, CO, adopted TGX Medical Systems' Alex Gold instrument tracking system in early 2011, it, too, discovered that the solution could do far more than pinpoint instrument set location. Currently, the SPD tracks all sets and also uses the system to scan in all peel pouch items. "We also use the system for all our loaner instruments, which has been really helpful for keeping track of that process," said clinical coordinator Michelle Long. "We've also started incorporating sterilization processes into the tracking system and we'll begin adding photos, too. We're also scanning in our load receipts that come off the sterilizers [with an actual scanner, not a barcode scanner], so we can know the parameters and see exactly what was in a load." An added perk: the facility is also using Alex Gold for tissue tracking, allowing the materials coordinator and circulating nurse to easily scan it in upon receipt. Prior to this, circulators relied on an archaic sticker-based process that was time consuming and highly inefficient. "Tissue tracking has become a very big Joint Commission issue. When we had a surveyor come, he really concentrated on the tissue tracking component," Long noted. "We are very proud of our progress with our tracking system and we actually wanted the surveyor to come into our department." Broadening the scope Although the exact extent that surveyors' focus, as well as GSl barcoding standards and unique device identifier regulations, will have on the instrument tracking segment - particularly in regard to instrumentlevel tracking - remains to be seen, some predict that the impact will be significant. That push will likely begin with providers and manufacturers of surgical instruments and then flow throughout the supply chain. Food and Drug Administration regulations are also on the horizon, and not as far away as some might expect. "From our discussions with the FDA, we know the timeline is within five years from the regulations becoming final for Class III medical devices," said Patterson, noting that, ultimately, it will be the Joint Commission or the hospitals themselves that will help push the requirement to track instruments to the patient level. "This capability already exists and we have many Censitrac customers utilizing it now." More hospitals are showing an interest in instrument-level tracking, with some vendors seeing the greatest push from multifacility organizations that aim to embrace instrument-level tracking at the corporate or regional level. "These organizations are seeing the value brought by standardization on a single solution that enhances information about the assets used during surgical procedures. [That] results in greater patient safety, while generating a return on investment," added Patterson. "These for-profit and government-owned multi-hospital networks are investing in tracking capabilities by budgeting dollars at the individual facility level for the purchase and implementation of instrument-level tracking solutions." Mancebo, too, is seeing more hospital networks getting on board, as opposed to just individual hospitals buying for themselves. "They want one database, so they can have that visibility and transparency across their different facilities," he said. "If there are three hospitals in a network, for example, and they have to share instruments, they can see exactly where those instruments are - plus, they can have the record to show where and how those instruments were last processed, and by whom," he said. Alex Gold also features new document scanning technology, allowing any PDF document to be scanned into the system, thereby giving staff easy, at-a-glance access to processing instructions and other pertinent information on virtually any item in inventory. While Albany Medical Center isn't yet tracking to the patient level, it's one of Ferriero's top goals. "From an infection control standpoint, this is an invaluable capability because you can trace the instruments all the way to the patient and you can establish whether there were any anomalies in the processing of instruments for that particular patient," he explained, noting that this could be a particularly valuable tool for hospitals facing lawsuits associated with infections or other adverse events. Another goal, which will soon become a reality by 2013, is tying TDOC to the OR's scheduling system, he said. Tony O'Hehir, product manager for TDOC and Getinge Online, further pointed out that the opportunity to eliminate lost instruments and enable full traceability back to the patient and procedure is invaluable - especially when managing a process failure or instrument recall. "The time, cost-savings, level of detail, and confidence that the SPD and OR teams gain with these benefits enables them to focus on other key areas that improve patient safety," O'Hehir said. In addition to ensuring that procedures are met and that effective washing, disinfection and sterilization occurs, it also helps prevent the skipping of required steps, added O'Hehir. Because coding a hospital's entire inventory can be a long and costly process, instrument manufacturers are working to take away some of that burden. When hospitals are ready to move forward with implementing individual instrument tracking, purchasing instruments that already have the code on the instrument will save time and money because they won't have to code the individual devices themselves, noted Molina. The majority of Aesculap surgical instruments are already manufactured with a data matrix code that includes an individual code, the UNICOS code, to each instrument, she said. "This means each instrument marked with UNICOS code is uniquely identifiable. The instrument carries the ÚNICOS code both in plain text and encoded in a machinereadable Data Matrix," Molina continued. "The information that can be read consists of the article number and a five character unique identifier. This data matrix code can be read with a 2-D camera system and tracked individually through a hospital's instrument management system." Other marking technologies are available that are compliant with Global Harmonization Task Force final guidance for unique device identification. SignaKey, for example, is an encrypted automatic identification technology (Auto-ID) marking system that uses laser DMP on the instrument's surface and can guarantee that every instrument is unique - an obvious requirement for any UDI. Using only five of the 14 available fields, a SignaKey mark can track 281 trillion unique instruments - and a SignaKey UDI cannot be duplicated or cloned, said Richard McDermott, Ph.D., CEO of SignaKey LLC. "The FDA hopes that UDI can improve visibility for a range of issues that include medical device recalls, plus tracking and tracing, and anti-counterfeiting/ diversion/' he said. SignaKey is based on proprietary closed system software that can track, trace and authenticate. "Almost all other marking systems depend on Data Matrix, which is based on an open source technology," he said. Scalable solutions offer security With the looming regulations, it's prudent for facilities in the market for instrument tracking systems to explore solutions and vendors that can offer them a scalable technology that can allow for instrument-based, patient-level tracking - even if the hospital isn't yet ready to tackle tracking to that level. "We think it is a proactive measure when our prospects take instrument-level tracking capabilities into consideration when choosing a tracking solution, as it will one day be a requirement," said Patterson. "While we obviously encourage our customers and prospects to adopt instrument-level tracking as quickly as possible, we also assist in a phased-in implementation of functionality." Many customers start with tracking flexible endoscopes or mobile equipment or sterilization data, for example, and then begin phasing in tray tracking and, eventually, individual instruments as budgets and staffing resources allow - or as staff become more familiar with the application and tracking concepts, he noted. To provide greater scalability, Censis introduced several new entry-level products focused on specific areas of traceability and management, such as endoscope tracking, count sheet management or electronic sterilization recordkeeping. Further, the new modular design of Censitrac allows customers to increase their system's functionality whenever they are ready. To maximize a systems' long-term value, facilities should lean heavily on their vendor partners for as-needed training, inservices and system upgrades and enhancements. As part of Microsystems' technical support agreement, for example, customers receive an annual upgrade that includes all enhancements since the previous upgrade. The second phase of case cart management tools are being introduced, Cannady said, and will continue to have a favorable impact on departmental flow, service levels and fill rates to users. Additionally, Immediate Use Sterilization capabilities and enhanced tools for high-level disinfectors were introduced in February 2012. As part of its annual software management agreement, Aesculap' s Instacount PLUS releases software updates annually, with a new software version due for release this year that Molina said will increase functionality, while providing customers with a new user-friendly look and feel. Getinge typically releases a new version of T-DOC every 12 to 24 months - with the most recent software, Version 9.0, released in July 2011. This version features new flexibility in custom-naming error messages and alerts, and also includes two new optional modules - the remote messaging module that allows TDOC alerts to be sent to cell phones - and the OR PlanAssure module that lets staff manage transport and turnaround times to predict the availability of instruments. Whichever vendor and tracking system a hospital ultimately chooses, Ferriero confirmed that there's tremendous value in creating a true partnership with the vendor and working together to drive the most benefits and functionality of the system. "An instrument tracking system is a big investment for a hospital, and it's one that I believe it definitely worth the expense and hard work," he said. "But if you're going to implement it, it's important to do more than scratch the surface. I know firsthand how staying committed and finding creative ways to make it work better and harder for you can really pay off in the end." The instacount PLUS instrument management system from Aesculap being used in the CSSD to assemble an instrument set. Aesculap's surgical instruments already come with a data matrix mark that includes instrument's catalog number and an vidual serial number. Advanced tracking with T-DOC at Albany Medical Center improves process efficiency, accuracy and customer service. (c) 2012 KSR Publishing |