Can A Surgical Instrument Tracking System using Automatic Identification and Data Capture Technologies (AIDC) such as RFID / barcodes deliver on Patient safety? The answer is a resounding yes! Here are 10 ways in which a good surgical instrument tracking system can enhance patient safety:
1. Missing / mismatched items in surgical sets.
Unavailability of instruments is recognised to cause delays and stress in the operating room, which can lead to additional risks for patients. A 2007 study by Verdaasdonk et al. observed 30 randomly selected procedures and found problems with instruments in 9 of them (30% incidence).
Surgical sets are assembled as per pre-defined instrument checklists and may sometimes contain over 200 instruments. A CSSD technician must meticulously assemble sets, making sure no items are missing or mismatched. This job is complex and requires technicians to have in-depth knowledge and experience. Time pressures are par for the course and it is not uncommon to find sets deviating from defined checklists. This task can be made easier through use of a tracking system that gives pictorial guides to technicians for identifying instruments, or better still, automatically identifying and matching instruments via RFID / Barcode reading.
2. Efficient handling of recalls
When handling recall of a sterilization batch, the key task is retrieval of affected items. Manual sterilization records seldom contain sufficient information about the load that was present in each batch, and it falls upon staff to check every label on packs in storage to retrieve recalled items. A good surgical instrument tracking system, on the other hand, creates detailed load records and can help identify the exact location of affected inventory. It also allows patient-wise traceability so that if any recalled item was used on a patient before the recall was announced, such patients can be carefully monitored by the care-giving staff.
3. Patient Traceability.
The J&J Articular Surface Replacement implant case threw light on the importance of patient level traceability for implants. An estimated 3600 of 4700 likely affected patients could not be traced leading to the setting up of the Indian Joint Registry. However, the task of keeping patient wise records is not limited to implants and a comprehensive Surgical Instrument Tracking system can help a hospital do so seamlessly.
4. Usage Cycle tracking.
Surgical instruments have their own useful life and manufacturers usually indicate the number of cycles an instrument can be used for. For e.g. bipolar vessel-sealing surgical instruments. A surgical instrument tracking system gives users the exact cycle counts completed by an instrument and in fact, can disallow further use after the maximum cycles have been reached. This completely removes user discretion and manual cycle counts and makes the process safer for patients. Additionally, usage cycles completed by each instrument is vital information for staff when performing instrument maintenance, or when making decisions to condemn / continue using these.
5. Focus on Quality.
Even the best surgical safety checklist cannot protect against a non-functioning surgical instrument that reaches the Operating Room. Cracked hinges, or needle holder jaws, for e.g. can not only harbor deadly infections but can also fall off into open surgical cavities leading to myriad complications from retained foreign bodies (RFBs) and extended anesthesia times. When instrument technicians are not properly trained and equipped to appropriately inspect each surgical instrument, patients are unnecessarily put at risk for instrument-related complications. A surgical instrument tracking system can give technicians quick access to manufacturer recommended instructions for care and maintenance. It can also allow staff to defocus from mundane jobs such as counting, writing, searching and focus on quality instead.
6. Accurate documentation.
Labels on sterile packs are the most important. An inaccurate or incomplete label compromises patient safety and can be a source of confusion for staff. Handwritten labels are prone to errors and mislabeling of surgical sets is common, especially since they are wrapped in linen and their contents cannot be seen. A good surgical instrument tracking system allows users to print pack labels which contain all the vital information required for use. Apart from labels, RFID tags attached to trays or instruments can also be read without line of sight to verify contents of a sealed sterile pack.
7. Identify and quantify instruments at handovers.
An instrument tracking system that uniquely identifies every surgical instrument via unique codes or AIDC technology ensures that treating staff know the exact number of items being opened and used on a patient. Additionally, RFID makes counting automated and easy, resulting in better compliance on SOPs. This greatly reduces chances of “Retained Foreign bodies” (0.3-1 cases in 1000).
8. Timely reprocessing of expired sets.
A good surgical instrument system can quickly identify expired items so that staff can make provisions for timely reprocessing of expired sets. Without a system, such identification is done manually by checking individual labels, a laborious task with chances of errors and omissions. Sets may lie in sterile storage much after their expiry dates, giving a false indication of inventory availability to users.
9. Easing time pressures.
The CSSD is always under pressure to quickly turn around instruments for scheduled procedures due to insufficient instrumentation. Additionally, the environment in most CSSD departments is prone to distractions when staff is called upon to resolve urgent matters, often disrupting workflow. Older hospitals run multiple sterile reprocessing areas (Theatre supply units), which sometimes lack standardization of processes. Staff may resort to risky shortcuts due to some of these factors. All these factors can be mitigated through use of systems that are “self-service” oriented and that introduce a common platform for all teams to effectively collaborate and share information.
10. Better data for patient safety advocacy
When a case needs to be made with managements about the need for instrument replacements / condemnation, lack of reliable data becomes the biggest blocker. Shortage of instruments or use of instruments much beyond their recommended age compromises patient safety. A Good surgical instrument tracking system gives deep insights into usage patterns, so that the right level of inventory can be maintained, wastages can be curtailed, and managements can be assured about the quality and maintenance of this key asset.
Well done Radhika and Adi. Wish you all happiness always.
Good Information Sir, Thanks
Very proud of you and your team….Keep it up…..
Thank you Mk
Very insightful and well written
Thank you Vineet
Nice article. This is an area which is neglected by many hospitals with disastrous consequences to the patients.