Getting on trackTracking technologies are improving supply chain efficiency and patient safety in the operating room
By Kimberly Retzlaff
Associate Editor, AORN Journal
There may never come a time when manual counting in the healthcare environment is passé, but new technologies are certainly bolstering accuracy, from inventory management to sponge counts. Developing and emerging technologies in the operating room, such as bar coding, radio frequency identification and unique device identification (UDI), offer the perioperative team a technological backup that improves patient safety, as well as the bottom line.
Bar coding
There are numerous ways bar codes are used in the hospital, including in sterile processing and supply, on dispensing cabinets for medications, on patient wristbands, and on surgical sponges.
A unique identifier and bar code allows perioperative
staff members to track sponges as they are used during
surgery, helping prevent retained sponges.
Photo courtesy of SurgiCount Medical.
Bar codes on dispensing cabinets not only bolster inventory tracking efforts, but have the financial benefit of reducing labor costs and automatically documenting medication use so it is properly billed, according to Rod Hicks, PhD, RN, FNP, CS, the University Medical Center Health System Endowed Chair for Patient Safety and a professor at Texas Tech University Health Sciences Center School of Nursing.
Combined with bar codes on patient bracelets, the best perk of bar coded medicines is patient safety because they help ensure that the correct medication is given to the correct patient in the correct dosage, he added.
In the OR, bar coded bracelets can be challenging, Hicks said, because the bracelet is on the patient’s arm, which often is beneath surgical drapes where it cannot be scanned. Removing the bracelet to scan it defeats the purpose of the technology, Hicks added, because as the patient is moved to recovery, the bracelet and subsequent scans will help with things like allergy alerts.
“Technology is a very important milestone in safety, but how are things implemented out on the patient care areas versus perioperative care areas? We don’t say no to the technology, but ask what the application is in the perioperative setting,” Hicks said.
One OR application for bar codes is for sponge counting, to help prevent retained sponges—considered by the Centers for Medicare & Medicaid Services to be a “never event.” Bar coding could easily counter the cost of implementing the system, said Ramona Conner, RN, MSN, CNOR, manager, standards and recommended practices, AORN Center for Nursing Practice.
“If you prevent one retained item in a year, it saves the organization hundreds of thousands of dollars. That’s a big incentive,” she said. “It’s why sponge counting technology is becoming so popular so quickly. Catch one or two retained sponges, and you’ve paid for the whole system.”
Bar codes may one day be used to track other devices, as well, said Ruth E. Vaiden, RN, CNOR, CRNFA(E), vice president clinical development and education, SurgiCount Medical, Temecula, Calif., and AORN past president. “We are currently looking at how to use the technology on instruments intraoperatively—counting instruments and certainly some of the other supplies that may be used intraoperatively, like needles,” she said.
Bar coding surgical instruments is possible but has some inherent challenges. “The hurdle is finding a methodology that can withstand the rigors of steam sterilization,” Conner said.
The problem is how to affix the bar code to the instrument. Metal tags are impractical, Conner noted, because they would interfere with the purpose of the instrument, and glue and tape are problematic because they aren’t able to withstand cleaning and processing through steam sterilization.
“Laser etching probably would work to withstand high temperatures, forceful sprayers, and enzymatic cleaners, although there are sterilization issues with etching,” Conner said. “Once the instrument surface is damaged, a place where bacteria and biofilms may form is created. Laser etched instruments would probably need a clear coat to recreate a smooth surface.”
RFID
In many ORs, the trend is toward using radio frequency identification (RFID) to track instruments, both in terms of locating them, as well as knowing how often they are used and when they are cleaned, Hicks said, which can improve efficiencies in the hospital. But there is a cost associated with installing the systems to support it.
“The use of RFID technology in health care is limited and isn’t seen as much [as bar coding] in hospitals,” said Sharon Giarrizzo-Wilson, RN, BSN/MS, CNOR, perioperative nursing specialist, clinical informatics, AORN Center for Nursing Practice. “There are multiple components to be installed for the RFID system to work, the tags, receivers, antennas and computers, and investments in personnel to install it and monitor its use, and expenses to train users.”
One possibility is that RFID and bar coding may be blended some day, Vaiden said, “but right now … the research and data are not there for [RFID]. Also, [RFID] in today’s economy is a little more expensive and may not be as cost effective for the OR as bar coding. You have to make sure that the solution is not eclipsing the problem with cost.”
Another possibility is incorporating RFID—as well as bar coding—data into the electronic health record. Currently, however, the technology has not been developed for this venture, but software engineers are looking into it, Giarrizzo-Wilson said.
“There’s huge potential with existing documentation systems to incorporate RFID technology,” she added. “It is a matter of the vendors and software developers working together to find a way for the technology to work with their systems.”
Unique device identification
Another concept on the horizon is unique device identification (UDI), which may be required in a final rule from the U.S. Food and Drug Administration (FDA) as early as spring 2010, according to Jay Crowley, MS, senior advisor for patient safety at the FDA. The FDA rule will likely require medical device manufacturers to code products with standardized numbers that combine the device identifier (what the product is) with the production identifier (lot or serial number, and expiration date if on the packaging) for easier product management.
Unique device identification, characterized by
standardized numbers that combines the device
identifier (what the product is) with the production
identifier (lot or serial number, and expiration date
if on the packaging) can enable easier product management
and tracking. Photo courtesy of Ethicon Endo Surgery Inc.
The catch is that this number is “unintelligent,” Crowley said, and requires data to back it up. The FDA currently is working on building the infrastructure, but it will be the industry’s responsibility to capture and maintain the information to back it up.
“Everybody downstream of the manufacturers—distributors, hospitals, payers—need to centralize on this coding concept so we’re all singing from the same song sheet,” Crowley said. “Hospitals concern me the most because they have a lot of competing demands, particularly from an IT perspective. In order to see the benefits, hospitals have to start to understand that this is coming and will really be in their best interest.”
The benefits of UDI will focus around visibility, tracking and tracing products from the manufacturer to the hospital all the way to the patients they are used on, Crowly said. From this visibility, healthcare facilities should see enhanced quality and patient safety, cost savings from reduced waste, improved supply chain logistics, easier implementation of anti-counterfeiting measures and easier recall facilitation, Crowly added.
“With the current technology, [UDI] is not achievable with instruments,” AORN’s Conner said. “We’re on the cusp, though, and we’ll see marketable ideas in the future. But right now, UDI is not enforceable for surgical instruments.”
For UDI to be a success, “Clinicians need to be advocates and work with their facilities to make this happen,” Crowley stressed. “It won’t happen all at once—it’ll be a phase in. In the surgical areas, there’s a lot of expensive things there, you see device tracking happening at a really granular level, which is great. It’s starting to happen, and I hope it will continue and grow over time.”
Getting involved
Perioperative nurses can be advocates of all beneficial new technologies in the OR, but education is key.
“[Nurses] may not make the financial decisions, but they can bring information to their directors and managers,” Giarrizzo-Wilson said. “Information needs to come not only from the vendors, but also from reading professional literature regarding new technologies and applications for practice. Every product has a benefit, but the benefits need to be weighed against the environment it will be used in.”
Hicks agreed, recommending perioperative nurses participate in vendor evaluations and ask questions about implementation in the OR. “We want the vendors who are making these devices to include nurses in their testing, so that the nurses can be appreciative of that technology,” he said.
“Technology will change the way we practice, both for better and for worse,” Hicks added. “The goal is that the technology works for us, not that we work for the technology.”
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