tracking system concepts -...
TRANSCRIPT
Tracking System Concepts An introduction to tracking systems,
data capture and databases
Tracking Systems
• Why we track activity
• What do we track
• Filing and retrieving information
• Databases
• Tracking activity into databases
• The quality management safety net
• Indentifying instruments individually
• Safety in Servicing
Topics
Tracking Systems
Why we Track Activity
•Documentation •Risk Management •Litigation Defense •Standards Require Documentation •Community / Social Responsibility
•Public expectations •A safe and controlled environment is expected
•Common Law •A duty of care exists in all services, which entails a adequate amount of documentation
Tracking Systems
Why we Track Activity
•Resources Performance monitoring
Workplace compliance
Benchmarking
Cost centre management
Tracking of related goods and services
Usage of materials
HR costs
Non conformances
Repairs and maintenance
Tracking Systems
What we Track
•Staff activity Each process is activity
Staff members are part of a process
Proper documentation includes the staff member that performed
the task
Tracking Systems
What we Track
•Instrument activity The surgical device / sterile item lifecycle
o Each time an instrument is used a set of processes occur
o These processes form a sterile
item lifecycle
o The sterile item lifecycle
happens many times in
a Surgical Instrument
Lifecycle
Entry to Service
Wrap Inspection
Repairs Maintenance
Assessment Condemnation Theatre
De-Con
Sterilizing
Tracking Systems
What we Track
•Internal Pathways •CSSD to Theatre •Theatre Episodes •Theatre to De-Con •De-Con to CSSD
Theatre
CSSD
Internal Pathways Sterile
Stores
De-Con
Tracking Systems
What we Track
Internal pathways
o CSSD to Theatre
The CSSD is a production facility
Each item that leaves the department must be checked for
conformity
o Validated sterilizer process
Validation / Biological tests
Sterilizer Parameters
o Non Conformances
Expiry dates
Failed loads
Theatre
CSSD
Internal Pathways Sterile
Stores
De-Con
Tracking Systems
What we Track
Internal pathways
o CSSD to Theatre
CSSD Store room
Multiple Store Rooms
o Current location of items
o Can see if item is in CSSD, Theatre or store
o Can even see if items are in a sterilizer or washer
Theatre
CSSD
Internal Pathways Sterile
Stores
De-Con
Tracking Systems
What we Track
Internal pathways
o Theatre Episodes
Count sheets and standard practice
Recent changes in US and Acorn Standards are moving towards
standardized counting practices
o Triple count items first
o Items categorized and always counted in same order
E.g. Hemostats first, artery clamps second etc
o Double count items second
Theatre
CSSD
Internal Pathways Sterile
Stores
De-Con
Tracking Systems
What we Track
Internal pathways
o Theatre Episodes
Newer technology allows us to etch all types of materials
Bowl sets
Black plastics
Diathermy leads
Small ophthalmic devices
Theatre
CSSD
Internal Pathways Sterile
Stores
De-Con
Tracking Systems
What we Track
Internal pathways
o Theatre to De-con
Turn Around times can be monitored
Do we really need to X-Ray everyone?
A thorough Check-in system highlights missing instruments very
quickly.
When items are detected missing early the patient can be x-rayed
sometimes before recovery
Theatre
CSSD
Internal Pathways Sterile
Stores
De-Con
Tracking Systems
What we Track
Internal pathways
o De-con to CSSD
When do we know when an instrument is back where it should be?
When is it ideal to know?
Quality Management as a safety measure
How we make this important job easy
o Using ID barcodes on instruments, Trays can be put together as
they reach decontamination area
o Trays become a electronic list very much like shopping in a
hardware store
o Items are scanned until the tray list is consistent with the list that
went to Theatre earlier
o Incomplete trays are flagged and dealt with A.S.A.P.
Theatre
CSSD
Internal Pathways Sterile
Stores
De-Con
Tracking Systems
What we Track
Sterilizer usage / validation and biological tests
Why it is important to link all cycles to a validation test
A sterilizer load may have passed its parameters but did the sterilizer validate?
A series of sterilizer loads are valid under the umbrella of the previous
validation
Is it important to link validation cycles to patients?
Part of a litigation defense claim will need to prove
o All sterilizer loads that the instruments were processed in were passed
o All sterilizers were validated and validation was current
How do we manage recall in positive Bio Tests?
Trays and their locations can be quickly listed
Reports on Positive BI’s can be produced simply and quickly
Tracking Systems
Filing and Retrieving information in a useful manner
What is the intrinsic nature of a filing cabinet?
o Items are entered in an alphabetical order, or by a pre defined singular index
o As the cabinet grows, items need to be archived off
The indexing system is difficult to manage
how do we arrange records in case a recall is necessary,?
By tray? Sterilizer cycle? By date / tray combination?
Traditional paper based Medical records are stored by patient!
o Recall is a very time consuming, tedious task
o Traditional medical records are not filed in an index based on
the need to recall all the cascaded uses of contaminated trays
Tracking Systems
Filing and Retrieving information in a useful manner
What is the intrinsic nature of a filing cabinet?
o The more items in the cabinet the longer it takes to locate records
o There is no check for consistency – records need to be very accurate to be
useful in a litigation defense claim
o How do we check for incomplete entry?
o How can we be sure that everything has been properly filled out?
Tracking Systems
Databases
What is a Database?
da·ta·base (dā'tə-bās', dāt'ə-) Pronunciation Key
n. also data base
A collection of data arranged for ease and speed of search and retrieval.
Also called data bank.
tr.v. da·ta·based, da·ta·bas·ing, da·ta·bas·es
To put (data) into a database.
Tracking Systems
Databases
o What is a database and how do they work
o A basic explanation of database is a ‘Repository of information’
A central location of data that all users connect to
Information is added in a way that doesn’t constrict the way It is pulled out
All activity is added to the database with an special ID
o Information is strung together by common threads
o Common threads are cross referenced and collated in any way
Common treads can be:
Patients
Trays
Sterilizer loads
Storage locations
In a tracking system all Technical aspects of the database are hidden from the user!
A good tracking system provides a simple, streamlined work flow
Tracking Systems
Databases
o How does a database solve many of our filing and retrieving problems?
Who can humanly search 1 million records a second?
10 years of sterilizing, repair/maintenance and theatre data can be
searched in just a few seconds
Contaminated trays can be isolated in minutes
Large summaries and reports can be created quickly
Recall emergencies are facilitated in a timely fashion
Patients that have come in contact with contaminates tray(s) can be
listed immediately
Quality Management of processes becomes a simple task
Monitoring of staff becomes a second nature
Tracking Systems
Tracking activity into Databases
How accurate can we be using a keyboard?
o Even in high end administration users, accuracy is only 80-95%
o Everyone has their own names / terms for items
Tracking systems promote standardized naming convention
How can using a scanner solve Accuracy problems?
o Barcode scanners boast over 99.9% accuracy
o A tracking system produces its own barcodes – less than 0.5% error
o All important information is entered once, and re-produced in a repetitive
consistent manner
o Scanners are very easy to use, and gather lots of information very quickly
Can be programmed to check if correct information is being scanned
Can be programmed to ensure completeness of all required information
Tracking Systems
Tracking activity into Databases
Theatre CSSD
Admin
Data Base
Theatre CSSD
Admin
Data Base
Central Reporting
Server
o Another advantage to using a database to track activity
In larger corporations Sterilizing and patient usage data can be accessed across
multiple sites
Bench Marking
Performance comparison
Cost base comparison
Tracking Systems
Quality Management Safety Net
o How does a tracking system provide a safety net?
Computers can monitor tasks and ensure completeness
Instruments must be processed correctly before moving to the next step
Errors in data is highly visible amongst a sea of consistency
o Why does activity tracking = quality management?
By tracking activity we natively introduce Quality Management
Standardized process is the key to quality
Benchmarking is the key to developing standardization
Tracking Systems
Quality Management Safety Net
o What do we typically notice about accuracy when we begin tracking hospitals
Paper based systems are difficult to quality manage
If people are not reliant on completeness, then completeness is rarely
observed
‘We don’t know what we don’t know’
We pick up on a lot of ‘exceptions’ in processes
Often processes that were not considered are not documented
correctly or not even documented at all
There is a lot of variance in people left to their own devices
People are relieved to have a standardized system that is easy to follow
People are proud to participate in quality
Tracking Systems
Identifying instruments as individuals
Why is individual identification necessary?
o Many instruments are managed in Batches, trays or groups
There are a variety of problems with this approach
Each item has its own set of circumstances
Each item has to be warranted on its own merit and when unable to
prove this it’s hard to have repairs consigned
One item is damaged… which one is it?
One of these identical items came in contact with an infected patient
and needs to be destroyed… which one was it?
o If you have an outbreak of infection and your trays have not
been kept in order how do you contain this issue?
o Cross contamination of trays is imminent without individual ID
o The longer the problem persists the worse it gets.
Tracking Systems
Identifying instruments as individuals
How does individual identification improve the life of an instrument?
o Routine inspections and servicing can be scheduled based on usage of
instruments, not entire trays
o Often servicing prevents excessive wear and tear
o Preventative maintenance proves to create safer usage results
o A documented service history forms a good litigation defense
What are the statistics on injuries from damaged devices in theatre? (TGA)
o 484 incidences in the last 6 months
151 temp injuries
61 Serious Injuries
20 Deaths
Tracking Systems
Safety in servicing
A tracking system can be used to keep track of instrument usage, hence its
servicing requirements
Each instrument has a service history that dates back to its original purchase
Before an instrument is used its integrity is checked, and service requirements are
flagged and servicing is tracked
Individual ID’s makes warrantee claims simple to prove
Diathermy insulation can be replaced before dangerous internal burns happen
Data about brands and common problems can be collated to form a intellectual
base
Tracking Systems
Conclusion
Tracking systems are becoming legislated as mandatory in the next 3-5 years
Already used widely in the USA and Europe
The ACORN standards are moving towards electronically generated
Theatre count sheets
Modern Tracking systems are a vast improvement in traditional paper-based
medical filing systems
The use of bar-coding systems increase accuracy levels beyond 99%
Scanning is quick, easy and produces standardized, consistent documentation
Good tracking systems are easy to use, and increase productivity
Tracking systems ensure complete, accurate and standardized processes
Tracking systems facilitate communication, quality management and safety