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Safety through surgical instrument tracking
Glen Hodgson, head of healthcare at GS1 UK, explores how GS1 standards are helping NHS trusts identify individual instruments used in procedures - improving patient safety and inventory management
The ability to match patients to the care they’ve received forms the foundation of many of the policies and legislation we’re seeing come into play around the globe. Whether it’s the Department of Health’s eProcurement strategy, the Falsified Medicines Directive or the recent EU Unique Device Identification regulations, the future of the whole healthcare system depends on us being able to track and trace every person, product and place in it. And when we do, we know we improve patient safety, we reduce clinical variation and we increase operational efficiencies.
What all the legislation and policies have in common is that they recommend the use of GS1 standards to provide unique and accurate identification – they’re the most implemented global standards system of their kind, endorsed by the Department of Health, NHS Digital, NHS England and the Medicines and Healthcare products Regulatory Agency (MHRA).
While they’re now being rolled out across the NHS, one of their first applications was for surgical instrument traceability and management. One of the main reasons for this was the risk posed by cross-contamination between patients, for example with variant Creutzfeldt-Jakob disease (vCJD). There are at least nine million individual surgical trays in circulation in the NHS at any one time, and hospitals need the reassurance that they’re being managed and identified effectively in order for cross-contamination not to happen.
In the UK, the Department of Health and MHRA guidance states that hospitals need to track instruments to at least tray level. But many hospitals choose to take this further, with each individual instrument uniquely identified. In an ideal world, the same instruments are kept in the same tray but this can be challenging to achieve – identifying each instrument means trusts can be certain of what instruments have been used on which patients.
More specifically, this involves the global and unique identification of each instrument tray or individual instrument, depending on the level the hospital requires. Each tray or instrument is identified by a unique GS1 Global Trade Item Number (GTIN), plus other information such as a serial number and an expiry date. On top of this, every component of the set needs a unique asset number – a GS1 Global Individual Asset Identifier (GIAI) – so that each instrument can be traced accurately to a procedure.
Using GS1 barcodes, this means all items are traceable from production to the point of care. It gives that certainty of truth of knowing exactly which instrument has been where, and which person it’s been used on. For patient safety this is vital, but it also helps save money – lost instruments can cost a 500-bed hospital over £100,000 per year.
University Hospitals of Morecambe Bay NHS Foundation Trust
Like many trusts, University Hospitals of Morecambe Bay NHS Foundation Trust (UHMB) was having trouble managing its surgical instruments, with tracking and tracing of single instruments proving difficult from decontamination through to the patient. It was using a method of 1D instrument marking and it was becoming unviable, due to the size of the barcode label and the size of the instruments needing to be identified.
The trust knew GS1 standards could provide the solution, not least because it had been recommended by the Department of Health; but the question was which technologies to use. There were a number of options available. The barcode for surgical instruments is the two-dimensional GS1 DataMatrix symbol, but there are a number of ways to mark this. The most frequently used include dot peening, laser etching, electro-chemical etching, and ink jet marking. UHMB chose dot peening, a method of marking instruments with GS1 2D DataMatrix using a diamond-tipped stylus.
The use of this technology by UHMB has enabled it to identify every single instrument it has, tracking and tracing them from decontamination to patient use. It gives the trust a full history of every single instrument used on a patient and means it has an accurate inventory of all the instruments it has on site – increasing patient safety and making its asset management more efficient.
Derby Teaching Hospitals NHS Foundation Trust
Derby Teaching Hospitals NHS Foundation Trust (DHFT) has taken this even further. Three years ago, it was running low on theatre space and needed a cost-effective solution. The trust introduced GS1 barcodes not only as a way of managing its inventory, including surgical instrument trays, but of tracking everything that takes place during a procedure. It scans the patient, the location, who is present and what job they’re actually doing, the type of anaesthetic used and anything that happens to the patient, in particular anything that’s implanted. This gives the trust full traceability, meaning that in the case of a product recall it can identify all patients that may have been affected. Before GS1 implementation this could take DHFT around 50 hours per patient, now it takes 30 minutes. And, it now earns over £1 million extra per year through the increased accuracy of its recording of OPCS codes.
Another benefit of this approach is that using barcodes has integrated its inventory management solution, product catalogue and financial system – automating the creation of orders to the trust’s suppliers, based on its actual usage of products and supplies. It’s reducing waste, saving £1.2 million in 2016/17, and saving valuable clinical time that had been spent ordering stock. Barcode scanning also gives the trust a lot of data, it’s now recorded over 97,000 theatre episodes recorded – information it can use to better understand patient outcomes and differences in clinical treatment.
This data also has huge implications for surgeons preparing for operating procedures. If someone comes to them who has been operated on previously at DHFT, they can know exactly what treatment that patient has received and what instruments they might specifically need to use. This could be, for example, someone who has had a facial reconstruction involving titanium plates and screws. The surgeon will know what screws were used and therefore what type of screw head to expect – invaluable in the preparation of trays for surgery.
The future of care
The benefits of tracking and tracing surgical instruments have implications for the whole healthcare system, and trusts like UHMB and DHFT have proven this. What has started as a better way to manage inventory in theatres can actually lead to a safer, more efficient system throughout a whole hospital – DHFT are rolling out scanning to their wards at the moment. With the NHS increasingly being asked to do more with less, new ways of working that save money whilst also increasing patient safety are vital for the future. The Department of Health recognises this, which is why they’ve mandated that all acute trusts in England, and their suppliers, are GS1 compliant by 2020. The level of traceability available for surgical instruments is just one example of how the whole healthcare system could operate. And, with increasing numbers of regulations and government policies backing GS1 standards, it’s the future of care.