實踐中的精確性：器械管理是成本控制和安全改進的關鍵.pdf

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1、PRECISION IN PRACTICE:INSTRUMENT MANAGEMENT AS A KEY TO COST CONTROL AND SAFETY IMPROVEMENTJuana Bez HernndezGrupo Sanitario Ribera(Spain)When the operating room loses,the laundry wins:two tons of misplaced surgical instrumentsThe law of large numbersEquivalenceTotal weight of instruments found in t

2、he hospital laundry 2,000 kgAverage weight per instrument box8 kgAverage numberof instruments per box40 Units.Average cost of surgical instruments$83Approximate number of instruments in the laundry 10,000 Units.Estimated value of instruments found in the laundry$826,478Code Red from Surgery Area:Whe

3、n Asking Turns to DemandingUnveiling the Pillars of Their ArgumentWorkflowWorkflow disruptiondisruption:The absenceof necessary instruments can lead to delaysoreven thecancellation of procedures,impacting not only thepatient and theircare process but also theefficiency of thesurgical unit and resour

4、ceutilization.Operational risksLegal and Compliance RisksIf theabsenceof properinstrumentsleads to harm orinjury,theorganization may facelegal claims.12RegulatoryRegulatory nonnon-compliancecompliance:The lack of specific instrumentsmay resultin thefailureto meetregulatory standardsand guidelines.Le

5、gal Legal liabilityliabilityUnveiling the Pillars of Their Argument Errors:Withoutthe appropriate instruments,healthcareprofessionals maybe forcedto improvise oruse less suitable tools,which can compromise the qualityof the procedures performed.Fatigue and emotional overload:The constantlack of inst

6、rumentscan lead to frustration and stress in the healthcare team,increasingthe riskof human error and deterioratingthe workenvironment,potentiallyaffecting long-termstaff retention.Safety and QualityRisks3Unveiling the Pillars of Their ArgumentPerceived Qualityand Reputational RiskLongLong-termterm

7、consequencesconsequences:Reputational damage can have lastingeffects,influencing patient choice and relationshipswithother medical professionals and institutions.Negative Negative perceptionperception byby patientspatients and and familiesfamilies:Delays,failures,orcancellations during procedures ma

8、y lead to a lack of trust from patients(inability to manage resourcesand maintain quality standards),whichcan damage the institutions reputationand affectoverall satisfaction(perceived quality).4Absolutely spot-on.yet thats not allDirect CostsEFinancial RiskAbsolutely spot-on.yet thats not allEconom

9、ic Impact:Hidden Costs 1HypothesisHypothesisHospital with 10 operating rooms.2FrequencyFrequencyOne surgeryper weekper operating roomrequiresopeningan additional surgical box given a failure in the contents of the main box.3TimeTime-relatedrelated ImpactImpactA 10-minute delayoccurs each time an add

10、itional box mustbe retrievedand openedfor this reason.Absolutely spot-on.yet thats not allDelay Costs-HiddenCostsDelay in minutesDelay in minutes10CostCost per minute of per minute of operatingoperating roomroom time*time*:$13,70Total Total costcost per per operatingoperating roomroom delaydelay:$79

11、,221*Accordingto ratespublishedin the OfficialBulletinof the Principalityof Asturias(BOPA)-May 2023.1Lost time8787 hourshours wastedwasted in in searchessearches Lost workdays12 12 workdaysworkdays lostlost,basedbased on 7on 7-hour hour shiftsshiftsTotal cost per operating room delayTotal cost per o

12、perating room delay*:$80,885*Restated value applying growth rate in Spain.2Absolutely spot-on.yet thats not allCostsof UnnecessaryReprocessing-HiddenCostsNumberof unnecessarilyreprocessedsurgicalbox:520Average sterilizationcostper surgicalbox:$25.5-$31.8*$13,260Total costof instrument reprocessing:*

13、Data extractedfromthe articlepublishedbyStokertat the Universityof Chicago Schoolof Medicine in 2014:“Assessingthe Magnitudeand Costsof IntraoperativeInefficienciesAttributableto SurgicalInstrumentTrays.”Update Total costof instrument reprocessing:$17,678*Average sterilizationcostper surgicalinstrum

14、ent:$0.51-$0.62*Average surgicalinstrumetsper surgicalbox:50*Restated value applying U.S.growth rateEconomic Impact:Hidden Costs Absolutely spot-on.yet thats not allTotal Cost:$98.563?Summary-ConclusionsSurgical InstrumentInvestmentSterilization consumption,disposable materials,and productsHuman res

15、ourcesexpenditureRisksSurgical WaitlistEquipmentmanintainaceand repair costs?1.The optimization of surgical instrumentsWhat does it mean specifically?Reviewand Complete InstrumentboxVerifythe contents of eachsurgicalbox.Completeinstrumentlossesaccordingto the standard inventory.InstrumentMaintenance

16、Assess theconditionofeachinstrument.Repair and/or sharpeninstrumentsthatare in poor condition.Replaceinstrumentsthatcannotbe repaired.RustPrevention and RemovalRemoverustfrom affectedinstruments.Implementmeasures to preventcontaminationamongitemswithinthe samekit or box.Lubrication and Functionality

17、TestingLubricateallinstrumentsthatrequireit.Conductfunctionalitytests oneachinstrument.InventoryAdjustmentsIncreaseor adjustthe inventoryof instrumentboxes to alignwith the surgicalschedule.Ensureadequatetime forthermo-disinfection and sterilization.12345What does it mean specifically?Inventory and

18、Classification Conducting a detailed inventory of accumulatedinstruments.Classifying by type.Condition Assessment Determining whichinstruments are in usable condition.Identifying items that require repairormaintenance.Reintegrationintothe Usage Cycle Reincorporating into the active inventory of the

19、surgicalarea.Redistributing instruments based on actual needs.Establishing safety stock withexcess inventory.123Surgical Instruments in Laundry?2.Seekinganintelligent solutionforthecontrol and managementofsurgicalinstrumentsWhy?DetailedRecord KeepingDocument for each box or set of instruments:conten

20、ts,unit cost,condition,surgical specialty,or storage.Uniqueand UnambiguousIdentificationInitially,uniquely identify each instrument box with a label containing codedtraceability data.Subsequently,coding can be applied at the instrumentlevel.Process TrackingRecord all processes applied to the instrum

21、ents:washing,disinfection,assembly,and sterilization.Quality ControlInclude results of quality control measures,responsible parties forsterilization processes,sterilization dates,and expirationdates.Advantages-BenefitsTotal inventory controlUpdate the status of instruments in the system to indicate

22、repair,replacement,orloss,allowing forloans and exchanges to replacedamaged instruments whilemaintainingmaintaining a a controlledcontrolled and complete and complete inventoryinventory.Loss ControlKnow the exact numberof losses by type and specialty foreffectivemanagement and improvement.Location o

23、f InstrumentsContinuousknowledge of the location of materials,both contained in boxes and loose,along withthe ability to manage theirstorage.Dynamic Inventory123 Management ofShipmentsfor:Marking,Repairand ReplacementAlways knowing theiroriginal box allowsthem to be placed back in the same location,

24、thus preventing losses.Maintenance ManagementAgile and Automated,Optimizing Times and Processes.Accurate information is obtained regarding the repairand replacement costs of each instrument.It allowsfor tracking the numberof repairsfor an instrumentto assess its profitability.This enables informed d

25、ecisionsregarding maintenance management and the acquisitionof new instruments.45Advantages-BenefitsTotal inventory controlExtraction ofSpecificDataThe use of a unique code for box assembly,along with specializedreaders,ensures that each box arrivesin the operating room with the correct instruments.

26、Thispreventsunnecessary reprocessing,thereby enhancing efficiency in the sterilization departmentprocesses.Numberof instruments by type,reference,manufacturer,orcondition,allowing the center to understand the entirety of itsinventory and make purchase requestsaligned withits needs.Detectionand Elimi

27、nationofCostsDue toUnnecessaryProcesses6 67 7Advantages-BenefitsTotal inventory controlTraceability of Surgical Instruments1Computerized DatabaseMaintains a computerized database that includes a detailed and comprehensive record of all processes conducted in the Central Sterilization Unit.2Reconstru

28、ction of HistoryThisallowsforthe precise reconstructionof the usage history orlocation of an item orproduct.Comprehensive TrackingFacilitates tracking of expirationdates,usage,processes,and qualitycontrol of sterile products and responsible parties in the process.3Advantages-BenefitsIntegration ofth

29、e InstrumentManagement and Traceability Systemwith the Electronic HealthRecord(EHR)Why?The integration between both systems establishes feedback throughreciprocal data transfer1.Management System2.Medical RecordIntegrates all the processes integrated into thereprocessing,as well as all the surgical

30、proceduresin whichthe instruments have been orare currently involved.Not only is the instrumentation used in a surgicalprocedure recorded,but also all data related to theprocesses to whichthe instrumentation was subjectedin the Central Sterilization Unit prior to its use.Thisincludes quality control

31、s and the parties responsibleforthe processes.Technicaland OperationalEnhancementofSafety3.Dual Database4.Discrepancy ReportA dual database is generated,allowing us toextract various reportson surgical and sterilization processes orthe relationshipbetween both processes.Its communication system inte

32、grates a securityfilterthat automatically generates incidentreportswhendiscrepancies in data between bothsystemsoccur,allowing forreal-time review and resolutionof potential recording errors that wouldotherwise be impossible to detect.Integration ofthe InstrumentManagement and Traceability Systemwit

33、h the Electronic HealthRecord(EHR)Why?Multidirectional Traceabilityof InstrumentsWith a singleclickAdvantages-BenefitsAll instruments used witha patient in one ormore surgicalprocedures,the processes to whichthey were subjected,and therequired quality controls.All instruments sterilized togetherwith

34、the patients and thesurgical processes in whichthey have been used,orif they havenot yet been utilized.Previous and subsequent surgical processes and the patients withwhichinstruments have been involved.Thissystem allowsfor quick identification of whether anincident isrelated tothe sterilization pro

35、cess.Thus,appropriatemeasures can be taken immediately.123It allows the identification of:GreaterControl and Improved Management of SurgicalInstruments:Sustainability/Efficiency-Quality-SafetyDetection and EliminationofUnnecessaryCostsReprocessingCostsDelayCostsCosts for Overtimeor Extended Shifts t

36、o Containor Reduce the SurgicalWaitlist(LEQ).Profitability AnalysisNumber of Uses:The quantityof times an instrumenthas beenreprocessedor utilizedis analyzed.Identificationof Obsolete Instruments:Obsolete or rarelyusedinstrumentsare identified,optimizingresources.Profitability:The number of repairsa

37、nd uses of an instrument(process)is studiedto evaluateits profitability.Optimized Purchases:Inventory Analysis and Adjustment toActual NeedsEffective Management:Optimizingresources,avoidingunnecessarypurchases,and ensuringthe availabilityof necessaryinstruments.Enablesstrategicdecision-makingregardi

38、nginstrumentmanagementand resourceoptimization.Costs and investmentsare established.132Advantages-BenefitsImprovement in Surgical Planning4Process Optimizationand Safety forthe Professional5With precise information on the usage and condition of instruments surgical planning can be improved.GreaterCo

39、ntrol over PreventiveMaintenance.ExactLocationof All Instruments.Box ClosureControl:Ensures thatboxes are always closedwith the correspondinginstruments.Efficiencyin the OperatingRoom:Prevents unnecessaryopeningof boxes in the operatingroom,optimizingworkflow.Reductionof RecordingErrors.Identificati

40、onof Process-ResponsibleParties:Central Sterilization+OperatingRoom.IncreasedAccountabilityfor Losses.Safety and Protection forthe Patient6MultidirectionalTraceability.The possibilityof cancellations or suspensionsis reduced.ImprovementoftheSurgicalWaitlist.GreaterControl and Improved Management of

41、SurgicalInstruments:Sustainability/Efficiency-Quality-SafetyAdvantages-BenefitsSomething else before leavingHidden Hidden Costs Central SterilizationPlant.Impacton CarbonFootprintand the EnvironmentElectricityConsumption*TOTAL CONSUMPTION PER BOX:15.5 KWH*TOTAL CONSUMPTION PER BOX:15.5 KWH*1 KWH=0.2

42、46 Kg 1 KWH=0.246 Kg CO2CO215.5 kWh=15.5 kWh=3.51 kg CO2 toto reprocessreprocessa box ofofinstrumentsinstruments.1Equivalences:Driving a gasoline-powered car for approximately 14.5 km.Using a 10W LED bulb for about 120 hours.Gas consumption of a small house for 2-3 days in winter.Total Litersfor Cle

43、aning,Thermal Disinfection,and Sterilizinga Single Box:39.1 L*Average Water Consumption per Person over a 20/26-DayPeriod!Water Consumption*2*Data extraction:SterilizationCenter,Los Arcos del Mar Menor Hospital(Murcia,Spain).Study conducted by the Nursing Area Supervisor,Carmen Pilar Navarro(2022-20

44、24).*Source:Equipment technical data sheet.Verified and validated.SOmethingelse before leavinG*Data extraction:SterilizationCenter,Los Arcos del Mar Menor Hospital(Murcia,Spain).Study conducted by the Nursing Area Supervisor,Carmen Pilar Navarro(2022-2024).*Source:Equipment technical data sheet.Veri

45、fied and validated.Chenmical products*EstimatedAverageConsumptionin ReprocessingEachSurgicalBox in a Hospital with 10 OperatingRoomsis 0.06 L*:20,000 boxes 1,200 LIt is estimatedthatthe averagematerial usageper per reprocessedreprocessed boxbox,whetherTST paper,polyethylenesheets,mixedpaper,or Tyvek

46、,is 50 grams:20,000 boxes 1,000 kgSOmethingelse before leavinG34Poorly controlled disposal could contaminate up to 1.2 million liters of fresh water-Filling of half an Olympic pool-This could severely affect aquatic life in an area equivalent to 10 soccer fields of a freshwater ecosystemStackedStacked,they could reach the height of a 3a 3-4 story building4 story building.If they were single-use plastics,this waste could take up to 500 years to fully degrade in a landfillConsumable Materials*SYUCKAHTOMNOHU