Use of scanning technology in theatres to improve efficiency

Royal Devon University Healthcare (RDUH) NHS Foundation Trust had recorded theatre implants and disposable supplies at a patient level for many years. This involved a laborious manual process, with staff typing product codes into an online database.

The repetitive entry process sometimes resulted in missing items, erroneous item selection and incorrect/missing lot numbers and expiry dates.

Situation

In 2020 the Trust introduced an electronic patient record. They moved multiple IT services from legacy systems onto a single software solution. The project brought major equipment upgrades with new PCs, additional scanning peripherals and improved network infrastructure. This afforded new opportunities to improve workflows.

Many medical supplies have a Global Trade Identification Number (GTIN) encoded in a GS1 barcode. This barcode often contains useful additional information such as lot numbers and expiry dates.

Aspiration

Use scanning technology in theatres to capture and link “devices, people and location”.

• To implement a digital scanning solution using implant and supply GTIN product identification numbers.
• To leverage data items contained within the GS1 barcodes to collect lot/batch numbers and expiry dates.
• To automate implantable device registry submission.

Solution

Scan4Safety (S4S) was set up across 6 pilot sites in 2016 by the Department of Health and Social Care (DHSC), focusing on scanning for inventory management. Scanners are used to track and record medications, equipment, supplies, implants, blood products and patient movements.

In 2021, a team in NHS Transformation Directorate has worked with 5 pilot Trusts to explore the barriers and best practices at each stage in the journey to scanning at the point of care. They found that scanning in theatres, at the point of care provides additional patient safety and financial benefits to Trusts.

• GTINs were sourced from imported manufacturer lists, national and international databases, supplier catalogues, other NHS hospitals and by direct scanning of current items.
• Supply and implant lists are uploaded to the EPR by regular manual imports from the Trust’s Materials Management System (MMS).
• The Trust worked with a third-party consultancy (PSC digital) to accelerate GTIN collection.
• The EPR software (Epic Systems Corporation) allows direct barcode scanning of GS1 codes into relevant sections of the patient record.
• The same hardware is also used to scan supply and implant barcodes, medication packaging, blood products, patient wristbands and to associate patients with medical devices (monitoring, infusion pumps etc).
• The software extracts each data item, identifies the product and enters it into the appropriate field.

Technology roll-out:

• The scanning process has been introduced in pilot areas starting with urology, vascular theatres and cardiology labs.

Impact

Scanning at the point of care offers a wide range of benefits. Organisations can make individual decisions about how much they scan; the more items scanned, the more benefits are realised.

Efficiency benefits:

• fast scanned data collection frees staff from manual information entry.
• improved data accuracy.

Patient safety benefits:

• scanning identifies expired and recalled devices, supplies and medications.
• allows tracing of impacted patients in a recall within seconds.
• accurate device implant history visible in patient EPR gives data on long term outcomes.

Improved trust operational pathways:

• better episode level costing and outcome analysis.
• improved whole service cost benchmarking.
• just in time re-ordering of supplies and implants.
• increased visibility of wastage costs.
• better procurement data.
• efficient and trustworthy submissions to implant registries.

Functionality

The system:

• works on Trusts computers using USB or wireless handheld scanners.
• allows procedural staff to document supplies and implants by scanning product barcodes.
• maintains coherence between the EPR and the MMS by regular file imports and exports.

Capabilities

The system:

• records the exact item used.
• records additional data from the GS1 barcode supplies (lot numbers and expiry dates) ready for submission to implant databases.
• informs staff when items have expired.
• can display costs for each item.
• allows documentation of wasted items.

Scope

• Scanning can be used in any organisation needing to streamline real time acquisition of barcoded patient, supply and implant data.
• With intelligent design, the same software and equipment can be used to scan supplies and implants, record patient movements, deliver bar coded medication administration (BCMA) and provide part of a safe blood transfusion solution.

Next steps:

• Wider roll out to other theatres.
• Automating implant report submissions to national databases.
• RDUH will be moving to a new materials management system.
• They intend to create an interface to provide a real-time link between this and Epic.

Key learning points

• GTIN barcodes should be obtained for all items and maintained by the procurement department.
• There should be a single source of truth for supply and implant types – this should be the Materials Management System.
• Messaging between the Materials Management System and the Electronic Patient Record should be frequent – an interface is preferable over manual import/export files.

The project team should include representatives from:

• procedural area senior nurses.
• procurement/Materials Management staff at organisational and theatre block level.
• EPR configuration team and IT interfaces team.
• EPR and Materials Management software supplier technical support staff and developers.
• a third party interface system if needed.

The system should be configured to handle:

• multiple suppliers for the same item.
• recalls of supplies/devices.
• price changes and differential pricing between procedural areas.
• temporary replacement supplies.

Digital equalities

The system is used by NHS staff with equity for all patient groups.

Key figures and quotes

• Staff report satisfaction with the faster documentation process.
• It has greatly increased recording of batch/lot numbers and expiry dates.
• The system has already identified drugs and equipment which had passed their expiry date.
• The system has reduced implant documentation time, for example by up to 5 minutes per case for busy urolift procedures.

Find out more

Scan 4 Safety

GS1 barcodes

GTIN barcode lookup (US)

Key contact

Dr Alastair Martin, Consultant Anaesthetist, Senior Medical Information Officer, Royal Devon University Healthcare NHS Foundation Trust

alastairmartin@nhs.net