Capturing Patient Hip and Knee Replacement Implant Data

Through Barcode Scanning and Ortech

Orthopaedic OR Nursing, Orthopaedic Surgery, eHealth/ITCS

QEII Health Sciences Centre, Capital HealthHalifax, Nova Scotia, Canada

Contact Jo-Anne Douglas, joannee.douglas@cdha.nshealth.ca

Canada’s Forum on Patient Safety and Quality ImprovementOctober 28-30, 2014

ContextHip and knee replacement surgeries conducted at Halifax’s Capital Health, QEII site utilize implant devices that provide valuable information in the areas of:

patient safety

economic case costing

routine patient charting.

Through barcode scanning implant data in the surgical operating rooms we have evolved our collection and retrieval of information from a manual process to electronic while contributing to the Canadian Institute for Health Information’s Canadian Joint Replacement Registry (CIHI CJRR).      

ProblemA gap existed within Capital Health to electronically search which patient received which implant.               

Historically patient specific implant data has been stored in a PDF format within the patient’s electronic health record. Manual chart review was required to link patient and implant.

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Contribution Providing a source of searchable electronic linked patient to implant allows:

Increased Patient Safety

Ability to quickly identify patients at risk if an implant were to be recalled

Quality Monitoring and Research of Safe Effective Implants Support surgeons choosing the best implants. As a contributor to the national CIHI Canadian Joint Replacement Registry (CJRR) we are helping develop a rich set of national patient-level clinical, surgical and prosthesis information.

Sample CJRR publication:Does adding antibiotics to cement reduce the need for early revision in total knee arthroplasty? Bohm E, Zhu N,

Gu J, de Guia N, Linton C, Anderson T, Paton D, Dunbar M. Clin Orthop Relat Res 2014 Jan;472(1):162-8. doi: 10.1007/s11999-013-3186-1.

Increase Data QualityManual data entry is replaced with point of care barcode scanning for submission to CJRR Reducing chances of transcription errors and increasing timeliness of data capture

Case CostingContribute financial patient/implant costing to inform decisions that balance sustainable health care and improved health outcomes

Partnership Team of over 50 individuals from Capital Health and, Ortech Systems (vendor).

Orthopaedic Operating Room Nursing, • Implant barcode scanning at point of care

Orthopaedic Surgeons, • Case knowledge including diagnosis and reason for revisions

Operating Room and Orthopaedic Administration, • Support and training of system use. Validation of system against historical system. Establish linkages between Capital

Health departments to utilize data. Provide feedback to all other partners in the project

eHealth/ITCS • Streamlining of process by creating a registration interface with existing hospital systems.

Ortech Systems• Software supplier of web based application to collect patient and implant data. The vendor recognized that the true

experts are the people who use the product everyday and were receptive to changes.. Several of our nurses’ recommendations have been incorporated into Ortech System’s product used at other sites

 

Intervention

January 2014 – present

Hip and knee implant information is collected during surgery utilizing barcode scanners and a web based application called Ortech. Data is submitted directly to CIHI CJRR. Capital Health Orthopaedic staff have the ability to electronically search which patients received a specific implant. 

Every implant device has a product sticker included in packaging that details manufacturer, model and lot number.

Prior to InterventionOR nursing staff transferred the product stickers onto paper forms which were manually entered in a database for submission to CIHI and scanned as a PDF into patient’s hospital chart.

Measurement

100% of our elective surgical cases for submission to the Canadian Institute for Health Information’s,

Canadian Joint Replacement Registry (CIHI CJRR) are completed through barcode scanning rather the use of

paper and sticker transcription.             

LessonsThe right partners are essential to provide content expertise

Example - OR nursing staff’s suggestion to display the count of implants was integrated into Ortech acting as a quality check for devices captured. A technique that is similar to their practice of counting equipment/supplies during surgery.

Example - Capital Health eHealth/ITCS was able to automate patient registration of demographic data through integrating an existing hospital system with Ortech. The need for manual patient demographic transcription was replaced providing time efficiency efficient and fewer transcription errors.

Communication and ongoing support is vital.Example - Follow up training sessions allow for processes to be standardized when the staff using the program have the opportunity to provide feedback on what works and what needs to be changed to make the process better.

Ongoing support and auditing is necessary to ensure qualityExample - An audit identified that patients with certain orthopaedic case types were not being registered. Follow up with eHealth/ITCS and Ortech was necessary to update the registration interface to include the missing case types.