191 - Optimizing a Real Time Locating System for Surgical Services
Clinical Issue: A Real Time Locating System (RTLS) was implemented in 2015 but was not optimized. The original implementation lacked adequate tagging processes resulting in inaccurate real time information. Since displayed information was often delayed or incorrect, the RTLS was not utilized for its intended purpose and was not functioning as an asset to our daily workflow. Description of Team:The RTLS optimization team consisted of registered nurses, informaticists, and surgical services leadership. Preparation and Planning:Planning took several months. The primary goal of optimization was to have 100% of OR cases tagged. Meetings were held with frontline users including OR staff and charge nurses, OR leadership and Information Technology (IT). Process mapping of current vs. ideal state guided the work, and identified barriers to tagging that would need to be addressed within the optimization project.
Assessment: With only 55% of cases being tagged, necessary information was poorly communicated between departments. There was not a tag tracking process in place, and tags were lost. Lost tags left insufficient supply to tag all daily cases. Paper schedules allowed staff an alternative to the RTLS, but did not assure accurate, timely updates. The system was not meeting the individual needs of all units, leading to less utilization. Staff retention of how to use the system had waned, and required remediation. Implementation:Implementation was phased over several months. Barriers were removed. New tags were ordered and labeled. Process changes for new tag tracking, and patient tagging were developed, with specific roles and responsibilities outlined. Staff was educated and coached in real-time to success. An online training module was developed. An electronic reference tool was made available in the system for immediate reference. Notifications were created to show when to send for surgical patients and paper schedules were eliminated. Department specific free text notes were added, as were icons for things such as: special needs patients; regional candidates and study patients. These enhancements were all at the request of OR staff. Outcome:Before implementation in June 2016, only 55% of cases were tagged, over 50% of tags were lost, calls to the OR control desk averaged 12.6K, and the average paper cost was $20.5K. After optimization, by June 2019, 99% of cases were tagged, only 2% of tags were lost, calls to OR control reduced to 8.8K, and the average cost of paper was $12.6K. Implications for Perioperative Nursing: Technological practice change requires collaboration among nursing, informatics, physicians and educators. All new processes require a clear implementation plan with committed owners to establish roles, responsibilities and accountability. The voice of the perioperative nurse is essential to identifying barriers within a new process and shared decision-making will contribute to overall effectiveness and staff adoption of new practices