Description: Clinical Problem:We had a problem in our OR's where wrong implants, wrong laterality and expired implants were being opened by company representatives before the circulator and or scrub could verify with the surgeon to have the implant opened. Company Reps were quick to open boxes and throw away boxes before confirmation with surgeons were made, stickers were handed off to circulators for documentation. In most cases the circulators do not immediately document the implant till later only to realize the wrong size, laterality or expiration date is wrong. Company reps were being allowed any sterile package in the OR's because most times the circulator is alone without a second helper and running around getting instruments or supplies for anesthesia or for the field.
Background: We had three instances in our OR's where the wrong laterality, wrong size and an expired implant was put in a patient. It was then when the Risk management team decided with the help of our director, educator and service line leaders to do something about this problem. It wan not only happened in an Orthopedic case, but a general case where a port-a-cath was placed.We asked ourselves how did we let this happen, patients depend on us to protect them from harm and give them the best care possible. Preparation and Planning: First we needed to have the company reps take a step back and not be allowed to open anything in the room to the sterile field. We then use the procedure where the rep shows the "box"(implant) to the surgeon to confirm size and laterality and expiration date. The circulator then shows the scrub the "box" and proceeds to write this information on a white board in the room for all to see what is being opened. The circulator confirms with the surgeon that is indeed what he/she wants as an implant and the "box" is opened to the sterile field. This is what we called our "TELS" project.We then implemented the TELS project. This stands for T: type of implant, E: expiration of implant, L: laterality, S: size of implant. Knowing not every implant will have all aspect of the TELS, some have no laterality, but this nonmonic is used for every implantable device used in our ORs, for every service.A white wipe board was created and placed in all OR rooms for use in all cases identified as a "TELS" case, meaning implants,. There was a learning curve involved with all staff, surgeons and especially company reps.The results from our six month audits show that no wrong implants are being opened or implanted in our patients. Everyone is following the sequence and it has become second nature in these cases. Cases are getting completed in the same time frame as before, but in a safer manner. The conclusion we have is to keep in house implants inventories current and all consignment implants being brought in current and updated. We continue to check expiration out dates often and not keep out dated products on the shelf. Every new employee is educated on this practice.