COMMENT: Life before RFID tagging

Annette Turnpenny, senior healthcare planner at Essentia, talks about the benefits of equipment tagging in hospitals from the point of view of one of the devices

Annette Turnpenny

I am a compact ambulatory syringe mini infusion pump – small, beautifully formed, and very efficient at my job, which is to deliver pre-determined doses of medication over a period of time via a syringe to a patient who is not bedbound.

My trust recently introduced an asset management system with linked RFID tagging, and this has changed my life completely.

Following extensive discussion between trust executives and the biomedical and hospital engineers it was agreed that equipment would no longer be ‘owned’ be a ward or department

Before I received my Radio Frequency Identification (RFID) tag I was ‘owned’ by a ward, which was supposed to look after me and utilise me to my full capacity. But often the ward didn’t have any patients who needed me and I sat at the back of a shelf in the equipment store for weeks on end. Often I couldn’t see anything but the back of another piece of equipment that had been put on the shelf in front of me!

Sometimes staff would come and look for me, but there were times when they couldn’t see me and assumed I had moved to another ward with a patient and not been returned.

I regularly missed service dates where I would have a deep clean and all my parts and circuits would be tested, so eventually I got a coat of sticky drug residue and dust and I was no longer beautiful.

Sometimes a member of staff would come and re-organise the equipment store and they were always surprised to see me and nearly always had to change or recharge my batteries before I could be used again. That usually involved a trip to the biomedical engineering department if I couldn’t be recharged on the ward.

They can also plan, potentially, to reduce their asset holding over time as the model of ‘sharing’ becomes more accepted and embedded

One day I was ‘resting’ at the back of the shelf wondering when I would get a chance to do my job and help a patient with their recovery when one of the biomedical engineers I recognised from my infrequent visits to his department came in with a hand-held device and scanner and started examining all the medical devices, scanning our barcodes – if we had one still – and checking his database.

Someone from the hospital engineering team came in and started a similar exercise of the non-medical devices such as patient transit chairs and bariatric commodes.

The engineer, Charlie, seemed really surprised to see me and commented to himself that I had been marked down on the database as being lost and not serviced for two years. I hadn’t realised it had been that long.

This exercise, I gathered from the chat between Charlie and the hospital engineer, was being carried out to locate all equipment across the trust, cross reference it against the current equipment databases and finance departments asset register (which for some reason is often different to the one held by the biomedical and hospital engineering departments), undertake an exercise to ‘weed out’ those of us past our useful life and plan our retirement, plan a catch-up maintenance programme on those of us who have been missing in action for some time, and identify the number of RFID tags required by the trust in order to have a comprehensive asset tracking system.

The initial cost of the RFID tracking system will be dependent on the size of the organisation, level of equipment needing to be tagged, and whether a Real Time Logistics Solution system is purchased at the same time

I stayed in the engineering department while this exercise was carried out, had a comprehensive service, my details were updated in the new asset management system, and eventually I received a brand-new RFID tag.

The Trust had decided to introduce RFID tagging and a more-robust asset management system because they didn’t have a clear picture of the value of their assets, how old they were, when they needed to be replaced, how much backlog maintenance there was, and whether the devices were being used effectively.

Following extensive discussion between trust executives and the biomedical and hospital engineers it was agreed that equipment would no longer be ‘owned’ be a ward or department.

Clinical staff were consulted to agree a base level number of items and types of equipment they used on a regular basis based on casemix and patient volume i.e. infusion pumps, nebulisers, vital signs monitors, ECG units, also equipment that is designed to be portable and relatively low cost such as infrared or tympanic thermometers and these devices were initially allocated to each area as per the guidelines agreed.

The remainder of the devices would be held in either a clinical or non-clinical equipment library. A list of exceptions to this rule was developed and included, among others:

  • Dialysis, Heart Lung, Anaesthetic and Ventilation equipment which would always be stored close to the point of use to ensure no disruption to health functions
  • Equipment that could be damaged by excessive travel i.e. mobile image intensifiers
  • Required extensive set-up or calibration i.e. perfusion pumps
  • Difficult to transport i.e. operating tables
  • Equipment that must be held locally i.e. life support equipment

I was allocated in the first tranche to an area I had never been before and was put to immediate use.

When my patient was discharged I had a clean and a check by the ward staff to make sure nothing obvious was broken or missing and I was put into the equipment store.

“Here we go again”, I thought, but after a couple of days I was collected by Charlie and taken to the biomedical engineering department so that I could be cleaned and checked more thoroughly. I wasn’t due a service on this visit, but once checked over I was available for allocation somewhere else.

One hospital case study published on the Harland Simon website references a request for 50 additional ambulatory syringe infusion pumps at a trust that had 40 on their equipment database of which they could only identify the location of four

The reason Charlie had pro-actively come and collected me was because my RFID tag had registered that I was no longer in a bed space i.e. not attached to a patient and I had been in the equipment store for a few days, which triggered a flag that I wasn’t being used and could be utilised by another department if required.

If the ward I had been on needed me again, they could just ring the equipment library and if I was available I would go back to that ward, but if I wasn’t available one of my colleagues would be dispatched, either from the equipment library or another area where they weren’t being used at the time.

I have been to so many different wards since the RFID tagging system was introduced and I feel I am contributing to the effective treatment and management of patients again.

The patient benefits from having access to well-maintained medical devices when required and the trust benefits because they have usage data and can plan their equipment replacement programmes with accurate data supplied via the asset management system.

They can also plan, potentially, to reduce their asset holding over time as the model of ‘sharing’ becomes more accepted and embedded in the hospital culture and confidence grows that equipment will be readily available when required.

These benefits also contribute to improved staff productivity, faster patient turnover, and more cost savings.

The initial cost of the RFID tracking system needs to be considered in terms of the longer-term benefits to the organisation and will be dependent on the size of the organisation, level of equipment needing to be tagged, and whether a Real Time Logistics Solution (RTLS) system, which allows you to track items/people in real time, is purchased at the same time.

A recent comprehensive, combined RFID/RTLS implementation in a 783-bed hospital in Australia cost in the region of £1.4m, but it doesn’t have to be a ‘big bang’ approach as it is possible to do a phased implementation over time to balance the RFID System costs against the year on year equipment cost benefits.

Here are some example costs of typical items of equipment that could be better utilised and overall numbers reduced as a result of centralised management and RFID tagging, excluding VAT, framework contracts, and volume discounts:

  • Portable Nebulisers – £100-150
  • Vital Signs Monitors, depending on specification – £1000-10,000
  • ECG Machines – £5,000
  • Single Channel Volumetric Infusion Pump – £775-1000

Hospitals may have hundreds of the above items that have been purchased over time and a review of these numbers, age, utilisation etc and the development of a replacement and withdrawal programme could make a significant difference to annual capital spend and the ongoing revenue spend on maintenance.

An 860-bed new hospital build some years ago, pre-RFID tagging, purchased as an example, 330 single-channel volumetric syringe pumps and 160 mobile vital signs monitors, with what we now know about the benefits of RFID tagging what would be the total numbers procured be now?

One hospital case study published on the Harland Simon website references a request for 50 additional ambulatory syringe infusion pumps at a trust that had 40 on their equipment database of which they could only identify the location of four.

The trust had been undertaking a phased implementation of RFID tagging and took this as their next area for rollout, finding a further 22 devices.

Once these pumps had been located staff felt there were sufficient in the system and the request for a further 50 was withdrawn, saving the trust approximately £50,000 on the purchase, plus the year-on-year cost of maintenance on the additional equipment and the funds could be redirected towards another service’s needs.

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