The use of radio frequency identification (RFID) in tracking surgical sponges and reducing wrong-site surgeries.

摘要

Even with the process of manually counting medical instruments and sponges used in open cavity surgeries, a Massachusetts' insurer estimated that 1 in 10,000 open cavity surgeries have claims of retained instruments and sponges. The major danger comes from any sponges that remain within a patient. These sponges can cause further complications including sepsis, obstruction, and death. While there have been developments in using radio frequency identification (RFID) technology to identify any remaining sponges within a cavity, the methods are still prone to human error. These errors might seem easily preventable since it does not seem all that difficult to have an accurate count of the number of instruments and sponges that have been used in a surgical procedure; however, there are continuously cases of retained foreign objects reported.;There has been some promising research in the use of RFID technology to ensure that medical sponges are not mistakenly left in surgical patients. The basic concept is that each sponge used in a surgery has an RFID tag attached to it. Before the patient is closed up after the surgery is completed, a handheld reader is passed over the patient to detect if there are any sponges that were not removed from the cavity. The initial trials were very successful, with 100% detection of tags remaining in the cavity, and no false readings (the reader detecting a tag not within the cavity). The issues of human error and retained sponges were raised during trials. For example, if the scan is performed incorrectly---the wand is too far away from the body---this could cause tags not to be read. Another concern is that any sponges used after the scan has been performed have a chance of not being removed.;I propose to research the possibility of having a continuously scanning RFID system. This system would eliminate the human interaction of the current handheld scanning devices. With the human interaction no longer a factor in the process, scanning the cavity too early to detect all of the sponges used or scanning at a distance too great for the tags to be read will no longer be of any concern. An additional advantage to a continuously scanning system is that a monitor can be placed in view of the surgeons that will display the number of sponges currently on the table. The surgeon can know the number of sponges in the patient at any point in the surgery.;In addition to the detection of sponges, tags could be placed on surgical instruments to ensure that there are no retained instruments in the cavity. In addition to the detection of RFID tagged sponges, RFID tags have the possibility to assist in decreasing the number of wrong-site surgery occurrences. It is estimated that one wrong-site surgery will occur in every 112,994 operations. Based on this statistic, it is estimated that a single large hospital will see an occurrence serious enough to be reported to risk managers or result in a lawsuit once every five to ten years. While the number of occurrences is small, 84% of wrong-site surgery claims lead to payment to the plaintiff. One study had a median payout of ;The proposed use of RFID technology to assist in the reduction of wrong-site surgery will not replace the Association of Perioperative Registered Nurses (AORN) guidelines to follow the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) protocols. Instead, the proposed use of the technology will assist in making the procedures to be performed and information on surgical sites more readily available during surgery. To do this, the procedure(s) to be performed and at what location(s) can be stored as information in a computer database. This information can then correspond to an identification number on an RFID tag that is placed on the patient. When the patient is then on the surgical table, the tag identification number read by RFID reader will be cross-referenced with the tag numbers in the database in order to display any information pertaining to the procedure. A written description of the procedure, in addition to radiographs and patient history, can be displayed on a monitor in the operating room.;The research performed shows promising findings that it is possible to have a continuously scanning RFID system used in the detection of surgical sponges within a surgical cavity. The tests performed on a freshly slaughtered pig carcass show that multiple tags could be identified while in the surgical cavity. Several more developments need to be made to the continuously reading system before clinical trials can be performed.;The paper also describes the development of a software program that utilizes RFID tags to increase the availability of information in the operating room to decrease the chances of wrong-site surgeries. This system needs to be integrated with a hospital database system before any clinical trials can be performed.;With possible benefits coming from using RFID technology in both identifying surgical sponges and instruments within a surgical cavity and increasing the ease of communicating information about the procedures that are to be performed, it is easy to see the attraction of further development of RFID in the surgical process.