Purpose or Case Report: For patients who had implants placed at our hospital, we found missing documentation when patients presented for imaging procedures. Lack of documentation led to patient safety concerns and time needed to research implants. Using continuous improvement (CI) methods, we aimed to eliminate instances of missing make, model, & manufacturer (3M) information in the EMR for patients recovering in the PACU after an implant procedure. We also aimed to reduce CT/MRI technologist search time for implant information in the EMR to ≤ 5 minutes.
Methods & Materials: Documentation of 3Ms was retrospectively collected for OR patients having implants placed during surgical procedure from December 2020 - February 2021. Specific teams comprising Purchasing, Anesthesia, OR Nurses, & Radiology were established for this CI event. Commitment to the project by team members was established through an agreement statement outlining participation responsibilities: monthly meetings, data collection, & feedback on improvement. Problems/barriers and implementation status that described our progress towards each goal were discussed monthly. After implementation of CI processes, data were immediately collected by manual chart review in the PACU for OR patients who were scheduled for same-day imaging studies. Data collected: presence/absence of 3M information upon PACU arrival & CT/MRI technologist search time for implant information in EMR.
Results: Before CI event, 9 instances/month of missing 3M information occurred and 68% of patients had proper implant documentation at PACU arrival. Technologist search time for implant information was 32 minutes for MRI & 16 minutes for CT. Four months after CI implementation 2 instances/month of missing 3M information at PACU arrival occurred and 3M documentation was properly charted on 99% of patients. MRI technologist search time was 10 minutes/patient & CT technologist search time was < 1 minute. Improvements resulting from CI processes developed included: new supplies built into our purchasing system, specific fields built into the EMR that prompted insertion of 3M entries, photograph/scans of implant cards added to the EMR, & each department educated team members and implemented processes for missing documentation.
Conclusions: We achieved 99% documentation of the 3Ms in patients’ charts through use of defined CI processes including multiple departments, identified team members, clear expectations and commitment, education, and an ongoing iterative process.