Effective Loaner Instrument Management in Sterile Processing Departments

By Martin Li, M.A., CRCST, CER, CIS, CHL

 

 

Introduction

Loaner instrument management is crucial for sterile processing departments (SPD) in healthcare facilities. These instruments, also known as "loaner trays" or "vendor trays," are borrowed from manufacturers to supplement in-house surgical instruments when the facility's inventory is insufficient to meet surgical demands. This situation can arise due to a backlog of procedures, unexpected emergencies, or specific surgical requirements that exceed the facility's standard instrument sets.

Benefits of Using Loaner Instruments

Loaner instrument sets offer several advantages for healthcare facilities, making them an essential resource for maintaining surgical efficiency and patient care:

1. Cost-Effective: Facilities can avoid the high costs of purchasing new instruments by borrowing them as needed.
2. Space Management: Loaner instruments help facilities with limited storage space by providing instruments only when necessary.
3. Flexibility: Part-time surgeons and those requiring specialized instruments can meet their needs without permanent inventory additions.
4. Access to Innovation: Facilities can use the latest surgical tools, ensuring optimal patient care.

Challenges of Loaner Instrument Management

While loaner instruments provide significant benefits, they also come with several challenges, particularly in scheduling and reprocessing:

Scheduling and Coordination

Managing the delivery and pickup of loaner instruments can be challenging, especially with unscheduled arrivals and tight surgical schedules. Unscheduled deliveries can overwhelm the sterile processing department (SPD), especially if vendor representatives arrive unannounced with multiple trays for imminent procedures. This scenario creates stress and potential delays in processing [2].

Reprocessing

Loaner instruments must be reprocessed with the same care as in-house instruments. Missing IFUs (Instructions for Use) can delay this process and increase the risk of improper sterilization. Often, loaner instruments arrive without the necessary IFUs, leading to delays as SPD staff must locate these instructions. Proper reprocessing cannot occur without adhering to the specific IFUs, increasing the risk of errors and potential patient harm [1].

Inventory Tracking

Keeping track of multiple loaner sets requires robust inventory management systems to prevent loss and ensure timely availability for surgeries. Effective inventory management is critical when dealing with loaner instruments. Larger facilities can receive hundreds of loaner sets weekly, making tracking and organization essential to prevent mix-ups and ensure timely surgeries. Implementing a robust ITS, such as LoanerLink from Censis, allows real-time communication and tracking of loaner sets between the facility, surgeons, vendors, and SPD professionals. This system ensures:

• Timely arrival of instruments, adhering to the recommended 48-hour pre-procedure delivery.
• Complete delivery of all expected sets, allowing for immediate follow-up if any are missing.
• Accurate location tracking of all loaner sets to prevent loss or misplacement [4].

Risk Management and Safety

Proper management of loaner instruments is essential to minimize risks such as infection, surgical delays, and financial losses. Implementing policies and utilizing technology, such as instrument tracking systems, can help address these challenges effectively. Risk management in the context of loaner instruments involves identifying, assessing, and mitigating potential threats:

Unfamiliar Instruments

Technicians may encounter unfamiliar instruments that could be broken or improperly cleaned.

Improper Decontamination

Instruments that are not adequately decontaminated pose infection risks to patients. Proper reprocessing of loaner instruments is paramount to patient safety. Hospital-acquired infections (HAIs) pose significant risks, with nearly 1.7 million patients acquiring infections annually while being treated for other conditions, according to the US Center for Disease Control. Meticulous adherence to IFUs and reprocessing protocols ensures that instruments are sterile and safe for use, preventing life-threatening infections [3].

Last-Minute Deliveries

Instruments delivered close to surgery time increase the risk of processing errors. To mitigate these risks, facilities should schedule in-services with manufacturers to educate SPD staff on proper handling and reprocessing of loaner instruments. Empowering staff with this knowledge allows them to advocate for patient safety and identify unsuitable loaner sets promptly [2].

Who Needs Loaner Instrument Management?

Not all facilities will require loaner instruments. The need depends on several factors, including the size of the facility, budget constraints, and storage capabilities. Facilities should evaluate their requirements by considering the following:

1. Instrument Turnover: Are the existing instruments being turned over rapidly to keep up with surgical demands?
2. Storage Space: Is there adequate space to store all necessary instruments?
3. Backup Sets: Are there sufficient backup sets available, or is the facility reliant on Immediate Use Steam Sterilization (IUSS) cycles?

Answering these questions can help determine if a loaner instrument management program is necessary [2].

Establishing a Loaner Instrument Management Program

Once the need for loaner instruments is established, the next steps involve coordination with various stakeholders:

Collaboration with Surgeons and Leadership

Work with surgeons and perioperative leadership to identify preferred vendors and necessary instrument sets. Surgeons' preferences play a crucial role in selecting the appropriate vendors.

Financial and Contractual Agreements

Engage with facility finance teams and leadership to negotiate terms with manufacturers. Some vendors may require entire sets to be loaned, while others allow more flexibility in selecting specific instruments.

Vendor Representatives

Utilize the expertise of vendor representatives to bridge gaps between manufacturers and the facility, ensuring the right agreements and necessary in-services for SPD staff [5].

Importance of Proper Instrument Processing

Proper reprocessing of loaner instruments is paramount to patient safety. Hospital-acquired infections (HAIs) pose significant risks, with nearly 1.7 million patients acquiring infections annually while being treated for other conditions, according to the US Center for Disease Control. Meticulous adherence to IFUs and reprocessing protocols ensures that instruments are sterile and safe for use, preventing life-threatening infections [3].

Conclusion

Loaner instrument management is a critical aspect of maintaining efficient and safe surgical operations. As an SPD educator, understanding the benefits, challenges, and best practices of managing loaner instruments ensures that your facility can meet surgical demands without compromising patient safety. By establishing robust policies, leveraging technology for inventory tracking, and ensuring thorough reprocessing protocols, SPD teams can navigate the complexities of loaner instruments effectively, providing optimal care and maintaining operational excellence.

References

1. Censis. (2024, April 16). What is Loaner Instrument Management? https://censis.com/blog/what-is-loaner-instrument-management
2. Denver Health. (2022). Management of Loaner and Consignment Instruments and Implants. https://www.denverhealth.org/-/media/files/about/for-vendors/2022/management-of-loaner-and-consignment-instruments-and-implants
3. Huter-Kunish, G. G. (2009). Processing Loaner Instruments in an Ambulatory Surgery Center. https://aornjournal.onlinelibrary.wiley.com/doi/10.1016/j.aorn.2009.02.002
4. LinkedIn. (2023). The Trials and Tribulations of Loaner Instrumentation. https://www.linkedin.com/pulse/trials-tribulations-loaner-instrumentation-davi-schmidt
5. ScienceDirect. (2009). Processing Loaner Instruments in an Ambulatory Surgery Center. https://www.sciencedirect.com/science/article/abs/pii/S0001209209001069