September 2010

Tracking Lead
By William M. Wesp, RT(R), BSM
Radiology Today
Vol. 11 No. 9 P. 16

A Minnesota medical center developed its own simple bar-code scanner and spreadsheet system that efficiently tracks more than 500 protective garments in the facility.

A large academic medical center may have hundreds of lead aprons and protective garments, and each one needs to be checked periodically for defects, according to The Joint Commission and state laws. The date the aprons are inspected must be documented along with the presence of any small holes or cracks affecting the garment’s protective integrity.

Most facilities use a paper log sheet to document the testing of the lead. Others may use an electronic spreadsheet to keep these records. Both of these systems work, but sifting through many sheets of paper to find the apron that was just checked consumes time and can be frustrating. In addition, many aprons have been around for years and the numbering system may have changed, making it difficult to find the correct number associated with the garment. Some lead aprons may have a serial number on them from the manufacturer; others may have been written on with a marker: “T-1” for thyroid shield or “IR 3” for an interventional apron, for instance. Such variation leads to inconsistent records.

Even when aprons are properly inspected, the garments typically do not have any visual indicator that technologists and radiologists can use to confirm that an item has been checked. Someone must go to the log and determine whether the inspection has been performed. The following is how Fairview Health Services devised its own solution to tracking this important information.

Time-Consuming Problem
Fairview Health Services is an academic health system comprised of seven hospitals, 48 primary care clinics, and multiple specialty centers throughout Minnesota. The University of Minnesota Medical Center, Fairview is a respected teaching institution. Located on two campuses, one on the east bank and one on the west bank of the Mississippi River near downtown Minneapolis, the medical center includes inpatient and outpatient facilities with services ranging from primary care to care of patients with the most complex conditions. Areas of specialization include organ and blood marrow transplantation, heart disease, cancer, neurosciences, pediatrics, and behavioral illness. The hospital is recognized by U.S. News & World Report as one of the nation’s best.

The general diagnostic radiology department at the medical center’s university campus performs 52,000 diagnostic x-ray and fluoroscopic exams annually. This includes service to a 23-bed emergency department and 22 operating rooms. The department operates seven rooms, including three fluoroscopy suites. Lead protective equipment is found in 11 different areas in the hospital, including the general diagnostic department, endoscopy, CT, the operating rooms, and a special procedures room. Many lead vests are associated with radiologists or individual technologists. When you add up the number of lead aprons, vests, skirts, individual thyroid shields, gloves, and various lap shields for patient protection, the total exceeds 500 pieces. Some items are brand new, while others date back to the mid-1990s.

At the medical center, the lead aprons are checked each June using an electronic spreadsheet that contains 11 tabs, one for each of the various identified areas. The general diagnostic department and the operating room take ownership of the most lead at 120 and 104 pieces, respectively.

In setting up the system, we first needed to devise a numbering system for the lead aprons and other gear. The issue we encountered was that the newer lead had a five-digit serial number displayed on an attached tag from the manufacturer, while the older lead contained handwritten lettering made with a permanent marker. These markings ranged from IR 3, standing for “interventional lead apron No. 3,” to in-house fictitious codes such as E4. This produced an inconsistent numbering system that made it more difficult to find the appropriate lead on the spreadsheet because organizing the aprons in a logical or numerical order was impossible.

In addition, finding these markings on the lead aprons was sometimes challenging. Some were marked on the front, some on the pocket, and some on the inside of the equipment, making this annual process even more time consuming. The markings also tend to fade over time through use and/or cleaning. Difficult-to-read markings slow the process and make the logging less accurate.

Bar-Code Solution
Looking to improve the accuracy and organization of lead apron testing, we developed a new process, investigating options and efficiencies gained in implementing a bar-coding system. We discussed options with the hospital supply chain staff and after a short meeting, the project was under way.

We decided the best time to implement the new system was during the annual lead apron testing and created a new spreadsheet (see below). The new format included columns for the following:

• the new bar-code number;

• the date the garment was checked;

• any identifying letters or numbers (serial numbers);

• the type of lead (apron, vest, skirt, gloves, gonad shield);

• color;

• any staff name associated with the apron, vest, or skirt;

• the department where the lead should be located; and

• a status column to record any tears, holes, or cracks or whether the lead should be removed from service.

We then gathered materials needed for the project. These included 500 clear acrylic key fobs with a bar-code sticker attached to each. We used tie wraps to attach the key fobs to the garments  and placed small stickers on the back sides of the fobs so the person checking the aprons could locate visual clues that the items had been checked.

Laptop in Fluoroscopy
Once the supplies were acquired, the real work began. We loaded the new spreadsheet for lead aprons onto a laptop computer and placed it in one of the fluoroscopy suites. As each lead apron was checked with the fluoroscope, the spreadsheet data was inputted and a bar-coded key fob was attached. This bar code had an “F number,” such as F0033656, associated with it that was also recorded. The computer spreadsheet provided an electronic record of when the lead was checked, and the fob let the tech know we had checked the lead for safety.

The following year we placed an orange sticker on the fob so the tech knew the apron had been checked. Each year, a different color sticker will be used. The sticker also serves as a check for technologists who find missing aprons or ones that were temporarily misplaced. If the fob has the wrong color sticker, the technololgists know to bring it to the main department to get it checked.

Another improvement to our system was adding the bar-code scanner. Originally when a tech checked an apron, it was necessary to look through the different tabs to find the F number. Now the technologist scans the bar code, and the computer automatically highlights the F number on the spreadsheet. This eliminates the time spent searching, which is time consuming in a facility with more than 500 protective garments in inventory.

The annual lead checking process is fairly quick now that this system is in place. A technologist uses the fluoroscope to check the lead, scans the bar code, and cuts and pastes the date into the spreadsheet. The appropriate color sticker is attached to complete the job. Any tears, holes, removal of damaged lead, or lead not found must also be documented. Lead removed from service due to defects is discarded or donated to underdeveloped countries.

The new lead apron testing at University of Minnesota Medical Center, Fairview proved to be a big process improvement. We now have a standardized numbering system and an electronic record of the lead that can be e-mailed as necessary. There is no paper log that can be lost or damaged. The bar-code scanner has given us a faster way to find the lead on the list. The colored stickers enable the techs and physicians to instantly determine whether the lead has been checked and alerts staff to bring lead that has not been checked to the radiology department. The whole system is faster, more efficient, and promotes safety.

— William M. Wesp, RT(R), BSM, is manager of general radiology and ultrasound at University of Minnesota Medical Center, Fairview.

 

			2010 Lead Apron Check
Date	Number	Type	Color	Department	Status	Apron Name	F #
6/24/10	460	Apron	Blue	General	OK	Billy	F0033511
6/26/10	1910	Skirt	Green	General	OK	Jill	F0033796
6/28/10	1909	Vest	Green	General	OK	Jill	F0033722
6/30/10	U1	Vest	Blue	General	OK	No Name	F0033757
6/28/10	1610	Vest	Red	General	OK	Amy	F0033712
6/29/10	1611	Skirt	Red	General	OK	Amy	F0033658
6/28/10	402	Skirt	Gray	General	TEAR	No Name	F0033721