Presented by: Orthopaedic OR Nursing, Orthopaedic Surgery, eHealth/ITCS QEII Health Sciences Centre, Capital Health Halifax, Nova Scotia, Canada

1. Capturing Patient Hip and Knee
Replacement Implant Data Through
Barcode Scanning and Ortech
Orthopaedic OR Nursing, Orthopaedic Surgery, eHealth/ITCS
QEII Health Sciences Centre, Capital Health
Halifax, Nova Scotia, Canada
Contact Jo-Anne Douglas, joannee.douglas@cdha.nshealth.ca
Canada’s Forum on Patient Safety and Quality Improvement
October 28-30, 2014

2. Context
Hip and knee replacement surgeries
conducted at Halifax’s Capital Health, QEII site
utilize implant devices that provide valuable
information in the areas of:
patient safety
economic case costing
routine patient charting.
Through barcode scanning implant data in the
surgical operating rooms we have evolved our
collection and retrieval of information from a
manual process to electronic while contributing
to the Canadian Institute for Health Information’s
Canadian Joint Replacement Registry (CIHI
CJRR).

3. Problem
A gap existed within Capital Health to
electronically search which patient
received which implant.
Historically patient specific implant
data has been stored in a PDF format
within the patient’s electronic health
record. Manual chart review was
required to link patient and implant.
?

4. Contribution
Providing a source of searchable electronic linked patient to implant allows:
Increased Patient Safety
Ability to quickly identify patients at risk if an implant were to be recalled
Quality Monitoring and Research of Safe Effective Implants
Support surgeons choosing the best implants. As a contributor to the national CIHI
Canadian Joint Replacement Registry (CJRR) we are helping develop a rich set of national
patient-level clinical, surgical and prosthesis information.
Sample CJRR publication:
Does adding antibiotics to cement reduce the need for early revision in total knee arthroplasty? Bohm E, Zhu N,
Gu J, de Guia N, Linton C, Anderson T, Paton D, Dunbar M. Clin Orthop Relat Res 2014 Jan;472(1):162-8.
doi: 10.1007/s11999-013-3186-1.
Increase Data Quality
Manual data entry is replaced with point of care barcode scanning for submission to CJRR
Reducing chances of transcription errors and increasing timeliness of data capture
Case Costing
Contribute financial patient/implant costing to inform decisions that balance sustainable
health care and improved health outcomes

5. Partnership
Team of over 50 individuals from Capital Health and, Ortech Systems (vendor).
Orthopaedic Operating Room Nursing,
• Implant barcode scanning at point of care
Orthopaedic Surgeons,
• Case knowledge including diagnosis and reason for revisions
Operating Room and Orthopaedic Administration,
• Support and training of system use. Validation of system against historical system. Establish linkages
between Capital Health departments to utilize data. Provide feedback to all other partners in the project
eHealth/ITCS
• Streamlining of process by creating a registration interface with existing hospital systems.
Ortech Systems
• Software supplier of web based application to collect patient and implant data. The vendor recognized
that the true experts are the people who use the product everyday and were receptive to changes..
Several of our nurses’ recommendations have been incorporated into Ortech System’s product used at
other sites

6. Intervention
Every implant device has a product sticker included in
packaging that details manufacturer, model and lot number.
January 2014 – present
Hip and knee implant information is collected during surgery utilizing barcode
scanners and a web based application called Ortech. Data is submitted directly
to CIHI CJRR. Capital Health Orthopaedic staff have the ability to electronically
search which patients received a specific implant.
Prior to Intervention
OR nursing staff transferred the product stickers onto paper forms which
were manually entered in a database for submission to CIHI and scanned as
a PDF into patient’s hospital chart.

7. Measurement
100% of our elective surgical cases for submission to
the Canadian Institute for Health Information’s,
Canadian Joint Replacement Registry (CIHI CJRR) are
completed through barcode scanning rather the use of
paper and sticker transcription.

8. Lessons
The right partners are essential to provide content expertise
Example - OR nursing staff’s suggestion to display the count of implants was integrated into Ortech acting as a
quality check for devices captured. A technique that is similar to their practice of counting equipment/supplies
during surgery.
Example - Capital Health eHealth/ITCS was able to automate patient registration of demographic data through
integrating an existing hospital system with Ortech. The need for manual patient demographic transcription
was replaced providing time efficiency efficient and fewer transcription errors.
Communication and ongoing support is vital.
Example - Follow up training sessions allow for processes to be standardized when the staff using the program
have the opportunity to provide feedback on what works and what needs to be changed to make the process
better.
Ongoing support and auditing is necessary to ensure quality
Example - An audit identified that patients with certain orthopaedic case types were not being registered. Follow
up with eHealth/ITCS and Ortech was necessary to update the registration interface to include the missing case
types.