Documentation of In and Out screws

[Mytake]

Today I was circulating in the OR for a total shoulder. The rep handed me a package that cobtained 4 separate pins. These were used for in and outs. The person who does out charge sheets was furious because I documented each individual pin as an in and out. She said the patient would be charged 4 times. I explained that no I documented each pin on the implant log. She stated that because it came in a 4 pack box that I am to document that only one time on the implant log. Can yall tell me what is your practice for documentin implants and outplants. I was always taught never take shortcuts by saying (x4) always document each individual item.

[Rose_Queen, BSN, MSN, RN]

We never charge a patient for anything that they don't leave the OR with (implants only)- the facility eats the cost. If it's put in but comes back out, it is documented as a wasted item.

However, if something comes in a multipack, we charge by the multipack, not the individual unit. Often, the price comparison is different- it might be that the charge for a single item is $25, but a pack of 4 costs $80. Therefore, if we use all of the multipack, we charge the patient less than if we charged 4 times for the individual item.

What is the official documentation policy? Go by that, and you'll have something to back you up.

[Mytake]

What I am talking about is the implant log. The charting of what was used as implants and what was used as in and outs. Do you document the in and outs at your hospital?

[Rose_Queen, BSN, MSN, RN]

What are you calling in and outs? Implants that ended up being removed because they were the wrong size or something similar? Or are you referring to trial pins? In which case, those aren't implants and we don't list those on the implant section- they are part of the standard charges section. If it's a chargeable item that isn't an implant, it is charged by the package. Again, refer to your facility's specific policies on documentation.

[PositiveVibesRN]

Hi, I do spine and ortho cases in which In and Outs are common. I'll share what I do.

Charge sheet and Implant sheet are two separate documentation. So for instance if I have 3 screws and 1 was an in and out, I would charge 3 screws but document the 2 that was actually implanted in the Implant log but charge for 3 screws.

I would pay attention during the case and listen to the measurements and what's being discussed with the REP and Surgeon. If I didn't catch it, I would ask the Rep. I always confirm with the rep which were implanted and which are charges only.

I always document each Implant individually. (Eg. Instrumentation from the rep's tray). If it comes in a package.. there should be an Implant sticker for the whole package.

Keep track of what was actually implanted and document only that in the Implant log. Some reps are great about specifying.

In our hospital, we charge in and outs. Usually if it touches the patient we can charge. If we drop an instrument, instrument was compromised during implantation process or if the situation is the hospital staff's fault, we don't. Certain grayish situations I run it by the front desk.

Hope this helps

[PositiveVibesRN]

Oh wait, "package of 4 pins"

There should be a package sticker that represents all 4 pins in that package, therefore charge once as a unit.

If not, always clarify with your REP. Usually they have a charge sheet as well and you can clarify and compare.

[Spiker, ASN, RN, EMT-P]

What I am talking about is the implant log. The charting of what was used as implants and what was used as in and outs. Do you document the in and outs at your hospital?

We document the on the patient implant log only the items they leave the OR with. As for a pack that contains multiple items, since it only has 1 serial number/ID number & expiration date, it's treated as 1 item for charging purposes. If this multi-item pack is then implanted & REMAINS implanted, you can note the implant info as usual, & note "total 4 pins" or whatever, to complete the implant record. As with others commenting here, if a screw is put in, then removed, we list it on the charge sheet as such, since it needs to be replaced into stock. Patients usually don't get charged for a screw or whatever that isn't the right one.