Notices for Surgeons

The NJR data entry system contains an in-built series of validation routines or business rules to validate implant combination choices prior to acceptance as an NJR record. This validation process issues ‘alert’ messages to NJR data entry users in the case where implant combinations might fail in any of these validation checks.

Examples of such cases where an alert would be raised:

  • Mismatched sizes (for hip implants) e.g. use of a socket and head of incompatible sizes
  • Mismatched side (implant side to procedure side for knees) e.g. use of a left-sided knee implant in a right-sided procedure

The NJR has worked to further improve patient safety by enhancing these post-surgery validation checks already in place, by developing a number of new tools that can be used pre- or intra-operatively to check compatibility of prosthesis combinations prior to implantation, thereby helping to eliminate potential ‘never’ events.

Enhanced validation checks also included:  

  • Never Event checks:
    • Total Hip Replacement (THR):
      • Mix and match: The femoral stem and femoral head implants are manufactured by different companies.
      • Size mismatch: The articulating implants (liner/cup and head) do not match in size.
    • Total Knee Replacement (TKR):
      • Side mismatch: There is a mismatch between the side of the procedure and the implant side.
      • Mix and match: The femoral and tibial implants are manufactured by different companies.
  • Additional checks:
    • Expiry date check: To check the implant has not expired.
    • Hips – Metal on Metal (MoM): The composition of the articulating femoral head and cup/liner components selected are both metal.

A number of interfaces have been developed that allow pre-operative checks to take place by use of an Application Programming Interface (API), a web-based application for use with a handheld barcode scanner and a mobile device application.

Application Programming Interface (API) 

The NJR has developed an API – a ‘back end’ that allows third-party systems to securely interface with the NJR business rules. The system deploys NJR ‘business rules’ in a way that they can be applied to a submitted set of components. Once an implant list is submitted, details are validated against NJR validation rules and the API subsequently generates an output to the user that describes the combination of implants as either compatible or incompatible against a specified patient procedure.   

Barcode scanner, NJR Implant scanning interface

This API has been tested by Derby Hospitals NHS Trust (a Scan4Safety pilot site), and their Scan4Safety system provider Prospitalia H-Track and is now available to any third party for real-time validation check by the NJR, independent of the NJR data entry process. Third-party systems can integrate this function, embedding the NJR implant validation API within local systems and processes (including Scan4Safety systems) to validate implant combinations. Through integration, the electronic interface will pass a procedure type and implant list to the NJR, then ‘test / validate’ the combination, and output a ‘pass’ or ‘alert’ message to the recipient.  

For organisations that wish to integrate the API within their systems to provide these validation checks, the NJR can offer this interface subject to a subscription charge and acceptance of terms and conditions. 

NJR Implant Scanning Interface

In addition to the API, the NJR has also developed a mobile/tablet friendly responsive website interface. This interface provides an NJR-developed ‘front end’ that allows details of component lists to be scanned with a bar code scanner, mobile phone or tablet, and the results or flag concerning the combination are returned directly to the user. 

The advantage of this interface is that users are able to access the implant validation function without the need for the development of other third-party IT systems. This independence from third-party systems is beneficial when a hospital does not have the Scan4Safety system, or access to IT system development resources. 

This option is offered free of charge to all hospitals that undertake orthopaedic joint replacements in England, Wales, Northern Ireland, the Isle of Man and the States of Guernsey.

Please contact us at: should you wish to make an enquiry regarding either interface. 

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