Best supply practices revolve around patients
Best supply practices revolve around patients
Materials management saves $15 million
An innovative stock supply program and cross-trained work force have saved Stanford (CA) Health Services more than $15 million in labor and inventory costs over four years and enabled caregivers to spend less time with paperwork and more time with patients.
Nurses no longer run around the unit gathering supplies. Charges aren’t lost. Inventories aren’t overstocked. These processes now are completed with a few computer keystrokes. The information is instantly transmitted to the appropriate departments, and within minutes, a clerk from a satellite stock room on the unit arrives with the supplies.
"We’re here to support the [caregivers]," says Nick Gaich, director of materials management for Stanford Health Services. "We want to remove the administrative burden so they can provide more direct patient care."
By streamlining processes, clinicians spend less time on non-direct patient care activities and more time with patients. The redesign includes the creation of a new position, a support service assistant, who is cross-trained in housekeeping, patient transportation, and supply management. (See "Retraining support staff," p. 99.) The assistant works on the unit as part of the care team, providing materials management staff with a better understanding of the clinicians’ needs.
The program has saved $850,000 in labor costs, $13 million in supply contract reductions, and a one-time inventory reduction of $900,000. Gaich says the redesign paid for itself "several times over."
Stanford spent one year researching and designing its materials management program. It formed a committee composed of representatives from nursing, environmental and support services, materials management, human resource management, staff education, and housekeeping.
The team benchmarked other hospitals, conducted literature reviews in search of ideas for its own model. Based on its research, the team decided to set up a system of five satellite supply centers, called business centers, scattered throughout the hospital to serve 24 units. Each center stocks supplies used only by its units. The team chose the center locations based on the facility’s existing layout and the ability for the clerks to deliver the supplies within three to five minutes of receiving the order.
When deciding on the computer system itself, they researched the market for options and chose an off-the-shelf program by Enterprise Systems in Chicago. "We didn’t want a customized system," Gaich says. "We wanted something that was flexible and could adapt as our needs changed."
How the system works
If a nurse needs to order supplies to change a dressing, she pulls up her unit’s screen on the computer. She selects the name of the patient who needs the supplies, then selects the procedure in this case, a dressing change.
Preset keys allow clinicians to order supplies based on a procedure, such as replenishing an IV line. All supplies needed for the procedure are listed under one key. Supplies also can be ordered individually. The order is transmitted to the business center, and all the supplies needed for a dressing change are automatically printed so the supply clerk can pull them. An alarm sounds in the business center to alert the clerk that a new order is in. The clerk fills the order and delivers it within the desired time frame.
Meanwhile, the computer also has sent the order to the billing department’s records and logged it under the patient’s name, subtracted the items from the inventory, and reordered more from the supplier. (See flowchart, p. 98.)
The team chose different software applications based on each unit’s needs. For example, to meet the demands of a critical care unit, the system is designed to restock supplies automatically as they are used. Instead of entering an order into the system, the critical care nurse scans the supplies’ bar codes as she uses them, prompting a reorder to be sent to the business center.
An added feature is the system’s ability to track supplies by a variety of data, including patient population, diagnosis, episode of care, or physician. By monitoring these data, managers can spot variances in patient care plans or forecast supply needs based on patient population.
The team tracked the clinicians’ ordering habits to determine the hours of operation and staffing for the business centers. The research showed that orders picked up in the morning and tapered off at night. So the centers open at 5 a.m. with one person. From 8 a.m. to 11:30 a.m., two people fill orders. From 11:30 a.m. to 1 a.m. when work slows, one person staffs each center. The centers are closed between 1 a.m. and 5 a.m., except for the one on the critical care unit, which remains open 24 hours a day.
To accommodate clinicians during closed hours, the centers provide a box of supplies for emergencies. Also, before the night shift leaves, they provide nurses with needed supplies, such as an IV bag that must be changed at 3 a.m. according to the patient’s care plan.
[For more information, contact Nick Gaich, Stanford Health Services, 300 Pasteur Drive, Stanford, CA 94305. Telephone: (415) 725-4504.]
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