Decrease your ED’s supply par levels and save

Do you store intravenous lines, pulse oximetry supplies, and disposable blood pressure cuffs in treatment rooms? If so, dollars are likely trickling out of your ED in the form of missing or uncharged supplies.

"We often wasted money on stocking supplies in nonacute rooms and having the par levels stay in the rooms," recalls Vernon Craig Meche, RN, BSN, CEN, ED nurse at Lafayette (LA) General Medical Center.

At Saint Vincent Hospital in Green Bay, WI, a team of an ED nurse and two technicians reviews supply levels regularly to make sure they are not overstocked, with par levels assessed by usage and decreased if needed, says Paula Hafeman, RN, MSN, director of the cancer and emergency center. For example, the ED saved $650 by decreasing the number of Level I fluid warmer tubings, which cost $65 apiece, from 16 to six.

"If supplies are used infrequently in the past 12 months, we will check to see if they are stocked elsewhere in the hospital," she explains. "If available in another area, we will eliminate the supplies from the ED and acquire them from another area as needed."

For example, the ED had assembled a cart for intracranial pressure monitoring insertion based on a neurosurgeon’s request, but after a year, the cart had been used only once. "The supplies were available in surgery, so we disassembled the cart and saved $5,000 on instruments," says Hafeman.

Uncharged supplies equal lost revenue

Lafayette’s ED switched to an automated dispenser system (Pyxis SupplyStation, manufactured by Dublin, OH-based Cardinal Health) to replace supplies so items are automatically charged, says Meche. "We were losing a lot of revenue by not charging par items," he says. This loss usually occurred in high acuity patients in which the focus is on patient stabilization and treatment and possible transfer to a higher level of care, Meche says. "Often, charging items is a last thing on a nurse’s mind," he says.

To decrease par levels of equipment in rooms, nurses now go to the Pyxis to procure supplies such as syringes, nasal cannulas, and blood pressure cuffs. Once supplies are used, they are automatically replaced using the patient’s name and account number to restock. Only the par level of supplies is kept in the rooms, including two of each popular size of intravenous catheters, two saline locks, two occlusive dressings, and two tourniquets. "The nurse is limited to these amounts before going back to restock," Meche says. "Previously, individual ED technicians or nurses stocked rooms according to personal preferences. Some nurses had six or seven sets of Jelcos, blood pressure cuffs, and pulse oximetry devices."

Central supply monitors what is being taken, to ensure that all supplies are being charged. "The Pyxis can give a report at any time on which employee pulled what supply item and also can give a total inventory of all floor stock supplies," says Meche.

At first, nurses were frustrated with having to go to the automated medication dispenser cabinets for supplies that were once at their fingertips. "But when the staff saw how much floor stock was not being charged to the patient, attitudes did change," Meche says. He estimates that about 30%-40% of small par items were not charged before the switch.

The ED uses computerized charting to document all procedures and orders on-line, which provides much more accurate information then a handwritten record, he says. For example, if no supplies are charged for a procedure requiring an intravenous (IV) line, the audit department will call the unit to find out if the patient did have an IV, says Meche. "The charges are also compared to the doctor’s orders," he adds.

ED equipment tech saves $15,000

At McKay-Dee Hospital Center in Ogden, UT, an ED equipment technician is in charge of stocking and ordering supplies, making minor repairs, and keeping nurses updated on new equipment, reports Kayleen L. Paul, RN, CEN, care center director for emergency, critical care, and trauma services. "We require this individual to be an emergency medical technician so he or she understands the needs of the department," she adds. "The tech works with a liaison from materials management who knows and appreciates how the ED works. Those two people, working together, are a great money-saving team."

Par levels are revised every six months based on utilization data, and supply areas have been redesigned to reduce inventory. "We used to have very decentralized supplies in every room, and the nurses hoarded like crazy," says Paul. "Now, minimal supplies are kept in the rooms, except for the resuscitation rooms, yet supplies are readily available in nearby carts."

Paul estimates that more than $15,000 has been saved in an 18-month period by decreasing reordered supplies and reducing par levels. "But the biggest saving is in decreased aggravation for staff, who waste less time looking for things," she says. "There is no more begging or arguing with materials management when we need something urgently in the middle of the night."

[Editor’s note: Do you have a cost-cutting tip to share with ED Nursing readers? If so, please contact Staci Kusterbeck, Editor, ED Nursing, 280 Nassau Road, Huntington, NY 11743. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail: StaciKusterbeck@aol.com.]

Sources

For more information on reducing par levels in the ED, contact:

  • Paula Hafeman, RN, MSN, Director, Cancer and Emergency Center, Saint Vincent Hospital, 835 S. Van Buren St., Green Bay, WI 54307-3508. Telephone: (920) 433-8428. E-mail: phafeman@stvgb.org.
  • Vernon Craig Meche, RN, BSN, CEN, Emergency Department, Lafayette General Medical Center, 1214 Coolidge, Lafayette, LA 70505. Telephone: (337) 289-7183. Fax: (337) 289-7172. E-mail: cmeche@lgmc.com.
  • Kayleen L. Paul, RN, CEN, Care Center Director, Emergency, Critical Care, and Trauma Services, McKay-Dee Hospital Center, 4401 Harrison Blvd., Ogden, UT 84403. Telephone: (801) 387-7006. Fax: (801) 387-7038. E-mail: mkkpaul@ihc.com.