Its Time to Operate. Do You Know Where Your Instruments Are?

The average patient has no idea that materials management or biomedical engineering departments exist, but without these departments, patients would have a radically different experience.

Surgeries would come to a grinding halt and efficiency would fly out the window. Staff members in these departments, after all, deal with equipment maintenance, repair, installations and pre-purchase evaluations. They also maintain databases, deliver stock, order items, monitor budgets and process recalls.

Most stressful is that materials in these departments are needed around the clock. Organization is therefore not only helpful, but mandatory, and a materials tracking system can play a vital role.

Tracking Systems

Some administrators do not feel that a tracking system is feasible at their facility. Regardless, staffs of all facilities should consider one, says Jean Sargent, director of materials management at the University of Kentucky HealthCare, in Lexington, and president of the Association for Healthcare Resource & Materials Management (AHRMM).

I do think that its extremely important that everybody has some kind of a tracking system for supplies and equipment, Sargent says. Its a matter of whether the system will be an electronic or a manual process. The decision will be based on several factors including current systems and their capability as well as staffing and the need to interface between multiple systems."

A device tracking system is of particular help when a product recall has been issued.

If we get a recall notification from our medical device manufacturer there has to be a mechanism for each facility to trace those devices, Sargent says. And obviously the more automated the process, the easier it will be to retrieve that information.

Sargent implemented tracking systems at UCLA and is implementing tracking systems at the University of Kentucky HealthCare. She thinks such systems are the wave of the future.

We will see where the tracking of supplies, equipment and instruments will be tied to patient safety, in that you always know where these instruments are and who they have been used on, she says. Instrument tracking traces movement of the instruments from decontamination to sterilization, or if theyve been flash sterilized due to extenuating circumstances Patient safety issues that are addressed with systems avoid delays in care, particularly in reference to knowing where your instruments are located. This, in turn, avoids delays in surgery."

Sargent recommends that staffs discuss and take note of the new Association for the Advancement of Medical Instrumentation (AAMI) standard (ST79) that states, Sterilization quality control relies heavily on historical data, especially when quality assurance measures yield conflicting evidence. Recordkeeping is needed for both epidemiological tracking and ongoing assessment of the reliability of the sterilization process. Accountability to the patient and surgeon for the sterility of a reprocessed device requires documentation that can be directly traced to the patient. Traceability of implants is especially important because the consequences of implant-related infections are particularly severe and result in increased morbidity and mortality.

Several computerized device tracking systems that can improve patient safety are on the marketplace, says James Smoker, MPA, CMRP, an AHRMM board member and director of materiel resource service at WellSpan Health. Some employ barcode technologies while others employ smart RFID tags which can be activated to find the device(s) or are active (24 hours a day, seven days a week) and provide real time device location information, Smoker says. Ideally, the cost-benefit balance should be in reducing the number of physical assets a hospital requires through improved device tracking and utilization, he adds. I am not certain that the market has matured at this date.

Going Without

Bartlett Regional Hospital in Juneau, Alaska, does not have a tracking system and their infection control directors have not expressed an interest in getting one, but theres a possibility that a system would be helpful, says Bruce Bennett, director of materials management at Bartlett.

I have not been at a facility with a tracking system, but have talked with other materials management directors who have them and overall their response was favorable, Bennett says. It would allow for improved communication between the OR and central sterile reprocessing areas and should improve on efficiency in those areas.

There are ramifications of not having a tracking system, he says. There is a potential for financial impact and for patient and staff safety, he adds. Any infection caused from this could have significant financial impact.

According to Smoker, a poor or non-existent tracking system could result in a lack of quality data upon which to make significant clinical improvements.

Tracking systems have been available for years, but its often difficult to get hospitals to invest in them, according to Bob Marrs, BA, CRCST, CHL, director of sterile processing at St. Davids Medical Center in Austin, Texas.

The administration at St. Davids recently approved such a system. Ive been here for five years and Ive been fighting for it since day one, Marrs says. I had a system in Ohio and I came here wanting to get (one) implemented immediately because I knew it would help us. We spend an exorbitant amount of time looking for lost instruments and a tracking system would help us with that greatly I (talked) with my administration and said, I think this is a huge issue and I think we can affect our patient care here if youll let me get this system.

The administrators finally agreed. One called Marrs at home on the weekend to break the good news. Marrs felt like it was a holiday. Thats one item off his list wish, but an important item remains. Something that I would love to see, is the Joint Commission or whoever coming in and saying, We require you in sterile processing to have a tracking system of some sorts, Marrs says. We want to be able to track these instruments through the entire process and ultimately to the patient.

Good tracking systems are easy to use but do require an initial investment of time-consuming data entry. Companies that sell the systems often do most of that, Marrs says.

We send them header sheets for all of our instrument sets and what we want everything to be called; what sterilization process it will go through; whether its steam or STERRAD, etc.; the length of time it takes to assemble a tray and then once we get the header sheets in we will then send them actual count sheets for every tray that we have, Marrs says.

After they get the count sheet it lists how many instruments we want on the tray and we put the vendor number on there for reordering. Its going to be wonderful.

There are a few key ways to convince the powers that be to finance a system. The team at St. Davids started tracking the amount of time they spent looking for items and determined that at least three hours per day were being wasted in the search. Lost productivity spoke volumes to administrators, especially when Marrs helped them understand how much time a tracking system saves.

If we had a tracking system we could type in, missing plastic tray, and then we would at least know the last place it was located, which is great, Marrs says. We could say, we looked on the shelf and its not there but we know that employee x put it in case cart 23 yesterday at 17:00. We can track that case cart down and say, okay great, its out here in the hallway.

The system is also useful to track worker productivity. With the push of a button a tracking system user can print a report of how many and what types of trays an employee prepared. A manager or director can find that information through manual logs without a tracking system, but the process is cumbersome.

A Delicate Balance

Having proper materials is important. Having enough for a disaster is too, but having more than necessary leeches space, budgets and the supply chain.

The main word here is adequate supplies, Sargent says. We definitely want to discourage stockpiling. AHRMM is spreading the word to their members to not stockpile, but that its still imperative that we have adequate supplies. Its a matter of having supplies on hand for your own facility, and to make sure that you have contacts with other facilities in your area, so that way if your facility is the one that gets all the patients you can look to the others for support and vice versa.

Most facilities dont have the storage capability for stockpiling anyway, Sargent says. Its a matter of working with your distributors to keep certain quantities set aside for you, she says. Im a proponent of systems and having systems that are easy to use and that give us the feedback to ensure that were supporting patient care in a safe manner.

Manufacturers are all about moving units, but there is a limit. The manufacturers do not have the capacity to backfill the supply chain if people start stockpiling, Sargent says. Theyre not geared to do that unless as an industry we say, everyone needs to have x percent increase for their normal annual or monthly purchases, and say as of this date were going to do this as a nation and therefore manufacturers you need to prepare to be able to backfill.

Infection Prevention

One benefit of a tracking system is that it can better pinpoint instruments that are used in surgical cases where an infection might have occurred, Sargent says.

There are significant patient safety issues when you dont have the equipment needed to take care of the patient, she says. By having these various tracking systems it enables you to know where the products are to get them to be used with that patient.

More so, effective and efficient tracking leads to staff satisfaction because it means staff members are better able to care for patients by having the equipment and devices they need. All the way through, communication is vital, especially since materials management involves so many departments.

This is always a challenge in a multi-entity health system with multiple service lines, Smoker says. I feel there is an increased focus on products, processes, and procedural standardization across our health system driven by the need to incorporate best clinical practices across our health system.

Likewise, the electronic health records initiatives are also driving standardized processes, he adds. More and more, multidisciplinary teams, including materials management representatives, are included in process redesign Experience tells me that the ability for infection control to standardize data collection processes and to methodically report findings is a keystone issue. Clearly, as electronic health records initiatives progress data collection processes will be enhanced.

Smoker says that partnerships with infection control services are strengthening as a result of clinical projects such as the 5 Million Lives campaign sponsored by the Institute for Healthcare Improvement (IHI).

An example of a significant success story was the development of a central line cart program which standardized not only the products, but the care practices employed by resident and attending physicians, and nursing personnel, Smoker says. A central line cart exchange program was developed by a multidisciplinary team which involved materiel resource services and central sterile services.

This reduced patient-central line infection rates, quantities of outdated central line products, and nursing care time, Smoker says. It also improved charting and billing for the central line services and products and standardized nursing and intensive care unit products.

This is but one example among many where materials management is actively engaged in reviewing products and processes which lead to improved patient care, he says.

A computerized tracking system saves hours and possibly lives, according to Marrs. As far as infections go, right now we have to track manually, he says. (Under the manual system) if an infection control nurse calls and says, so and so patient came in and for a total hip and they acquired a pretty significant nosociomial infection and wed like to know what trays were used on that patient and what load they were in, can you at least look and tell us that the biological was negative? its a huge manual tracking process. But if we had a computer tracking system we could say, Well certainly. Let me have the patients name. Well get everything in the computer and get everything back to you in about 10 minutes, as opposed to about a day.

Benchmarking

Directors of materials management can benefit from comparing and contrasting their practices with those carried out by similar facilities.

I think that materials management has a wide array of benching results in many areas that are used in most acute care facilities, Bennett says. They are easily accessed through professional groups including many of the group purchasing organizations.

The healthcare materials management industry would benefit from more benchmarking results, Smoker says.

Benchmarking initiatives in healthcare materials and resource management have been limited to date to periodic snapshots or very high-level supply cost outcomes data, Smoker says. He looks forward to the release of a joint healthcare supply chain project that is being constructed by AHRMM and the W.P. Carey School of Business at Arizona State University.

It is a very exciting project, according to Smoker, and will be based around an online survey. The initiative is called the Healthcare Supply Chain Benchmarking and Performance Improvements Metrics and is in its first phase. It is expected to be released in October of 2007.

The surveys creators hope it will improve the analysis of healthcare supply chain performance.

This benchmarking initiative, as I understand, will take benchmarking to a much higher level of utility, Smoker says. The online survey tool will encompass both outcome metrics and process metrics a first in our profession.

The survey will use research techniques from supply chain performance benchmarks that have been applied in other industries. The ASU tool will show data on centralized/decentralized supply management, distribution systems, consignment inventory, and information technology systems. It will also include quarterly inputs of financial and operational metrics and a bi-annual evaluation of supply chain structure and practice implementation.

Survey Reveals Potential Supplies Shortage During a Pandemic Event

By Michelle Beaver

Materials managers have plenty to worry about and the daily grind leaves little if any time for extra projects such as preparing for pandemic events. Preparations are necessary, but according to one survey, only some hospitals are making these plans and most would run out of supplies in less than one week.

The survey was conducted by Novation, a healthcare contracting services company of VHA Inc. and the University HealthSystem Consortium (UHC). The survey asked materials managers to determine the status of their pandemic disaster preparations; 68 people responded.

More than half of the materials managers surveyed (68 percent) reported that their facilities developed comprehensive pandemic-specific disaster plans. Seventy-nine percent said they could continue operations without external resources for less than one week. Fifty-four percent said operations could continue for one to three days.

A three-to-five day supply would be better, says Bob Marrs BA, CRCST, CHL, director of sterile processing at St. Davids Medical Center in Austin, Texas. I think (three to five days of supplies) would at least get you through the initial rush of patients you would find, Marrs says.

The St. Davids staff is fortunate to have about two weeks worth of supplies. St. Davids partners with four other hospitals, all of which share an off-site warehouse.

Procuring disaster items should be a very important priority, Marrs says. We keep hearing that disasters will be coming but it seems like were often more reactionary than proactive, Marrs says. If you are prepared for something you certainly can go through all the steps you need to much more easily than if you have a knee-jerk reaction, Marrs adds. Its like a Joint Commission survey I tell my staff all the time that we need to be prepared every day like theyre coming in. You waste more time and energy when youre not prepared for something and you add stress.

The majority of managers (93 percent) surveyed have made arrangements with product suppliers to receive critical items. More than half of the survey participants have arranged for products to be delivered automatically if a pandemic event occurs. More than half also claim they can manage critical business functions offsite and can support existing business functions with limited staffing through cross training.

More than half of survey participants (60 percent) keep their pandemic supplies separate from standard inventory and almost one-third (31 percent) of the participants have preprinted disaster preparedness order forms.

In the event of a pandemic flu, respirators will be vital. Seventy- eight percent of the materials managers surveyed said their facilities know how they will obtain additional respirators. Thirty-nine percent will buy them and 22 percent will rent them, while 39 percent will purchase and rent.

Teamwork is invaluable and having designated people at the helm helps the team stay afloat. Its therefore wise to appoint such leaders in advance so they can prepare for their respective duties.

Sixty percent of the survey participants say their facility has designated specific people for this role, including materials management directors, infection control coordinators, directors of nursing and emergency preparedness committee members.

The respondents noted that the biggest roadblock to preparation includes, buy-in within the hospital, public panic, space, staffing, security, budgets, and items that have short shelf lives.

Every facility should have a bare minimum of two to three days of supplies, says Bruce Bennett, director of materials management at Bartlett Regional Hospital in Juneau, Alaska. If renting a storage locker offsite is necessary than that should be done, Bennett says.

A facility should work closely with their primary distributor to get an understanding of what their contingency plan is for getting supplies out to all their customers during a pandemic outbreak and natural disasters. If you are in a community with other medical facilities then an agreement could be made for a central storage location for all facilities to share.

Preparing for a natural disaster is just as important as preparing for a pandemic event, he says. We maintain a three-day supply of what we have determined to be critical supplies that are stored on site and have a written plan of action with our distributor for emergency supplies, Bennett says. Because of our isolated location, we can only get supplies by boat or plane, so we also have arrangements with our local freight carriers to respond quickly to our needs during an emergency.

In the grand scheme of materials management at a healthcare facility, stocking adequate supplies for a pandemic event is crucial, says Christine Miller, portfolio executive at Novation. This is not, however, a green light to buy every product in the free world.

What Ive seen is a lot of hospitals tend to anticipate more supplies than theyll actually need, Miller says.

The staff of one hospital, Miller recalls, sent her a 13-page list of items. That was far more than they needed, she says. Staff of another facility went one step further by purchasing brassieres in case they ran out of masks.

(Administrators) tend to get locked down in these what if scenarios, Miller says. They got so far into this paralysis through analysis that the what-ifs turned into well if we got masks seized by the government what would we use for facial protection? (Getting) bras was their best response.

Planning for pharmaceutical needs lags nationwide, Miller believes.

There are a lot of variations to consider and its almost overwhelming,she says. Although antivirals and respiratory medications are a focus, what people need to keep in mind is that if a pandemic does strike, the community is going to be turning toward the hospital for refilling of their medications, in addition to those inpatients who need their regular medications too.

In an effort to mitigate this problem one of the countrys largest pharmacy groups the American Society of Health-System Pharmacists, (ASHP) has partnered with Novation and other professional groups to help facilities acquire antivirals, respiratory medications and other necessities through a more plausible pharmaceutical formulary listing to which hospitals can refer.

Since staffs do not always know how many supplies will be needed, Novation recently developed a supply needs assessment pool.

Members can go in, plug in their bed count or their anticipated surge capacity and it will auto-calculate the amount needed to have on hand for one week, Miller says. Its been a real success with our members. It helps members predetermine their purchase needs to best prepare clinically and financially.

Several other supply listings are also available.

Fortunately, there are many ways to procure and store necessary pandemic inventory items, says James Smoker, MPA, CMRP, director of materiel resource service at WellSpan Health. Smoker is also a board member of the Association for Healthcare Resource & Materials Management (AHRMM).

Smoker suggests that staffs, work up an agreement with your primary medical surgical products wholesaler to consign the goods for the health system in the wholesalers warehouse and pay a monthly fee to cover inventory carrying costs, stock rotation costs, and overhead expenses incurred by the wholesaler.

Most personal protective goods have a shelf-life of three to five years under normal temperatures which means the periodic rotation of stock is vital, he says.

While I would like to place faith in science and the promise of a low-cost avian flu/pandemic vaccine, the doctrine of the prudent person requires planning and preparation which includes having at least a small on-hand cache of critical supplies to mitigate any shortterm disruptions in the supply chain, Smoker says.

There are also the challenges of determining what products to select, accessing stored goods, developing a policy/procedure for their distribution and cost, he adds. If the goods are booked as inventory there is merely a transfer of cash assets for materiel assets. Depending on the size of the preparedness supplies cache, this can be a significant tie-up of capital resources and operating expenses to manage the cache.

Many hospitals have partnered with local facilities including their own competition to build a supply chain that can be mutually utilized in the event of a disaster, Miller says.

These supplies should be close enough to all the partner facilities, however. A lack of proximity has caused some regional initiatives to fail, Miller says. Keeping supplies offsite is challenging because they must be monitored and stock must be rotated.

You want to look at financial negotiations, who pays for what, who gets what how will it be distributed and then outlying any ethical decisions with letters of understanding, Miller says. Depending on certain scenarios, one hospital might want to use more supplies than another and those things have to be worked out ahead of time.

Stockpiling is not the answer.

A majority of hospitals seem to have increased their supplies by very slowly ramping up their current par levels on necessary items, Miller says. That particular strategy allows for stock rotation on items that they use on a daily basis and it really doesnt affect their financials significantly as one mass purchase would do.

Overall, Miller was pleasantly surprised with the findings of the Novation survey. Part of our survey that surprised me was that 69 percent (of facilities) had specially addressed their plans and have increased their supplies, she says. I thought that number might have been a lot lower because of the struggles they have

This isnt time for celebration though; its time for preparation.

I would say not until hospitals are at 100 percent will (the results) be adequate, Miller adds. A lot of hospitals say, yes, we have plans in place, but they have not acted on them.