Chapter 11 - Inventory Control, Storage & Distribution.pdf

CHAPTER 11  Learning Objectives 1) Describe the various inventory control, stock distribution, and patient charge mechanisms used in healthcare facilities. 2) Understand the responsibilities of the receiving department. 3) Understand the importance of proper storage, selection, handling, a...

CHAPTER 11  Learning Objectives 1) Describe the various inventory control, stock distribution, and patient charge mechanisms used in healthcare facilities. 2) Understand the responsibilities of the receiving department. 3) Understand the importance of proper storage, selection, handling, and transport of supplies. 4) Understand cost containment and the importance of a well-managed inventory system.  Distribution Systems -are designed and managed to ensure efficient delivery of appropriate medical, surgical items and devices in sufficient quantities without compromise of function, cleanliness, or sterility when en route to patient care providers. As noted in Chapter 1 - Not all SPDs are responsible for distribution of all inventory items.  All distribution Systems must have the following elements: *Receiving *Requisition *Selection *Transportation *Storage and Handling *Patient Charging Inventory Control is very difficult to maintain unless a clear managed system is used. Focused mainly on the following areas… (because they are the largest users). uNursing units uEmergency departments uSurgical areas.  SPD should be capable of planning approx. 90% of the total needs of a unit. —Stocking is routinely done once a day u“Emergency” specialty products are needed immediately. The Receiving Area First to accept responsibility for supplies. Receiving inventory system ensures supplies are received and accounted for. Policies and procedures for receiving supplies must be followed.  The Receiving Area Conditions to prevent damage to supplies vtemperature not to exceed 75oF (24oC) vrelative humidity not to exceed 70% v8 inches from floor, 18 inches from sprinkler fixtures * In the Receiving Area, Holding, and General Store Areas, all medical and surgical supplies must be kept separate from food, waste, and potential sources of contamination.  Requisitioning of Supplies u Cornerstone of the distribution system u All other elements of distribution depend on the requisition. u Be received with sufficient notice to ensure timely distribution u Must be legible u Specifically identify the product u Specify quantity requested u Specify where items are to be deliverd u Provide means of documenting delivery and other desired data Techniques in Selection and Handling Requisitioned Items Handling packages to preserve the function, cleanliness, and sterility of the contents; Verifying the item selected against the requisition, including the product number; Specify the quantity requested, based on established units of issue selected against the requisition (e.g., box, case, each); Specify where the items are to be delivered; Inspecting the item to ensure that it is complete and appropriately packaged and that the package integrity is not compromised delivery and other desired data (eg: sign-off)  Techniques in Selection and Handling Requisitioned Items Verifying, for hospital-sterilized items, that the item was subjected to the sterilization process (by examining external chemical indicators) Verifying, when appropriate, that the expiration date has not been exceeded (the policy and procedure should specify the disposition of an item past its expiration date; i.e., that the item should be separated for further handling, and either returned to the manufacturer or hospital reprocessing area or disposed of) Verifying that the item is properly labeled in accordance with departmental standards.  Delivery Methods: -the most common means of transporting medical devices and other supplies is the “distribution cart”. Other means of transportation…. -dumbwaiters -dedicated elevators (1) for dirty pick-up’s that go directly to Decon.** and **(1) for clean delivery from sterile area (used only to transport clean or sterile items), which might be used to deliver case carts directly to using areas or departments)  Supply Distribution Systems Goals of a supply distribution system… meet patient and user area needs maintain the integrity of clean or sterile supplies maintain low inventory levels while meeting patient needs use personnel efficiently; effectively control costs ensure good inventory control efficiently and effectively retrieve patient charges  PNEUMATIC TUBES or “P” TUBES *which might be used to deliver “STAT” supplies* *Most Common Distribution Systems used in Healthcare Facilities* -Demand Distribution -Par Level Replenishment -Exchange Carts -Case Carts -Specialty Carts -Just-In-Time (JIT) delivery ((Policies and Procedures… must be made available for correct handling of supplies))  Demand Distribution - used when a user requires few supplies or when no automated patient charge system exists-based on direct patient charge requisitions or stock requisitions. - using department is responsible for maintaining the levels of inventory for that unit. - the user can use a computer to order supplies directly from SPD. - is a simple system, if no requisition is made… …then no supplies are issued) - it is considered “labor-intensive”. - SPD & storeroom personnel are interrupted to fill requisitions.  Demand Distribution “Piggy-back label”: - Described as “a label is removed from an item and placed on a patients charge card or bill”. - If a request is made by phone, SPD is responsible for activating the charge system that is in place in the facility.  Par Level - a predetermined inventory list is prepared for each supply needed by the using department during a given time period. - inventory levels must be periodically reviewed on the basis of historical data, changed to reflect actual use. - Computerized locked supply systems are a variation of this system-referred to as vending machines or ATM’s for supplies.  Centralized Exchange Carts **Considered to be the most efficient system for close inventory control.** …How it Works… *(2) identical carts are created, (1) left in distribution area and the other (1) is placed in the using department. *Carts are restocked in distribution area with items typically needed w/in 24 hours. *Stocked carts are delivered to using departments *Used carts are brought back to distribution area to be replenished – recycled when needed again.  Exchange Carts -Not commonly used today because of… Your text here * duplicate inventories required * expense of purchasing the carts * additional space needed to store cart time needed to distribute carts Also, a balanced cart for every end-user department will not take care of every need, because in any given 24-hr per. there’ll always be exceptions and emergencies that require indiv. Items to be issued.  Case Carts - used in specialty areas such as… *Operating Room *Cardiac catheterization labs *Labor & delivery departments - list (case preference list) of required supplies must be developed for each surgical procedure.  Case Carts u 2 TYPES: 1. Closed case carts – more challenging to clean 2. Open case carts – easier to clean but provide no protection for items on the cart *Reusable covers for carts should be cleaned and disinfected after use  Case Carts - there must be good communication between SPD and the using department. -at the end of each procedure, the cart can be used to transport soiled instruments to the decontamination area but must be cleaned / sanitized before it’s reused. (The carts do not require sterilization)  Specialty/Procedure Carts Example of Specialty Carts are: *Code *Dressing *Respiratory *Latex-Free *Dialysis  Specialty Carts *Disaster Carts *Specialty Catheter *Isolation -  Specialty Carts *Disaster Carts *Specialty Catheter - Like a case cart system, a specialty/procedure cart is used to distribute supplies for specific procedures or emergency situations. The carts are stored where they are readily accessible and can be immediately dispensed to the areas where they are needed. The system requires cooperation between using departments and SPD for the initial set-up, ongoing monitoring and for updating inventory lists.  Just-In-Time - also known as “stockless” distribution systems (it is not truly stockless) however; it reduces storeroom inventory but does not totally eliminate it. - a primary vendor or distributor directly supplies using departments wherein no storage is needed. - eliminates the need for distribution department. - NO inventory maintenance is needed. INVENTORY CONTROL AND MANAGEMENT Computerized Inventory Management Periodic Total Perpetual Inventory Inventory Inventory System Control Management Inventory Management  vTotal Inventory Control: - responsibility of materials management department. - refers to an efficiently organized, cost- effective process for maintaining optimum levels of inventory in the storeroom and in all user areas. vTotal Inventory Control: Storeroom staff inventories each using department daily - Including… Medical and surgical supplies Office supplies Forms Housekeeping products Sterile procedure products - this system allows the best control of a facility’s supply inventory but it is extremely labor-intensive. vInventory Management: Computerized Inventory Management: Perpetual Inventory Management: Periodic Inventory System: The inventory of medical & surgical supplies can represent up to 40% of a facility’s operating budget.  Computerized Inventory Management: ücan store records or receipts and issues for faster processing of data ücalculates up-to-date information ütrack utilization of each item in inventory ücommunicate data to the materials management system for direct reordering of the items.  Perpetual Inventory Management: (cont.) (Known as… “Ongoing Management of Inventory” - hence the word “perpetual” - each item is tracked individually - is considered to be time-consuming, but important. - an example is a… “Yearly Physical Inventory” - all items are counted and compared to information on hand.  Perpetual Inventory Management: (cont.) - another example is the… “Cycle Count” - a small amount of inventory is counted on a given day. - less disruptive to daily operations - provide ongoing measure of inventory accuracy and procedure execution - can be tailored to focus on items of higher value or higher movement (fast moving items)  Periodic Inventory System: Inventory is checked at specific interval between placing orders--if the quantity is below the base level, an order is placed. Sometimes classified according to “A B C” system – based on dollar value & frequency of use. A: Items with large dollar value – not used frequently B: Items moderately priced and used relatively frequently C: Items with a low dollar value  Reorder Points (ROPs): -lowest quantity of an item that can be on hand before it is reordered. Minimums and Maximums: Like an ROP (Reorder Point) … -minimum is the smallest amount of stock on the shelf before an order is placed for replenishment. -maximum is the largest amount of an item that should be in stock at any one time. Economical Order Quantity (EOQ): - the optimum quantity of an item to order - Based on historical data, this helps to prevent over ordering  **COMPUTERIZED SYSTEMS IN SPD** Inventory and distribution practices should be consistent throughout the healthcare facility and should be verified by an initial quality audit and by ongoing monitoring and documentation, with appropriate corrective actions taken when needed All services in SPD mandate computerization of the various processes to enhance data management and provide detailed management reports.  **COMPUTERIZED SYSTEMS IN SPD** The quality of inventory and distribution can be assessed and improved by the following measures Example: -Inventory -Surgical case cart systems -Surgical instruments & supplies to OR’s - and other specialty department  “Count Sheet” Is the most commonly used system in SPD. Count Sheets are also known as “recipe cards” for surgical instrument sets. Typically reviewed by OR staff to verify accuracy. Data includes… Correct Name of Instrument The Manufacturer Catalog Number Descriptive Information (ex. length, curved /straight, etc.) Example of a… “Count Sheet”  Tracking Systems: -used for tracking… *Instrument Sets *Loaner instruments *Specialty devices *Surgical case carts *Employee productivity *Equipment and Instrument Utilization *Specific Processing Information *Preventive Maintenance of Instruments  Tracking Systems: -using “bar codes” specific to each item or set. Bar coding is an integral part of Tracking System -also use of marking instruments by laser, etching, applying an adhesive dot or using a peen marker which does not damage the chromium oxide layer of the instrument for identification.  Summary The inventory of medical and surgical supplies represents 40% of a facility’s operating budget. Inventory must be managed to reduce costs and increase efficiency. We are all being asked to increase quality, do more with less, reduce inventory, be competitive, and do our part in helping our facilities grow. Computers and good, sound information systems provide the tools needed to be better, more prudent, successful managers. Sample Questions: “Sterile Storage” “Inventory Management and Distribution”  Sample Questions Sterile Storage, Inventory Management and Distribution 1. In which distribution system are requisitions filled and delivered as they are received? a. Specialty cart b. Case cart c. Par level d. Demand  2. Sterility maintenance covers should be placed on sterile items… a. as soon as the items come out of the sterilizer b. after the items have been aerated c. the day after the items have been sterilized d. when the sterilized items cool to ambient room temperature  3. Which of the following statements is the primary reason that items are allowed to cool on sterilizer cart before being placed in storage? a. Items removed too quickly may be hot enough to burn the technician b. Condensation and contamination may result if items are moved to cooler areas when they are still warm c. The packaging material may be damaged if packages are moved when they are still warm d. Tape seals may come loose if packages are moved when they are warm  4. Which of the following BEST describes the general environmental conditions of SPD sterile storage? a. Controlled temperature and humidity, limited traffic b. Controlled temperature and high humidity, limited traffic c. High temperature and high humidity, no traffic restrictions d. Controlled temperature and humidity, no traffic restrictions  5. Outside shipping cartons should NOT be brought into the SPD because they are often… a. extremely heavy b. lint producers c. biologically contaminated d. water repellent  6. Which of the following is the MOST important factor in preventing bacteria from contaminating sterile packages? a. The sterilization method used b. the quantity of packages c. The handling of packages d. The correct use of sterility maintenance covers 7. When transporting sterile packaged items by hand… a. Place them in a plastic bag. b. Stack them on top of one another. c. Cradle them in your arms. d. Place a linen wrapper over them.  8. "Inventory performance" (a rough indication of the effectiveness of the inventory system) is evaluated by all of the following EXCEPT… a. inventory turnover b. percent of back orders c. availability of critical items d. departmental preference 9. Which of the following is the MOST efficient and cost-effective method for inventory control in the SPD ordering and data generation? a. Computerized Inventory Control System b. Exchange-Cart Distribution System c. Par-Level Restocking Distribution System d. Stockless/Just-in-Time Distribution System  10. Before releasing an item to fill a sterile supply order, all of the following must be checked EXCEPT… a. the expiration date b. cost effectiveness data c. whether the package is damaged d. verification of chemical indicator END