A Case for Inventory Control
By Marcia Frieze and Arlene Carlo, RN, BSN, FCSP
Healthcare workers (HCWs) are continually seeking ways to enhance service and quality, and improve the financial bottom line. An effective inventory control management system for surgical instruments in the healthcare setting is one way to achieve this goal.
Why control surgical instrument inventories?
Every hospital wants to get a handle on managing instrumentation. Surgical instrumentation has become increasingly complex and expensive. The instruments represent a substantial financial investment for healthcare facilities. Money is tight and HCWs do not have the luxury of buying excess inventory. This is especially true of endoscopic instruments, which have become a costly and necessary financial investment as HCWs increasingly utilize minimally invasive surgical procedures.
In today's healthcare setting, there are hundreds of instrument sets containing thousands of different types, designs, and sizes of instruments that are used in surgical procedures. As the number and variety of instruments used in surgery has increased throughout the years, so has the cost of these instruments. In addition, surgical cases and the need for rapid turnover of sets have contributed to the need for better organization and control. Remember, an organized inventory management program keeps trays under control and circulating. The volume of procedures can be better handled and tracked avoiding the need to routinely flash instruments.
The volume, high cost of surgical instruments, increased turns, and limited inventories make it essential that an effective management system for this asset be in place to provide accurate control and timely data.
Instrument management systems
Every hospital sees the need to manage its instrument sets. Having an established written policy and procedure regarding instrument inventory management is one step; having the cooperation of the staff to implement these procedures when overwhelmed by the increased volume of cases and responsibilities is another. In other words, we need a team of dedicated staff trained to utilize the system each and every step of the way. Training and cooperation are crucial in maintaining an inventory management system. Furthermore, the system must be consistent and easy to implement.
Healthcare facilities typically utilize a manual record-keeping system, or an automated system, to document information. However, all healthcare facilities are not the same. The decision as to which system to utilize, whether manual or automated, is based on several factors, including the size of the facility, the number of surgical instruments, procedures, staff compliance, and the financial resources of the institution. It is important to choose an instrument management system that will best meet the healthcare facility's particular needs. Whatever system is used, it should be efficient, cost-effective, and easy-to-use. It is crucial for the staff to completely understand the system, be trained to use the system, and work together to achieve optimum results.
Manual inventory control systems
Manual instrument management systems are certainly a way to start. In the past it was the only option and these may work for smaller healthcare facilities and surgery centers. However, a manual inventory system takes a considerable amount of time and effort to maintain. Keeping manual logbooks where all processed instrument trays are listed and tracked is time consuming and labor intensive. There is a chance for error. Additionally, retrieving information from a manual system is difficult, as there are volumes of paperwork to look through before data can be complied and analyzed.
When there are many instruments, it is even more difficult to maintain accurate control with the manual system. It is also a challenge to consolidate information from the records to generate needed and valuable reports that are useful to enhance the operation of the department.
Organization and standardization of trays, color-coding, labeling, and instrument count sheets are a few solutions that can help manage the process. There are products currently on the market such as sterilization containers that provide organization and secure containment of surgical instruments. These container systems provide a location for the identification of set name or service, load card information for the sterilization record, and options to customize and standardize sets.
Automated inventory control systems
Computer technology has provided opportunities for improving instrument management. Computerized inventory management systems have the capability to manage and process large volumes of data quickly and provide reports that help the healthcare facility do a better job of managing its surgical instrument inventory. It is important to be aware of which systems are currently available in the marketplace and what they offer. Most computer management systems track the instrument set through all processes and services. Others have additional options, such as instructional features on line, instrument preventive maintenance reminders, and employee tracking for productivity.
Take time to review literature and assess different systems and costs. Although an automated system may require a substantial initial investment, it has proven to be a cost effective instrument management program. According to Valerie DeVries, RN, sterile processing manager at Lenox Hill Hospital in New York City, "It may cost thousands of dollars, but it's worth it. Now we can find the trays. At Lenox Hill, we have an outrageous volume of instruments and now we have a better handle on standardization and control over the instrument inventory." However, the system requires maintenance, backup, and someone to sit and input consistently.
When it comes to inputting data, bar coding is a valuable tool. Inputting data using a bar code system is a definite time saver over manual input as long as the information is recorded at time of use. Bar coded trays and a bar code scanner provide improved tracking of instrument sets. Using a tray system that provides a location for labeling as well as the ability to bar code is a clear advantage.
Scanning ensures accuracy of data entry. Instrument sets are scanned at specific workstations in order to know the location and status of any set at any time. Surgical instrument sets can be identified with a bar code label that identifies each set.
Labels can be affixed to inner baskets and outside of containers and to the outside of trays that are wrapped. Computers track the flow of sets through the department and at each stage of the processing department.
Reviewing the process:
Bar-coded trays and a bar-code scanner provide improved tracking of instrument sets.
First, instrument sets are scanned when they enter the decontamination area. Scanning creates a record that the tray is there. The tray is scanned when the set arrives in the prep and pack area for assembly, when sterilized, and when delivered to the operating room or storage area.
A count sheet for each set is printed when the set is scanned for assembly and bar code labels are printed to affix to the outside of the container or package before the sterilization process. Additionally, a backup plan is necessary as with all computerized systems. Implementation takes time and requires a concerted effort. When all processes and documentation rely on an automated system to function, if the system goes down, tracking documentation cannot be obtained. Therefore, service is an important feature of the system.
The system must be as user friendly as possible. At Sarasota Memorial Hospital, an 845-bed regional medical center, an automated inventory management system was approved by the staff in central processing and the OR, and put into use. According to Jim Heller, director of central services, "Sarasota Memorial's first goal was to have sets complete with the correct instrumentation. The facility created count sheets and imported photos for each instrument in the computer." Later they implemented an instrument maintenance program, a tracking system and standardized to a sealed container system to store and contain the instrument sets using bar code labeling.
In conclusion, choose an instrument management system that will work for you. Obtain consensus from everyone involved and do a step wise implementation program. Make it easy. Do a back-up and use trays that can be standardized and labeled. In the end, whether the inventory management system is manual or automated, what it comes down to are the people, their dedication, and commitment.
Marcia Frieze, MS, is the CEO of Case Medical, located in Richfield, NJ. Arlene Carlo, RN, BSN, FCSP, is an experienced clinical manager, educator, and consultant.
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