ICPs, Nurse Managers Play Critical Role in Product Selection
By Kathy Dix
Product evaluation and selection might appear a mundane task to the averageJoe, but that average Joe's health and safety depends on the ability of theproduct evaluation committee (PEC) to choose the best overall materials andequipment.
Humans always have tried to get the best deal on their purchases, oftensacrificing quality for cost. But modern consumers, especially those chargedwith the task of preserving others' health, must balance quality against costand, in these modern days, the additional consideration of time.
The cost/quality/time principle states that when purchasing a product, it ispossible to obtain two of the factors above, but never all three. Low cost andhigh quality might mean a long turnaround time to receive the product. Acombination of high quality and speedy delivery might necessitate a higher cost.PECs must determine which two factors are most crucial, then choose their stockproducts accordingly.
A product evaluation program has several benefits for the facilities thatchoose to adopt the policy -- improved patient or healthcare worker (HCW)satisfaction, improved inventory control (and therefore improved costs) andcompetitive pricing.1
The Association for Professionals in Infection Control and Epidemiology (APIC)recommends that new products and devices be evaluated to ensure that personnelcan be trained in its use and to circumvent any issues concomitant with a new,unfamiliar technology. APIC suggests that products to be considered must besafe, effective and conducive to "high-quality patient care;" thatthey be employed by a committee with "clearly defined responsibility andauthority;" that they be evaluated based on "objective criteria;"that a trial be conducted before selecting a product; and that an annual reviewshould be done of the policies and procedures associated with product evaluationand selection.
Such products should conform to the Association of periOperative RegisteredNurses (AORN)'s recommendations as well as those of the PEC, and APIC suggeststhat the PEC be comprised of people in the following roles:
A PEC has the Herculean task of assessing numerous products and materials anddetermining which ones best suit their facilities -- and their budgets. But eachcommittee takes a slightly different approach.
In the past, infection control issues were not always included in productevaluation. But in 1976, the Joint Commission on the Accreditation of HealthcareOrganizations (JCAHO) recommended that infection control be considered inproduct selection that impacts sterilization, disinfection, cleaning anddecontamination. Evaluators then had to add that consideration to those ofquality, safety, cost, standardization and serviceability.
Managed care has generated a greater consideration for cost-efficient medicalcare, at least in most facilities.
"The product selection process has become more formalized with variouscommittees, etc., that have complicated the process," observes Tom Hammond,vice president of sales at Regent Medical. "However, hospitals are stillvery interested in standardization, value, safety and quality. Those demands andexpectations have not changed with time."
For example, Hammond points out, one brand of surgical gloves might representa cost savings up front, but if the product is prone to rips and tears and HCWshave to double-glove each time, the cheaper gloves may not be a better value.
"That's the reason for the evaluation committee -- in trying tostandardize, in trying to provide the right kind of mix between price andquality, and I think there's still a recognition of that value, at least in ourindustry," he adds.
Suppliers of healthcare products are affected directly by the PEC. First,they must ensure that their product is presented to the committee, but directcontact with the PEC is not always allowed. There are several ways to introduceand influence the healthcare facility to view a new product fairly, Hammondnotes. These include:
The challenge of introducing new products to the "standardized"offerings of a hospital or other healthcare facility is that people resistchange. If surgical gloves are under consideration, for example, it is difficultto please everyone. A surgeon's preference might be for the gloves she becameaccustomed to in medical school.
"Again, the individual preference becomes an overridingconsideration," Hammond says. "If the hospitals can figure out a wayto standardize, to get everybody to change at one time, it is much easier.Often, they do re-approve an existing product because it is the simplest andeasiest path forward. The challenge for the non-incumbent is to create thereasons for the healthcare facility to change. It is very difficult tostandardize products like surgeon gloves that are very personal-type products.Therefore, new contenders must demonstrate value to be considered."
Once a PEC determines that a certain product may be suitable for its facilityand wishes to test it, it is unlikely that they will accept another hospital'strial results. Instead, they will want to trial the product themselves, Hammondpoints out. This, he adds, is only possible if the product has prior regulatoryapproval to be used in the market.
During a short trial period, potential users will be given the chance to usethe product under several different scenarios. But cost plays a part in thetrial -- some facilities insist that the product be provided gratis for theirtrial.
"There is a split between those who absolutely require that you givethem the products for evaluation and those who will purchase," Hammondexplains. "Usually if they purchase it, there is some kind of guarantee.For instance, it's an evaluation guarantee -- if you buy the product and don'tlike it, we'll refund what you purchase, but if you continue to use the productwe'd like you to pay for it."
"Sales representatives receive commissions for the sale of products --even for evaluations," Hammond comments. "Hospitals often recognizethe value in having a representative in service and will conduct the evaluationand will therefore consider purchasing the product."