Infection Control Today - 09/2003: Identity Crisis

Identity Crisis: Tracking Medical Supplies and Inventory

By Becki Harter,CST, RCST, CRCST, FEL

How to properly maintain, track andinventory medical supplies and instrumental inventory has been a keyorientation, education and implementation challenge for central service (CS) orsterile processing (SP) departments. Receiving, distribution and returning ofsupplies can represent a large chunk of the overall budget in lost, broken orotherwise non-retrievable if not managed properly.

With a tracking program in place and a dedicated staff thesetypes of budget losses can be minimized. Orientation, education, dedication anda very important key to a successful tracking program is accountability. The flow of accountability is: CS/CPD to the user departmentto CS/CPD.

The nomenclature of the past and in some cases the present isthat CS/SP departments are solely responsible for all inventories. If there wasloss, breakage, need for repair or misplacement, it all surely happened inCS/CPD. However, since no device, instrument or supply remains in CS/SP buttraffics back and forth, the responsibility/accountability flow is shared andmust be viewed as a shared entity if cost reduction and effective inventorymanagement is to be a part of a healthcare facilities overall quality assuranceprogram. The question now arises, how do you accomplish the task inside a livingbreathing clinical setting where time and resource are always in demand?

Step One

In every clinical setting the first place to begin is in therecording of all inventories:

(Par levels) on hand
Wrapped supplies
Disposable supplies
Instrumentation (single backup inventory to instrument sets)
Case carts
Equipment (monitors, IV poles, beds...etc)
Support products such as: detergents,disinfectants, indicators, wraps, tape, filters and other processing supplies.

Before you can begin to track your inventory you must knowwhat you have. This may require extensive research, as some supplies may be indepartments outside of CS/CPDbut CS/CPD still has domain over those suppliesas they are listed as a CS/SP item(s) in your healthcare facility.

Step Two

Who will be the CS/SP staff responsible for distribution? Somefacilities are so large that assignment to teams, sections or areas is needed toproperly monitor inventory flow. Each designated responsible staff must record,track and receive items in the assigned area or of the assigned inventory. It iscommon to expect that if there is a name attached to the process on both sidesof the accountability flow, the effectiveness of the inventory managementprogram is better than if there is not. Mystery accountability rises to blamingand the Who done it? Who Me? and I dont know,merry-go-round to which a great loss in time, money and resource can anddefiantly will result, as well as frustration and the minimization of customersatisfaction on both sides.

Methods on how to identify and track inventory can vary butthe standard of tracking practice is pretty much the same formula; quantity,description, receiving department(s) (CS/SP or user department).

Step Three

Choosing the method of tracking is key to the success of anyinventory management program. We will explore from the basic to the technology-supported methods. Below there are a few examples of inventory managementprograms. As it is with all programs, routine inspection and review of thequality management program must be done. A program left unchecked is not aprogram.

Method Three:

Application of a bar-coding program through one of the manymedical tracking systems available, or through the primary provider of yourfacilitys instrumentation needs is the best choice for inventory management.Through a comprehensive bar-coding system each individual item can be trackedand each compiled item can be tracked. For example: In an instrument tray there may be 50 or moreinstruments. Each instrument can be tagged and the entire set can betagged. The individual tags can give you information about that instrument(s)such as:

• Date of last repair, refurbishing or sharpening

• Issue date and who issued it

• Company/catalog and so on

The set tag can tell you:

• Who processed the set (how long did that take? Were there any problems? Instruments missing damaged or replaced?)

• Where the set went(user department to the CS/SP; in some programs the patient that the inventorywas used on is identifiable) Programs that allow inventory to be tracked to thepatient to include sterilization method, load and process indicators are veryvaluable in cases where infection control is critical (CJD) to protecting theoverall patient population. Infectious agents that inventory comes in contactwith, may require additional decontamination steps not found in the standard ofpractice and or quarantine or in some cases destruction of inventory.Comprehensive bar code or other tracking programs allow CS/SP to take control ofinventory. These programs address every area of inventory tracking:

• Etched or identification by bar code labels. This prevents and minimizes the use of tape or dipping of instruments/sets that will have to be replaced intermittently at an additional cost. However, there will may be some cases where taping and dipping are needed to identify doctors specials and so on.

• Distribution Receiving

• Inventory on hand or par levels. Use of tracking methods can help identify areas where inventory needs to be decreased /increased or eliminated.

• Identification of problem areas, so that these process inhibitors can be negated and proper education/training employed. (Repair logs can help identify where additional care and handling information/ education is needed to prevent/minimize future damage and inventory replacement expense.)

• Reduction in the paper chase. Digital and disc compilation of data, releases valuable storage space otherwise used for storage boxes full of paper. This space can now be used as part of the total operation of the CS/SP unit instead of being dead space. In some cases this means a better departmental workflow.

• Easy access to vital information can be stored in a database rather than endless searches through handwritten inventory data entries or time-consuming searches for sterilization information (JCAHO inspections immediately become easier).

• Companies that provide tracking programs will come in and inventory all products for you, thereby increasing effectiveness of productivity management. There are companies that provide instrumentation that also provide tracking programs. In many cases, these companies will offer the program free of charge and provide best pricing on instrumentation if a commitment is made to utilize their company as a primary resource for instrument needs.

• Reduction in overall cost from inventory on-hand to repairs, damage and loss of needed resources for daily operation of your facility.

Some facilities that cannot afford the best technology;however, an incremental application with potential for growth can always be doneand is achievable over a set period of time and as dictated by budgetconstraints. The facility must choose which segment of the program is mostcritical. Inventory tracking is commonly chosen first with good reason, as thisrepresents the largest expense to most CS/SP departments/ healthcare facilities.Other areas are added as budget allows.

Proper tracking and identification of all inventories willalways mean a more efficiently run CS/CPD and will diminish unnecessary costrelated to overstock, loss/displacement and/or damage. Organized CS/SPdepartments provide the opportunity for excellent customer service and pride inwork well done. Cost reduction seems to be the buzz word of this era inhealthcare and will continue to be a top priority as insurance reimbursementschange and patient populations get sicker and sicker because they are livinglonger and longer. Tracking programs are not meant to be regimental ortime-consuming, but if used as a tool for healthcare management of inventory(whatever form that takes), can be the right arm of your budget allowing you toexpand and fully explore new innovative methods of practice. Because you knowwhere your inventory is, what it is doing, and where it will end up, your budgetwill not suffer from mis-managed inventory. A large percentage of inventorybudgets are eroded by replacement of preexisting inventory, whereas bycomparison less is spent on new innovative devices/inventory. Proper management,tracking, overall identification and use of inventory can open up new avenues inthe budget for new technologies and devices. Materials-management programs canbe the catapult to a well-managed inventory and an expandable budget.

Becki Harter, CST, RCST, CRCST, FEL) is the 2003 winner of theAAMI Becton Dickinson Career Achievement Award and is president and CEO ofIndianapolis-based consulting firm Sterilization By Design.