If any of these scenarios – or perhaps all of them — sound familiar, you’re certainly not alone. Virtually every healthcare organization has faced storage-related challenges at one time or another – whether it’s stemming from a service expansion and the subsequent encroaching of space from an adjoining department (think an operating room expansion that consumes part of an already space-starved sterile processing department).

"Storage is a common challenge for hospitals because there are so many different items that need to be organized in a limited amount of space," said Anthony Manos, a consultant for Profero Inc., a Chicago-based quality and performance improvement company that provides services based on LEAN Enterprise concepts. "But there are some very effective solutions that can [overhaul supply areas] and eliminate or at least minimize some of the storage-related challenges."

While the idea of what constitutes a perfect storage solution or storeroom is anything but one-size-fits-all, experts contend that the most efficient, well-planned storage areas do share some similar characteristics. For starters, an ideal storage facility promotes effective, ergonomic work flow, maximizes available square footage, and incorporates a good organizational plan that can accommodate both current and future storage needs.

"The ideal supply storage environment is one that is optimized for the needs of the facility, while providing the highest levels of compliance with regulations, yielding the best patient outcomes and enabling the most efficient staff flow," explained Alan Yefsky, senior vice president and CEO, Briggs Medical Supply Co., Chicago.

While many healthcare departments may be tempted to jump right into a storage room revamp sources stressed the importance of first conducting a thorough evaluation of the space and current storage solutions, the supplies that need to be stored there and how often they are used, and any obstacles that are currently impeding effective inventory management, work flow and staff productivity.

When assessing storage requirements for the operating room, for example – a historically challenging supply storage area due to the ongoing changes in services and technology – it’s important to adopt flexible storage solutions that can be easily modified according to evolving needs.

"The OR is, in essence, a department with multiple sub-departments," noted Shannon Bennett, product training manager for InnerSpace Corp., Grand Rapids, MI, adding that the department needs to keep up with service lines that are "hot" and quick to change. "Bariatrics may be the hot service line today, while ophthalmology may be the hot service line tomorrow. Again, the key here is to pick a system with flexibility and the capability to store packages of all shapes and sizes in different ways without having to buy new each time."

Dave Salus, market manager for InterMetro Industries Corp., Wilkes-Barre, PA, also stressed the importance of flexible solutions, as well as the need for supply storage areas with appropriately-sized aisles and ample temporary storage for re-supply/exchange carts. The flexibility, he said, comes in the form of mobility for unit reconfiguration, ease of adjustability to modify storage levels, and modularity in the addition and removal of organizational accessories such as ledges, dividers, totes, bins, and labeling.

Health Care Logistics’ cabinets around Automated Dispensing Units, closed (left) and open (right)

"The ideal storeroom takes into account the immediate needs as well as the needs anticipated over the next five years," noted Salus.

Behavior modification is another vital aspect of effective space utilization and supply management. As Bennett explained, supplies may have been stored the same way and on the same shelf for years because behavior wasn’t changed or because no one ever questioned why the supplies were placed there. "A classic example of this is suture boxes. Ask yourself, ‘Why are we putting a four-inch-deep suture box on a 12-, 18-, or 24-inch-deep shelf?’ There are better ways to store suture boxes, from dedicated suture carts to gravity feed trays to specially designed pull-out suture shelves."

Such shortcomings are quite common, concurred healthcare director Gil Amoray of Tefen USA, a management consulting firm based in New York City. He said he’s seen many instances where redundant supplies are stored in many different locations – some of which may be tucked away in cabinets or closets, and also on carts in designated storage areas.

Amoray explained that many facilities consume valuable space by storing excessive amounts of supplies at the point of care, while also keeping an excessive amount of stock as a back-up. He said he has yet to enter a facility where the par levels actually match the supply demand. "I’d say in more than 95 percent of cases there’s significant overstock."

Common sense doesn’t always prevail, either. Amoray said he’s seen OR customers who were storing a large number of gloves of varying sizes, even though many of them were rarely used. Specifically, the facility had exactly the same amount of boxes of extra-small and extra-large gloves as the most common size – a significant waste of both space and money. "Again, make sure the supply matches the demand."

Once par levels have been determined and current supplies have been inventoried hospital departments must then devise a plan for keeping items in their proper place and properly rotated.

Partnering with a storage solution provider that can also provide consultative services regarding inventory and par level assessment, workflow and layout (often at no cost) can help facilities find a truly customized storage system that meets their space and budgetary requirements.

Supply storage area (before & after) from Tefen USA.

"We can’t stress enough that the key to a successful project for supply room storage is the early engagement of an experienced provider and the commitment of [the facility’s] staff to accurately define their requirements so the most effective system can be designed," said John Waner, president and CEO of IRSG, a Seattle-based shelving and storage solutions provider. "With the right company, this will ensure that the expertise to fully evaluate and execute a successful project is available."

Because different supplies will present different storage requirements, working with an array of storage solutions is a good idea for most facilities. As Robert Blatner, national account manager for Lyon Workspace Products, Montgomery, IL, explained, "depending on the SKUs, a storage room could use open/closed shelving, bulk storage racks, modular storage cabinets, double-door storage cabinets, safety cabinets, pallet racks and cantilever racks, and revolving bins and lockers." He noted that modular storage cabinets, which can be easily adjusted to accommodate supplies and bins of varying heights and dimensions, are especially effective for maximizing available cubic storage space.

High density mobile storage solutions are a good choice for facilities looking to free up valuable floor space. Offered by numerous storage solution manufacturers —such as IRSG, Spacesaver, Lyon, InnerSpace, LogiQuip, and InterMetro — the units can increase storage space by 40 percent or more by eliminating aisles between rows of shelving.

"If the space is to be permanent, high density track systems are the best solution to maximize the storage space," said Salus, adding that easily adjustable shelves, like InterMetro’s Super Adjustable Super Erecta, are key to facilitating reconfig-uration that allows the user to reclaim wasted space above supplies.

Both floor- and overhead-mounted high density systems are available. Extra-deep high-density storage systems are also available, allowing facilities to store and move (via floor tracks) large and heavy items with ease. Last December, InterMetro began offering its HD qwikTRAK system, an active aisle, double-deep high-density storage system designed to hold up to 2,000 pounds. The design of the qwikTRAK systems allows standard Metro shelves and posts to be joined end-to-end for more storage in limited physical space.

That’s not to say high-density storage should be reserved only for larger items, however. In fact, high-density storage can adequately suit smaller items by simply adding more shelves and appropriately-sized bins to each section.

Lyon Healthcare Lockers with advanced powder coating from DuPont and Agion Antimicrobial

Facilities don’t have to spend a fortune for moveable storage systems, either. Spacesaver’s QuickSpace pullout storage system can more than double the storage capacity in a facility’s current space and provide mobility without a fixed rail system. The system, available in a variety of standard sizes, configurations and finishes, has carriages that slide in and out, which makes an access aisle within the system unnecessary; QuickSpace utilizes the natural egress aisle in front of the system as its access aisle. With InnerSpace’s QuickWire floor tracks, existing shelving units can be easily and cost-effectively mounted onto carriages. The floor tracks eliminate excess aisles, allow up to 400 percent more storage capacity, and also allow multiple shelving units to be easily moved to one carriage. Carriages can also be easily relocated or expanded to accommodate changing needs.

If the storage space has the potential to be reclaimed as a patient care area or another function, Salus said independent shelving units on casters are recommended. "This will save on costly assembly/disassembly labor and time when it comes time to relocate."

Wall-mounted units are another attractive storage option. According to Gary Sharpe, founder of Health Care Logistics, Circleville, OH, wall solutions, such as the HCL System 88 and the HCL Louvered Panels, provide maximum flexibility and are inexpensive. "The wide range of bin sizes provides the right amount of space for the size and quantity to be stored."

Specialty or niche storage solutions are also worthy of consideration because they can keep items, such as high-dollar patient care equipment, safely contained and in easy reach. Bennett explained that for decades customers have been storing small diameter scopes in cabinets originally designed to store large diameter gastroscopes and colonoscopes. "This would make smaller scopes more susceptible to damage." Earlier this year, InnerSpace introduced three scope cabinets (managers) that are ideal for storing small diameter scopes. The solutions feature a contoured rear cavity that cradles and protects the scope’s fiber optic bundle and a small over-molded substrate that cushions the scope’s body; connector managers hold the scope’s light source connector assembly.

Environmental factors and a keen understanding of what is going to be stored in the room should also be considered when evaluating and selecting storage solutions. According to Salus, sterile wrapped packages are best stored on smooth surfaces (think polymer shelving). In a cold room (i.e., cooler) or other damp environment, epoxy-coated or polymer shelving is a must. "If it is wet or will be cart-washed, polymer or stainless steel should be used."

For areas such as the OR there are other key factors that must be considered. Salus pointed out that storage units must be easily cleaned and fully enclosed to protect the supplies (although supplies must still be easily accessible during the procedure). "Tambour door units are often considered, but the doors are difficult to clean because of the tambour grooves and the doors are cumbersome to open and close. This often leads to them being left open during a procedure, leaving the supplies exposed." For that reason, he said clear door storage units have become a popular choice.

While larger shelving units are a necessary storage element – and are particularly well-suited to back-up supplies, larger supplies and items used less frequently – it’s the portable supply storage solutions that can really drive efficiencies by keeping common items within easy reach and where they’re needed most.

Not surprisingly, specialized carts are taking off, with many equipped with ergonomic features and other design elements that improve durability, maneuverability, safety, and cleanability. Solutions aimed at safe, efficient medication storage and delivery are really moving to the forefront.

Metro’s Starsys OR Supply Carts

Of course, being able to secure medication, monitor drug supply and track user access should be of utmost importance when evaluating and selecting portable medication systems. As Steve Heffernen, general manager for Omnimed Inc., pointed out, drug supply can account for up to 30 percent of healthcare costs, and drug theft
or drug diversion now ranks among the top concerns of healthcare risk managers, pharmacists, security officers and human resource professionals because it puts patients at risk and drains operating budgets. "The most effective storage systems for managing these risks include electronic locks, which allow for audit trails of user access into supplies," he said.

Solutions that improve efficiencies related to drug delivery are also important. "Traditionally, when a nurse goes to the patient’s room he or she would only be carrying one patient’s meds with them at a time," explained Jeff Chochinov, senior product manager for Rubbermaid Medical Solutions, Hunters-ville, NC, adding that in many facilities the nurse would retrieve the medication, push a standard computing cart into the patient’s room, log onto the computer to track the activity, dispense the medication and then start the whole process over for the next patient. "Obviously, this [negatively] impacts work flow efficiencies. Having the ability to securely store and organize medications by patient on one cart allows nurses to simply move from one patient’s room to the next."

Rubbermaid Medical Solutions’ mobile medication carts feature keyless entry and locking side bins that can be used for different medication products, including IV solutions and syringes. Drawers and storage compartments come in a range of configurations. Integrated computer work surfaces are indented to prevent spills from damaging the computer, and are easy to clean (the work surface itself can be removed and completely submerged). The carts also feature ergonomic details, such as removable rear push handles and extensive height and keyboard tilt adjustments.

More than ever, hospitals also have access to carts geared toward specific specialties, allowing even the most difficult-to-store and transport supplies to be safely kept at the point of use. IRSG’s Orthopedic Supply System, for example, is a series of carts designed to provide organized visual storage combined with mobility to allow inventory to be kept within arm’s reach during procedures. "This eliminates time wasted searching for needed components during a surgical case and provides visual monitoring of inventory," said Waner. IRSG also recently added the Peel Pack Cart to its mobile solution lineup. The cart ensures that a supply of sterile instruments and items are always available in the OR core, eliminating increased OR time incurred during a case while the surgical team waits for replacements from the sterile processing department.

Facilities looking to maximize their storage solution investments by electronically tracking inventory will find some exciting options on the horizon. HCL is developing a user-friendly barcode system and software that will significantly reduce the amount of time staff has to spend counting. "It will also increase overall accuracy and reduce stock outs," promised Sharpe.

Look for RFID tie-ins, as well. According to Bennett, storage and inventory solutions that utilize RFID technology will be a growing trend well into the future. "InnerSpace recognizes that an RFID solution is the easiest way to reliably track and account for 100 percent of expensive clinical devices, such as drug-eluting stents, heart valves, total hip implants, and more," she said. "Ensuring accurate charge capture is the fastest way to improve the department revenue stream."

Toledo Hospital/ProMedica Health System lab storage

While some of the latest, more innovative supply storage solutions can certainly provide significant benefits, healthcare organizations will be pleased to know that successful supply storage can be accomplished – often at minimal expense – by combining existing storage solutions with some proven quality concepts.

Many once-disorganized hospital departments are crediting their revamped supply storage systems to the implementation of LEAN concepts that target storage from an effective, yet simple, layout, retrieval and replenishment approach.

"In the LEAN world, we talk about low-cost and no-cost first," said Manos. He described one project at the Toledo (OH) Hospital/ProMedica Health System where a core lab storeroom was revamped with very little financial outlay. The facility, which believed a larger lab storeroom was in order, found it had ample space after employing LEAN concepts.

"They had moveable shelving already in place, so we did a new layout and created more storage space – without having to push those heavy shelves around," Manos continued.

Mark Sattler, the facility’s administrative director recalled how the 5S technique, a five-step LEAN practice that stands for five Japanese words that constitute good housekeeping (loosely translated as sort, set in order, shine, standardize, and sustain) converted the core lab from a disorganized, cluttered space into an example of ultimate organization and efficiency. The 5S process uncovered a number of expired and obsolete items that were either disposed of or relocated to other areas where they could be better used. Apparently, it’s a common occurrence. Manos recalled another project where $10,000 of obsolete printer cartridges was still being stored on shelves.

Upon visiting the Toledo Hospital/ProMedica Health System’s core lab storeroom, one will find a one-point lesson at the door — essentially a 30-second rule so any person, regardless of whether they have been to the storeroom before, could find and retrieve an item in 30 seconds or less. According to Sattler, staff will find an alphabetical list of all items (both with common names and manufacturer names) in the storeroom, along with the rack number and shelf number that corresponds with that item. A map of the storeroom layout is also posted at the door, creating an at-a-glance visual to further aid efficiency. Heaviest and least-used items are located at the back of the storeroom – near where the pallets come in – and the most commonly used items are located near the front. Cardboard boxes were replaced with clear plastic bins.

Supply replenishment is an equally critical step and can be effectively accomplished through the use of simple visual-based techniques. Amoray described the benefits of another LEAN-related concept called Kanban, a Japanese word that literally translates into "a sign."A simple example of the Kanban system might be a two-bin system where an equal number of the same item (20 syringes, for example) is placed in each bin (one in front of the other) on the storage unit.The bins may have a removable card that contains the product details, storage location and other relevant information. When the front bin is empty, the bin behind it is moved to the front position and the empty bin and content card are moved to a designated area to signal replenishment."Beyond space constraints, as important, if not more, is how clinicians spend their time. They shouldn’t have to be spending much of their time managing supplies," Amoray stressed.

Visual cues can also come in the form of color-coding, HCL’s Sharpe noted. "Color-coding of supplies is very effective. Stock clerks can quickly locate where the stock supplies need to go and nurses and others who need the supplies can quickly locate what they are looking for.

Sattler said the lab storeroom revamp has been a hit with pathologists. Aside from simplifying the supply picking process, it now takes only ten minutes or less to take full inventory of the storeroom.

LEAN concepts, in and of themselves, may be simple, but Manos stressed that their success is rooted in the facility’s dedication and commitment to its implementation. A large storeroom can be completely reworked in a couple days with a team of roughly seven people, he said, but without full buy-in and acceptance of the process, the long-term effectiveness of the storage area will be compromised.

"Facilities new to the concept may want to pick a pilot area and try the concepts there before moving to a corporate-wide implementation plan. When you start smaller, you can train LEAN champions to offer guidance in other areas," said Manos.

Regardless of the approach a facility takes to supply storage and management, one thing remains certain: the benefits of having a well-designed, well-functioning storage system cannot be overestimated, particularly in an age where healthcare workers are expected to do more with less.