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1988 may be considered the pivotal year for healthcare quality and safety considerations. Three major reports were issued detailing concerns with our healthcare system:

• Institute of Medicine National Roundtable on Healthcare Quality reported three types of quality problems – overuse, underuse and misuse. Furthermore, these three problems occurred regardless of community size or payor source.

• The Advisory Commission on Consumer Protection and Quality presented research demonstrating there is no guarantee that any individual will receive high-quality care for any particular health problem. The report states, the "Healthcare industry is plagued with over utilization of services, underutilization of services and errors in health care practice."

• RAND Corporation performed a literature review of leading peer-reviewed journals between 1993 and 1997 supporting the above findings.

In 2000, the report To Err is Human: Building a Safer Health System, was issued, reporting that 44,000 to 98,000 Americans died annually as a result of medical errors. This was followed by Crossing the Quality Chasm by the Institute of Medicine, arguably the most important publication demonstrating the need to redesign healthcare delivery. This report highlighted not only the need for redesign but presented a road map for the future. After the release of Crossing the Quality Chasm, patient safety became one of the foremost concerns in healthcare today.

As a result, terms like "never events," "national patient safety goals," and the "30 Safe Practices" became common language across the country. The implications of these studies now permeate every area of the hospital, including the supply chain.

Patient safety added an entirely new dimension to the role of materials managers. Patient safety products ranging from bar code point of care systems (BPOC) to antimicrobial coated patient ID bands are filling stockroom shelves and clinical units. With these advancements comes substantial non-reimbursable cost increases over the "non-safety" alternative.

Materials managers are already contributing in many ways to patient safety. They serve as the "gatekeepers" ensuring clinical staff is provided uniform systems and products at the appropriate time and place. Materials management also provides staff education before an item arrives on the unit. Policing vendor access in the hospital also ensures only items properly reviewed are brought into the facility.

When evaluating products, safety and clinical efficacy is the first priority, followed closely by price. This ensures the best care is being delivered. To effectively address patient safety, materials managers must integrate safety into their existing product evaluation and value analysis processes. Clinicians must be involved from the onset to help assess the operational impact of any system and/or product. All products entering the system should be evaluated for its impact to patient safety and actual bedside practice. A system will need to be put into place to track not only cost and utilization of items, but if the new product is actually performing and having the desired clinical impact. This is best set up at onset of use so that all factors are being reviewed together.

The materials manager’s value analysis teams should be increasingly aware of items that are defined as "safety items." The addition of a safety system to a previously non-safety product or device can sometimes make the product more difficult to use, potentially creating a harmful situation. Only through careful trialing and evaluation can this be avoided as well as needless cost be avoided.

Another safety issue to consider is new products and stock outs. When evaluating an item with unique properties and or practice needs, will patients and/or clinicians be placed at risk if the product suddenly is not available and an alternative product is introduced? If this is the case the evaluating committee may want to consider something that is not so irreplaceable.

Lastly, materials managers need to educate themselves about regulatory issues regarding patient safety. Announcements such as the 2005 JCAHO patient safety goals mandating bar code technology for patient identification no later than January 1, 2007 would have greatly impacted the materials manager’s world. This proposal was later rescinded but is an example of the potential impact of regulatory changes.

References:

1. Chassin, Mark R. Galvin Robert W. The Urgent Need to improve Health Care Quality. Journal of the American Medical Association 280 (1998): 1000-1005.

2. Advisory Commission on Consumer Protection and Quality in the Health Care Industry. 1998. "Quality First: Better Care for All American." Available online at http://www.hcqualitycommission.gov/final/

3. Schuster, Mark A. Elizabeth McGlynn A. and Robert Brook H. How good is the quality of Health Care in the United States? The Milbank Quarterly 76(4):517-63,1998)

4. Crossing the quality Chasm: A new Health System for the 21stCentury. Committee on Quality of Health Care in America, Institute of Medicine. Washington, DC: National Academy Press; 2001.