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Having outdated material in circulation could be a serious patient safety issue. Further, accreditation and regulatory agencies like The Joint Commission or the local Department of Public Health seem to have "outdate" radar. If there are outdates around, they almost certainly will find them.

While it is ultimately the caregiver’s responsibility to check the dates on items before they use them on a patient, it is a materials management responsibility to assure that any supplies under their control are within their expiration dates. The best practicing organizations have established programs to assure that outdated products are not used. In addition, they do so in a manner that minimizes any fiscal losses associated with discarding outdated items.

In my experience, most materials management departments do a pretty good job of controlling outdates in central storerooms within their control. This is accomplished through strict adherence to stock rotation. New stock is always placed behind older stock. Another tool is lean stock levels. Keeping reorder points and reorder quantities low helps in both stock rotation and assuring only the freshest stock is stored. The biggest challenge in a storeroom is slow moving stock that must be maintained. This problem can be exacerbated when the items must be purchased in box or case quantities. Thankfully, there are usually only a few of these types of items.

The more significant challenge comes with automatic replenishment areas – typically nursing unit par carts or automated cabinets. These are more problematic for a number of reasons. Usage of many par items is inconsistent. Large quantities may need to be stocked even though the normal usage might be low. This can make it difficult to consistently restock from the back. Some supplies are stocked for emergencies even if they are rarely used. These items have a higher probability of outdating before use. Many hands can touch supplies on the nursing units. Even if supplies are regularly rearranged from front to back based on expiration date, there is no guarantee that the order will not be disrupted in between restocks. And distribution personnel can not be expected to check expiration dates each time they restock the item. Even identifying which items have expiration dates can be difficult.

A best practice is an expiration date system for par areas built to minimize the occurrence of stock reaching expiration before use and assuring that expired goods are not used. While there are many possible variations, the following is one system that has been proven to work.

• First, all items in a par area that have an expiration date are clearly labeled as such. Three ways to accomplish this are: A colored dot on the shelf label, the description highlighted on the label or a colored clear tape or plastic over the label. This alerts the clinical staff that they should check for expiration dates before using. It also alerts the distribution staff that they should try to keep older stock in the front.

• Second, distribution staff should place new stock in the rear of old stock when it is easy to do so. This is an important variation to normal instructions. For instance, if replacing two bags of intravenous solution where the par is 15 you would not expect the supply tech to take out the existing 13, put the two in the back and replace the 13 (checking expiration dates for all to assure the oldest are in the front). In practice, this probably would not happen anyway.

• Once each quarter (or other period but not normally less than semiannually) an expiration date check is conducted on each par area. Each stock keeping unit (SKU) with an expiration date is pulled, checked and restocked in expiration date order. Any item that will expire before the next scheduled check receives special attention.

• Items that will expire before the next check are clearly labeled. I like the use of a colored dot. Even better, write the numeric month on the dot. This becomes a visual cue that the item needs to be used first and that special care should be take to assure it has not expired.

• If the item is a slow-moving item for that unit but is used more frequently on another unit, it should be replaced and moved to the unit where it will more likely be used.

• During routine restocks between expiration checks distribution personnel should check the dates of those items identified as close to expiration. As an extra precaution you may elect to pull these from circulation at the end of the month prior to the expiration date month.

Another area of concern is departmental inventories like the operating room and catheterization laboratory, which may or may not be under materials management control. The same principles noted above can be used with these storage locations.