To help bridge the gap between critical care demands and expectations and supply chain management’s capabilities and performance, Healthcare Purchasing News has hosted and sponsored a series of panel discussions at the annual National Teaching Institute & Critical Care Exposition of the American Association of Critical Care Nurses (AACN). This year marked HPN’s 7^th in partnering with AACN-NTI to explore and stress the importance of critical care nurses working with the supply chain department to not only get the supplies they need when they need them, but protecting the hospital’s bottom line to boot.

Panelists for the twin sessions, "Critical Care Influence in Supply Chain Management," here included Carol Pennington, R.N., BSN, MBA, implementation manager, VHA Inc., Irving, TX; Lisa Manni, director of clinical operations at University of Pittsburgh Medical Center’s UPMC Passavant facility; Marsha Ballard, R.N., nurse manager, CoxHealth, Springfield, MO; and Christie E. Artuso, Ed.D., R.N., CCRN, CNRN, director of neuroscience services, Providence Alaska Medical Center. HPN Senior Editor Rick Dana Barlow served as panel moderator.  

Speaking to an audience comprising critical care and operating room nurses and supply chain professionals the panelists shared some wisdom from the trenches, offering some important tips that you can implement in your own facilities.  

Panelists all agreed that communication between critical care and supply chain is vitally important. And offering several forms of communication is ideal.

E-mail, internal newsletters, posters, establishing a supply chain voicemail hotline or designated e-mail box, or dispersing messages via the facility’s [Internet Protocol television service], can help prevent breaks in communication, providing front-line staff with an easy way to voice their opinions when they can’t break away for a meeting. It also provides materials managers with a way to get messages to clinical staff about backorders and product substitutions.  

Communication should be a two-way street between clinical staff and back to materials management, emphasized Ballard. In her organization, she’s found that a unit coordinator can be helpful in serving as a liaison.

"Supply chain should let clinicians know about backorders in at least five ways," Pennington suggested. "Sometimes no one informs the front-line staff when there’s a substitute," she added.

If a substitution was made, it’s important to not only provide clinical staff with information on how to use the new product, but also explain the thought process behind why the change was made, said Ballard.

"In my experience, you can’t communicate enough – and the communication needs to go down to the staff level," noted Manni. "Materials management depends on unit leadership to get the message down to the staff level."

As a nurse manager in a surgical ICU and a member of the product evaluation committee for five years, Ballard encouraged her management peers to be a "good voice" for front line staff, gathering comments and presenting them to materials management.

The panelists also urged bedside staff nurses to step forward and voice their opinions, since as the end users, they are the key stakeholders.

In fact, noted Pennington, identifying stakeholders is absolutely essential to any decisions involving product purchases. "If you don’t include the end users you’re doomed to fail," she stressed.

Conversely, the more collaboration between departments, the more successful your projects are likely to be, Ballard contended.

Nothing beats face time when it comes to smoothing any rough edges in developing relationships. Commented a staff nurse from the audience, "When you meet face-to-face it helps take away the tension."  

In addition to scheduling regular staff meetings and value analysis meetings, "rounding is extremely valuable," said Pennington. "You reap lots of benefits. You have to spend some time with it, but it’s well worth it." Walking in someone else’s shoes helps you understand the restrictions that both sides work under, she said.

In Ballard’s facility, rounding is a three-times-a-week routine, and more importantly, the staff is proactively empowered to speak their mind about problems or concerns with products.

Artuso suggested hosting a round table, to give participants the opportunity to learn about each other’s responsibilities and workflow requirements, to discover together, "what can we do to make our jobs easier?"

Avoid hostility at all costs, she added. Don’t badger materials management with accusations of, "Why can’t you do your job?" Instead of getting angry, respond "help me understand what we need to do to make it happen."

"It’s not about ‘no’ – but rather, ‘how can we make it happen?’" she emphasized.

Added Pennington, the goal should be moving towards "improvement sessions" versus "gripe sessions."

It always helps to know what each other is talking about. "From the supply chain perspective, help educate the staff about what they do, for example, explaining the significance of PAR levels, and turn times," noted Manni. "Help [clinical] staff understand the language and the processes."

Likewise, clinicians can help educate supply chain as to why certain products are needed. More and more often we see clinicians migrating towards careers in supply chain, and their influence may be helping to breathe new life into the profession. "As a clinician, you can offer a new perspective to the supply chain," said Artuso, a critical care nurse of 30 years, who just recently moved to an administrative position.

HPN’s Barlow described these types of department liaisons as serving a role similar to translation software, helping different "apps" work together.

Pennington offered a familiar opinion. "As a nurse, all I cared about was if the product was there when I needed it. When it wasn’t I was upset, and rightfully so." She also admitted to occasionally stashing IV pumps in the ceiling tiles or lockers during her time as an emergency nurse. "As a nurse, I thought I was doing what’s good for the patient, but now I know that I was costing the hospital money," she said.

To help prevent loss and ensure supplies and equipment can be found when needed, Pennington suggested a radiofrequency identification (RFID) tracking system, adding that whatever type of inventory management system is in place, staff has to be comfortable knowing that the product will be there when and where it’s needed in order for it to work as desired. The first step is setting up an efficient process, but the staff has to trust in that process, she noted.

For efficiency in materials management to be realized, both clinicians and materials management needs to be working towards the same goal which, generally speaking for clinicians, is quality patient care.

"Supply chain wants you to know they’re trying to do what’s best for you," remarked Pennington. "When products are on back order, they have to provide something. They want to get the best products for you." But perhaps more importantly, materials management "wants to have contracts in place for products you’ll use."

Supply chain managers might want to consider putting it in terms of patient care needs, the panelists emphasized. For example, help clinicians understand that a bar-coding system is not just for charging patients, but also for inventory control so they can be sure they have the product when they need it for their patients, Manni proposed.

Also, standardization can help improve efficiency, and any nurse can appreciate that. For example, questioned Pennington, "If there are five different chest tubes available, how efficient as a nurse can you be if you have to learn how to set up five different chest tubes?" It’s not always about dollar savings, it’s also about making clinical improvements, she added.

A common sentiment shared among clinicians is that materials management is "always worrying about the budget." However, position cost savings initiatives as a way to protect the future of the organization – and protect caregivers’ jobs – and you’re much more likely to be heard, reasoned Artuso.

By the same token, if clinicians want a new product, framing their request to what’s valuable for materials management, for example, showing that the new product is budget-neutral or can even save money is a plus, said Ballard.

Panelists stressed the importance of supply chain and clinical care nurses developing relationships with physicians. For example, noted Artuso, with spine surgery devices, there’s such disparity in the costs between approved/contracted products and non-contracted products.

"Help physicians understand that they need to partner to make decisions about implants," she advised. "Help them understand the impact." Adding to that, if the implant happens not to be FDA-cleared, or is otherwise safety-compromised, it’s the hospital who incurs the risk, not the physician.

Still, it’s a fine line between requesting cooperation and making demands. There needs to be a true partnership between clinicians (pharmacy, nursing and physicians) and administration (program directors, supply chain), Artuso encouraged.

"You can’t survive allowing each physician to bring their own products, yet you have a commitment to physician satisfaction," she emphasized.

You might just find that physicians are willing to work with you if given appropriate options, noted Ballard. For example, if you have five different trays for a surgical procedure, the physicians may agree to a modified kit that contains most of the commonly used items.

Sometimes projects don’t turn out the way you expected, but that doesn’t mean it’s a total loss. Panelists shared examples of product conversions they had encountered that in the end provided valuable lessons on perseverance and follow-through.

For example, there was the story about the hospital that converted to a lesser quality facial tissue as a cost-savings measure. Ultimately, however, the chaplain staff was unhappy with the quality so they began opening expensive sterile 4x4s for grieving families and visitors – essentially throwing any intended savings in the trash.

In another example, it was determined by one hospital’s product evaluation committee that the gloves they had been using were too costly so they switched to a less expensive brand. A year later they found out that many departments were ordering the more expensive gloves through "back-door" methods, so they didn’t accomplish the savings they had hoped.

Another panelist told the story about the health system that only allowed flushable disposable washcloths in the ICU. However, staff continued flushing the non-flushable wipes down the toilet, causing expensive plumbing problems that ultimately negated any costs savings.

One way to avoid surprises and determine how to move forward is to constantly re-evaluate outcomes. "Measurement is important to sustaining any program," said Pennington.

It’s really important to measure on the back end and anticipate usage, she explained. "If it’s less than anticipated, what are they using instead? Or if they’re using more than anticipated, how are they using the product incorrectly?"

An example might be with butterfly needles, caregivers should only be using them about 20 percent of the time for phlebotomy. "Look at the back end to see if you’re getting the results you anticipated," said Pennington. Doing so may require some effort. After all, it’s only human nature that "if you have a lot of projects on your plate you tend to check off the list and move on," she said.

Artuso agreed. "If you’re not getting the savings, go back and look at how [clinicans] are using the product. For example, if you’re supposed to use it every two hours, are they doing so? You have to make the commitment to use the product as directed," she said, adding, "If you just say, okay, it didn’t work, what about the next time you have a great idea?"

Pennington described the difference between a trial and a "validation" when it comes to product evaluation. A trial can last up to three months and is designed to see how a product can improve outcomes, as opposed to a validation that should last no more than a week, and is simply a test to see if the product works as intended and if it’s clinically equivalent to an existing product in use.

For a trial to work, you need commitment from front line staff to use and critically evaluate the product, said Artuso.

It’s important to go back and communicate, what end-user nursing staff likes and doesn’t like about a product, said Pennington. When developing criteria for a product evaluation, it’s also important to discern between the "must-have" and the "nice-to-have" as far as what the product must do versus what features would be nice, she described.

Using pre-printed evaluation forms provided by the vendor can open up your evaluation to bias, cautioned Pennington. "Never use the evaluation form from the vendor. Make your own specific to the product," she advised.

If the vendor needs their own form completed in order to justify a product trial, be sure to also provide those on the evaluation committee with an in-house version to complete, offered Artuso.

In the end it’s all about patient care. "Evidence based care has to be the foundation," Artuso insisted. Products can enhance the process, not replace it, she said, adding that in addition to care improvements, with the introduction of any new product, it’s important to look for ways to save healthcare dollars.

"It’s much easier to throw a product at something versus changing practices and making process changes," Pennington agreed.

Finally, as the needs of the organizations evolve, you need to continually evaluate and adapt processes to support patient care, Manni noted.