One of the nightmares that can cause critical care nurses to toss and turn during even the deepest sleep goes something like this.

It’s Friday afternoon minutes before a shift change when three patients are admitted into the medical intensive care unit for a treatment that will extend through the weekend. The critical care nurse searches the exchange carts like a harried father rummaging through the toy store shelves for that popular gizmo the day before Christmas Eve. Because the product needed right now was last consumed about three months ago materials management readjusted the PAR levels to reflect the lack of demand. From that moment on the critical care nurse purposed in her heart to make sure the MICU would never run out of that product again and kept a hidden cache in the cabinets next to the ice machine.

And that’s how the materials manager’s nightmare begins.

"Materials managers have to realize that the ICU doesn’t have a routine or static inventory process," said Joan Roberts, R.N., director of medical and surgical services at Novation (Irving, TX). "You have to look at what’s normally needed but you have to develop contingency plans for those just-in-case products." For example, if you have a patient on peritoneal dialysis you may see that patient every three months for two days at a time, she noted, and as a result you may only keep one product on the exchange cart for that purpose.

Roberts, who spent 10 years in the ICU prior to joining Novation, recalled one particular instance when her facility had three patients at the same time come in on a Friday afternoon, which meant they would be receiving treatment through the weekend. When they couldn’t find enough supplies needed to care for those patients, someone naively suggested that maybe they just couldn’t do the treatment. That wasn’t an option.

"If you don’t understand the area then you can’t make an assumption like it’s a restaurant," Roberts said. "At a restaurant if there’s not enough waiters you make people wait longer. The ICU is not a restaurant."

When the specialized, highly trained nurses who staff ICUs are caring for critically ill or injured patients the last thing they need to – and should – have to worry about is supply availability.

"When [critical care nurses] are in an emergency situation, they are all about taking care of the patients and keeping them alive," she said. "If you look at this from a nurse’s perspective, I need supplies when I need them to care for patients. It’s that simple. If I don’t have those products and equipment available in an emergency situation then I absolutely need to be [the materials manager’s] priority. The nurse manager has another perspective. She wants the right inventory on hand but not too much that she has to carry a lot and account for it."

Deb Laughon, R.N., manager of systems improvement at Lakeland (FL) Regional Medical Center and a board member of the American Association of Critical-Care Nurses, discussed the challenges and opportunities between critical care and materials management with her ICU nurse managers – Carrie Ogilvie over the CCU, Pam Johnson over the SICU and William Cuza over the MICU.

"The situations they shared all have a stressful impact on the business of running an ICU," stated Laughon, who also serves on the editorial board of Healthcare Purchasing News. "At any given moment, not having supplies or a quality product can impact a patient’s outcome and that’s a serious threat for the manager." Examples include not having enough specialty beds so the ICU has to spend thousands of dollars for rentals that could be used for staffing or running out of intravenous pumps. "Time searching for or hoarding supplies and equipment blocks time that should be spent on patient care," she added.

Last year Novation conducted some research among its hospital members to determine the number and types of ICUs in operation. The supply chain company for healthcare alliances VHA Inc. and University HealthSystem Consortium found that the average hospital operates four different types of ICUs. Surgical, medical and coronary care ICUs represent the standard three. The fourth encompasses several choices according to facility. In fact, 60 percent of the hospitals Novation surveyed operated neonatal ICUs. Other types include a trauma ICU (for those facilities with a larger trauma program), a cardiovascular ICU or a thoracic ICU.

Of Roberts’ decade-long career in the ICU she served as a surgical ICU manager for three years, a cardiac rehabilitation ICU manager for three years and a cardiovascular/thoracic surgery ICU manager for four years.

"That’s why critical care nurses need to work together," Roberts said. "The better the relationship is the better it is for the patient. It’s important that the lines of communication remain open between them."

As a result, Roberts encourages critical care nurses to become more involved in the product evaluation and value analysis processes, offering the finance and operations sides a clinical voice. She urges materials managers to demonstrate a willingness to seek out new technology, work with suppliers to offer educational opportunities for nurses, screen sales representatives and control their access and help nurses more with product conversions.

"Thirty percent of hospital costs come from the ICU," Roberts noted. "That’s big business. Clinical outcomes, length of stay and patient flow are key issues." Materials managers need to recognize this and actively participate in such programs as the Institute for Healthcare Improvement’s national "100,000 Lives Campaign," dedicated to implement changes in healthcare delivery that have been proven to prevent avoidable deaths. They include preventing central line and surgical site infections and ventilator-assisted pneumonia. "There’s a lot of products involved with those issues so materials managers should concentrate their efforts in these areas," she said. [For more information, visit the Institute’s Web site at www.ihi.org.]

Critical care nurses simply want the right product mix, such as antibiotic-coated catheters, to help generate desired clinical outcomes but not have to worry about materials management pursuing the lowest possible acquisition costs, according to Roberts, who admittedly fully understands the financial demands and pressures materials managers face.

"The nurses’ primary focus is on delivering quality patient care, but the financial focus is different," she said. "They’re looking for the most effective care in the shortest amount of time. They want the best care possible but faster. But the best product doesn’t have to be the most expensive. It could be the least expensive. But that’s not the point."

While materials management may stress the need for standardization, it may be just as unreasonable to standardize to one particular product as it is to have 17 different products, according to Roberts. The strategy to keep in mind is whether the less expensive product will lead to a cheaper outcome or a better one?

In an ideal world, ICUs would have their own dedicated materials manager, someone who intimately understands the department’s product needs and serves as a partner to make sure it has the right things on the cart and that it appropriately charges for patient items, according to Roberts. Until then, an open line of communication and serious cooperation must suffice. Laughon also noted that her group favored dedicated purchasing professionals for the ICU managers "so they are content experts to bridge the needs of ICU and purchasing." She added that a user-friendly information technology system that facilitates patient charging and inventory management and provides easy access to detailed cost reports would be helpful, too. Roberts concurred.

The bottom line is that materials management needs to integrate clinical input into product decisions, Laughon noted. Integrated and open communication between the two departments is paramount. "The [ICU] managers do not feel this is the norm."

Editor’s Note: Do you have any more ideas to share? Be sure to attend the 2005 Critical Care Exposition of the American Association of Critical-Care Nurses, May 10-12, in New Orleans, compliments of Healthcare Purchasing News and AACN. HPN hosts two panel discussions during AACN’s National Teaching Institute. The first explores how critical care nurses can work with materials managers to make smarter buying decisions; the second covers how they can collaborate on developing streamlined inventory management procedures.