Stop Moving Dirty Equipment
Save money, increase nurses’ direct patient-care time, reduce the spread of germs.
Seattle, WA, June 3, 2009 — Allen Caudle, a partner with Appleseed Healthcare Resources, suggests that applying lean management techniques to the use and maintenance of mobile patient critical use equipment (CUE) — such as feeding tubes, IVs, leg compression devices, and patient controlled analgesia and syringe pumps — saves time and money, increases nursing time for patient care, and could be helpful in reducing hospital-acquired bacterial infections such as MRSA, C.Diff, and VRE.
“Hospitals and healthcare systems commonly move CUE between units, floors, and housekeeping facilities for sterilization. The results: Typically, fully 60 to 90 percent of CUE is not at the point of use. The ramifications of this common practice are many — all of which are negative: time wasted searching for needed equipment, frustrated nursing staff, time and money spent monitoring wayward equipment and cleaning warehoused dirty equipment, and increased patient risk of infection (and attendant costs) from germs spread on unclean equipment traveling between locations,” stated Mr. Caudle.
“Keeping CUE at the point of use maximizes efficiency, which saves time and money, increases the time available for direct patient care, and prevents the spread of germs, which, in turn, lowers the risk of infection for staff and patients alike; it’s a huge win, easily accomplished, for all involved,” he continued.
Mr. Caudle notes two examples of the time and cost benefits to be gained from maintaining CUE at the point of use:
Nursing staff at a mid-sized hospital in the Northwest saved 15 minutes — which could then be applied to direct patient care — for every nurse on every shift.
A California-based 500-bed hospital was able to redeploy eight full-time supply chain equivalents from the effort of maintaining CUE and realize a saving of roughly $250,000 annually.
Mr. Caudle offers the following lean management process for using and maintaining CUE at the point of use. ?
Assess Use. Decide what equipment is needed in each patient room, by nursing unit/floor. If any piece of equipment is used 60% of the time or more, keep it in the room.
Maintain at the Point of Use. Establish cleaning protocols with input from infection control. Instruct and train all appropriate employees to follow the new procedures.
Store at the Point of Use.? Identify/create a location within each unit for clean safety stock and equipment used 40% of the time or less. Create another, separate location for dirty safety and/or lesser used equipment for maintenance to be followed with return to clean area following proper maintenance and cleaning.
Monitor Movement.? All needed equipment should be at the point of use, either in the room (equipment used 60% or more of the time) or in a clean storage facility (equipment used 40% of the time or less) on the unit.
There are only three valid reasons for a piece of equipment to leave its “home” nursing unit:
patient transfer
breakage
preventive maintenance
Equipment should be monitored by supply chain personnel two to three times per day to ensure that clean, usable equipment in the determined necessary amount is continually available at the point of use.
Establish a Task Force. Create a multi-disciplinary team consisting of representatives from nursing, epidemiology, supply chain, bio-med, and housekeeping/environmental services to participate in the implementation of the new process and engage all parties involved.
Obtain Corporate Buy-In. Involve senior-level nursing administration to champion the new paradigm to the c-suite.
Conduct a Trial. Establish the new paradigm in several key areas to evaluate the new approach and work out issues before rolling it out system-wide.
Sustainability. ?Establish metrics to score progress and ensure processes are being followed.
Created in 2002, Appleseed Healthcare Resources is a partnership of senior healthcare executives dedicated to empowering providers with innovative strategies and the knowledge, skills, and tools necessary to achieve tangible and sustainable operational excellence. Additional information may be found at http://www.appleseedhc.com.
Allman RM, Goode PS, Burst N, et al. Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. Adv Wound Care 1999; 12:22-30.
Exner M, Kramer A, Lajoie L, Gebel J, Engelhart S, Hartemann P. Prevention and control of health-care associated waterborne infections in health care facilities. Am J Infection Control. 2005; 33 (5 suppl): S26-S40.