Sterile Processing Case Studies Project

QUESTIONS

Objective

The purpose of the case study is to allow you to analyze information retained over the duration of the sterile processing program and apply that knowledge obtained to provide specific solutions to common issues that may occur within the sterile processing department.

Instructions

Choose two of the four topics as listed below: Decontamination Principles, Sterilization Methods, Preparation of Medical Equipment and Supplies, and Inventory Control and Distribution Systems. Once the two case studies are chosen, answer the questions using your own vocabulary and address the conflicts or issues with solutions specific to your topics of choice. To fulfill the requirements of this case studies project, you must employ research techniques. You can utilize your text or other credible sources from the internet to build a thorough paper that contains at least six main ideas with supporting details regarding the topic chosen and a minimum of three credible references. The paper must be written in APA format with an extensive introduction, body, and concluding statement per case study. Minimum of four pages, double-spaced excluding title and reference pages per case study. Please refer to the rubric regarding specific grading criteria.

Case Study Scenarios

Decontamination Principles:

Dr. Sarmiento is a well-known neurosurgeon at Baptist Medical Center. He is known for working on complex cases that involve the spine and other neurological tissues. This past week, his private scrub tech has discovered that dirty neurological instruments have made it into the OR. The technician consults with the patient care manager of surgical services because the incident has been reoccurring over the past few months. With this knowledge, respond to the following questions:

• What issue(s) have occurred, and what may be the cause of these errors?
• What other special precautions may the sterile processing tech need to take with instruments exposed to neurological tissues?
• What might the sterile processing department have to do to resolve this issue?
• Thoroughly explain the decontamination process. What extra efforts should be made to ensure that clean instruments are delivered to the surgical suite?

Sterilization Methods:

Kristine, a technician in the sterile processing department, has noticed that after the sterilization of surgical equipment and supplies that at least two out of every four loads sterilized for the day have been moist. She has consulted with her supervisor on effective ways in which she could troubleshoot the concerns with wet loads, because it has now affected the department’s work efficiency and quality control.

• Define a wet pack.
• Define a wet load.
• Why might the loads be wet?
• What solutions can Kristine apply to ensure that the processed instrument sets aren’t moist?
• Discuss how this issue can affect both the operating room and the sterile processing department. How should Kristine handle the wet packages to ensure quality control?

Preparation of Medical Equipment and Supplies:

Over the last month, the operating room has received rigid containers without filters, assembled instrumentation such as Poole suction devices in sterilized sets, and closed versus open packaged and processed instruments on the stringer and within the instrument sets.

• Discuss in detail how these occurrences can impact safe and efficient patient care.
• Discuss the instrument preparation process. What can the sterile processing technician do to ensure that all items are prepared and packaged correctly?
• How does this situation impact the operating room staff?

Inventory Control and Distribution:

The sterile processing department at Hershey-Chocolate Medical Center has an excessive amount of inventory. Management has decided to restructure the inventory system used in their facility and has asked you to research at minimum four different inventory systems that may help with the safe and efficient distribution of medical supplies and is also cost-effective.

• What inventory system may work well for their department? Discuss at least four types of inventory systems and how each could initiate a more controlled environment of inventory for the facility.
• How can distribution be affected by excessive inventory?

Please review the rubric to see how you will be graded for this final project. Ensure that all of these areas are covered to ensure the best achievable score.

Length/Formatting Instructions

• Length: 300 word minimum
• Font: 12 point, Arial/Times New Roman no more than 1″ margins
• Program/file type: Use a word-processing program, preferably Microsoft Word, to complete the examination.  PDF submissions will be returned.
• Attachments: Attachments should be pasted into the Word document if possible.
• Part of your grade will depend upon you following the proper style. If you need help with the formatting and reference page, please use the APA referencing system. 
• You’ll be graded using the following rubric:

ANSWERS

Case Study 1: Decontamination Principles

Sterilizing surgical instruments is central to surgical safety and hospital infection control activities. Failure to properly sterilize surgical instruments can cause person-person pathogen transmission (e.g., hepatitis B virus) or transmission of environmental pathogens to patients/staff (Alfred et al., 2019). This problem also presents a significant financial burden. Alfred et al. (2019) indicate that healthcare-acquired infections (HAIs) cost the country $20 billion annually, and sterile processing deficiencies are responsible for some of these costs. The authors also reveal that reprocessing failures are responsible for over 3,700 patients infected with HIV and hepatitis B and C in New Jersey alone (Alfred et al., 2019). These incidents may damage an organization’s reputation, reduce patient satisfaction, and instigate disciplinary reviews from accrediting agencies or lawsuits, underscoring the importance of prompt intervention. This paper examines the contamination issues raised by the case study and their potential causes. It also reviews possible solutions to the problem and discusses the decontamination process.

Identified Issues and Possible Causes of the Errors

The issue in this case study is the presence of contaminated surgical instruments in the operating room. This issue could result from poor decontamination practices, given that the incidents have been reoccurring. Common causes of poor decontamination practices include workforce negligence, ineffective sterilization equipment and supplies, and substandard decontamination instructions or procedures.

Failure to strictly adhere to the organization’s decontamination guidelines may lead to sterilization failures. For example, staff skipping the pre-cleaning process before the sterilization process could lead to improper sterilization. They may also have poor workspace practices, e.g., using the same sink used for scrubbing to clean the surgical instruments, resulting in cross-contamination (Fast et al., 2017). Staff could also be placing sterilizers in the decontamination room instead of a separate room. The staff may also lack a consistent workflow procedure. They need a one-way flow of instruments from one area to another to prevent mixing dirty instruments with clean ones (Fast et al., 2017). Failure to have these workflow procedures could result in poor handling of cleaning & decontamination equipment.

The sterilization equipment, e.g., autoclaves, temperature timers, and gauges, may malfunction, or the sterilization equipment or disinfectants may be of low quality (Fast et al., 2017).  The extent or duration of cleaning before sterilization could also result in sterile processing deficiencies. Suppose assigned staff do not have adequate cleaning & disinfection supplies. In that case, they will not clean or disinfect/sterilize the surgical instruments for the recommended time, leading to poorly- cleaned/sterilized instruments.

Precautions required for instruments exposed to neurological tissues

Other precaution the technician needs to take is tracing the instruments exposed to neurological tissues. According to Belay et al. (2013), neurological sets need to be treated under unique decontamination protocols. For example, the reprocessing of surgical instruments used on patients with Creutzfeldt-Jakob disease (CJD), a neurological disease, must adhere with specific CJD decontamination protocols, especially if the devices have not been reprocessed for more than 10 cycles (Belay et al., 2013). Additionally, mixing neurological items with general surgical items is prohibited (Belay et al., 2013). Therefore, the technician should implement an instrument tracking procedures to facilitate appropriate management of exposure incidents.

Resolving the Issue

The sterile processing department needs to conduct an internal assessment to validate its policies and procedures and ensure they conform to industry guidelines. Validation involves systematically analyzing the organization’s reprocessing instructions, sterilization equipment, operational manuals, and the quality of cleaning materials. This systematic review will help the organization determine whether they are operating within industry standards and identify the root cause of the problem. Based on the review findings, the department should undertake the appropriate steps to ensure organizational protocols and practices comply with industry standards.

The department might also need to train all relevant staff on the decontamination lifecycle and institutional reprocessing policies (Rutala & Weber, 2019). The staff needs to be aware of their responsibilities, the appropriate cleaning & disinfecting procedures, the physical/chemical nature of each instrument, the nature of cleaning & decontamination materials, etc. All staff must wear PPE throughout the process.

Decontamination Process

Cleaning the surgical instruments is the first step in the decontamination process. Surgical instruments often contain patients’ tissue and mucus membranes, chemicals, fluids (e.g., blood), feces, sputum, and dirt and dust. These foreign materials often interfere with the disinfection/sterilization processes. Hence, they must first be eliminated be sterilization takes place (Rutala & Weber, 2019). Surgical instruments might need to be presoaked and pre-rinsed at the point of use because dried blood complicates the cleaning process. The aforementioned foreign materials can be removed through manual cleaning (e.g., friction), mechanical cleaning (washer-sterilizers, ultrasonic cleaners, & washer-disinfectors), and automatic disinfectors/washers. Regardless of the washing method used, the facility must ensure that each instrument is cleaned per the manufacturer’s recommendations (Rutala & Weber, 2019). Also, they must use cleaning solutions compatible with the instrument’s metal or material.

The next step is disinfection. There are many disinfection techniques, but the most common ones are liquid chemicals and moist heat. Moist heat involves washing or rinsing the instruments in water temperatures ranging from 73°C to 90°C  (Rutala & Weber, 2019).. Instruments that cannot withstand heat will be disinfected using chemicals.

After cleaning and drying, the staff should inspect the instruments and discard or repair those that are damaged. Packaging is the next step. This step is not required for all surgical instruments (Rutala & Weber, 2019)). This step is often undertaken when certain sterilizers are used in decontamination. Those instruments needing sterilization should be wrapped in rigid containers or appropriate packaging material per AAMI guidelines.

Surgical instruments are classified as critical items. Sterilization is the recommended reprocessing method for critical items. Depending on the nature of the surgical instrument, sterilization can be achieved through steaming, ethylene oxide (EtO), liquid sterilization, plasma sterilization, etc. The loading and arrangement techniques should allow free circulation of the sterilizer. The instrument’s surface should also be directly exposed to the sterilizing agent. After sterilization, the surgical instrument should be handled with aseptic techniques to prevent re-contamination (Rutala & Weber, 2019). The instruments should be placed in secured contained and safely transported to a decontaminated area. The storage area should allow free air circulation and cleaning ease, and it must comply with fire codes. The following chart illustrates the decontamination lifecycle:

Figure: Decontamination Lifecycle

Continuous monitoring and oversight over the reprocessing procedures are required to ensure clean instruments are delivered to the surgical suite. The organizational leaders must supervise all reprocessing work until the staff demonstrates competency in reprocessing tasks. They should also implement a quality control program for all surgical instruments. The quality control program should include a system for process monitoring, visual inspection of sterilized and packaged material, and periodic review and maintenance of decontamination equipment.

Conclusion

Contaminated instruments in the operating room can have disastrous consequences for the organization, patients, and staff. Therefore, these issues must be promptly addressed to prevent adverse outcomes. Negligent practices and inefficient disinfectants or sterilization equipment and materials can result in poorly-sterilized items. The organization needs to conduct an internal investigation to identify the root cause of the problem and undertake the appropriate corrective measures. It might also need to provide hands-on training to all relevant staff on the proper reprocessing and decontamination procedures. The decontamination lifecycle typically involves cleaning the surgical instruments, disinfection, inspection, packaging, sterilization, and storage & transportation. A comprehensive monitoring and quality control program might help the facility ensure that the surgical suite always receives clean surgical equipment.

Case Study 2: Sterilization Methods

A steam supply system should ideally be capable of supplying adequate steam to the autoclave, and the steam should be suitable to ensure sterilization efficacy. The system should also be capable of delivering a dry load on completion of the sterilization cycle. However, this is not always the case because wet packs are common challenges in hospital sterilization units. These wet packs are often associated with increased organizational inefficiency, patient safety issues, and costs (Basu, 2017). These issues underscore the importance of promptly addressing wet packs. This paper reviews common causes of wet packs and suggests solutions for addressing the identified issues. It also suggests quality control measures for the wet packs.

Wet pack definition

The Association for the Advancement of Medical Instrumentation defines a wet pack as the presence of residual moisture in the form of dampness or droplets inside or outside a sterilized product or package (Basu, 2017). Any package that contains moisture after sterilization is considered a wet pack.

Wet Load Definition

When two or more packages accumulate too much moisture, the resulting package is called a wet load. Klacik et al. (2010) indicate that “one wet pack is considered a single wet pack; however, if there are two or more packages the load should be considered a wet load.” Therefore, a wet load can be two or more wet packs or sterilized products with residual moisture.

Causes of Wet loads

Poor steam quality, i.e., wet steam or steam with insufficient dryness, can cause excessive condensation inside the autoclave. Poor steam quality occurs due to high demands on the steam supply (boiler) and excessive pressure drops. The wet seam lowers the steam’s heat transfer efficiency, causing inefficient sterilization procedures (Sandle, 2015). It also traps non-condensable gases (NCG) such as nitrogen, carbon dioxide, and oxygen. NGCs form due to long cycles or faulty vacuum pumps, which form air pockets in the sterilizer.

Another potential cause is autoclave loading practices. Some organizations stock the autoclave chamber with excessive products to meet demands (Sandle, 2015). However, this dense packing can challenge steam circulation and cause excessive condensation. Faulty packaging involves placing materials such as cotton inside the surgical set or stacking too many metals in the surgical set. Cotton can hold excess moisture, while the metal masses increase weight and form condensates when the chamber temperature is lowered.

Design issues are characterized by temperature differences between the sterile store and the autoclave chamber. Condensates can form due to these temperature differences because steam often loses energy and condenses when in contact with temperatures lower than itself. Steam can also condense if the steam generator and water separator are located further away from the autoclave, if the steam generator’s capacity is insufficient for the autoclave, and if the steam pipes run toward the sterilizer (Sandle, 2015). Poor pressure control can cause differences in steam velocities.

Solutions

Kristine should conduct a root cause analysis to determine the actual reason causing the wet loads. In addition to the root cause analysis, Kristine can also consider preventive measures such as periodic maintenance of the autoclaves, avoiding overloading the sterilizer, allowing adequate drying time, using suitable quality packaging materials, periodically checking drain valves, and installing a room heater or de-humidifier in the decontamination room.

The organization can invest in vacuum pumps to dry the load after sterilization. Sandle (2015) recommended this practice but warned that vacuuming can also cause water to accumulate due to the long cycle times. Laranjeira et al.’s (2019) study provided a solution to this problem. The authors recommend setting the vacuum at 90bar at the drying phase and conditioning phase. Setting the vacuum at 90 mbar will cause more running time in the vacuum pump but will reduce the time the load takes in the drying phase. The organization can use non-water or computerized recirculating water system vacuums.

The SPD can also prevent condensate formation by heating the load to a certain temperature before introducing it to the chamber. This process involves establishing a “load heat up” phase at the start of the sterilization cycle. An alternative option involves adding a heat exchanger in the air in-bleed assembly at the start of the cycle. The approach will raise the temperature of the chamber load more quickly, reducing the likelihood of condensate formation.

Although using heat exchangers is not mandated, they can also be helpful, especially if the organization deals with dense loads and large chambers. If the organization is against heat exchangers, it can opt to increase the jacket temperature to a given point. Increasing jacket temperatures also helps reduce the probability of condensate formation. However, practitioners must be cautious when using this approach because increasing jacket temperature can result in superheated steam. Superheated steam is inefficient in killing microorganisms, so caution must be taken when increasing jacket temperatures.

The organization should also optimize charge rate control, especially if the autoclave lacks a proportional control valve. If an autoclave chamber has operational issues, steam can flood the chamber, leading to instant condensate formation. Therefore, the department should ensure the chamber’s control system is properly working and can effectively control the rate at which steam is injected in each cycle. The department should also measure steam quality, including its dryness value, and check for any steam trappings to prevent condensate carryover. They should consider best practices in preventing wet packs, e.g., avoiding sterilizer overload.

Impact of the Issue on Operating Room (OR) and the Sterile Processing Department

Wet packs can create infection-related issues in the OR. The residual moisture on the package can create pathways for microorganisms to move from the environment into the packaging material, consequently contaminating the instrument (Basu, 2017). Once the instrument has been contaminated, it risks infection, potentially harming the patient. Also, a wet pack discovered during surgery cannot be used. This incident will force the healthcare team to break down the entire sterile field and set it up again using different disposable items. This process will result in delayed or canceled surgeries, reducing patient satisfaction.

Wet packs also cause increased staff workload, costs, and waste time and effort in the sterile processing department. The department will need to reprocess the medical equipment after wet packs or wet loads have been discovered. This repetition is a waste of time and increases water and electricity costs.

Quality Control Measures

Kristen should list affected items and return them to the sterilization department. The department must treat the returned items as unsterile materials. The goal is to ensure that all wet pack incidences are efficiently handled to reduce wastage and maintain quality.

Conclusion

Wet packs are associated with infection risk to patients, poor patient outcomes, waste of time and effort, increased cost, delayed/canceled surgical procedures, and increased workload. Wet loads are commonly caused by poor steam quality, poor packaging material, and temperature differences between the container and sterilizer chamber, faulty packaging techniques, improper loading techniques, sterilizer malfunction, and design or operational problems. These issues can be resolved by ensuring good steam quality, periodic maintenance of autoclaves, avoiding chamber overload, allowing sufficient drying time, using suitable quality packaging materials, and temperature control in the sterilization and storage area. The unit manager should list affected items and return them to the sterilization department as a quality control measure.

Case Study 3: Preparation of Medical Equipment and Supplies:

Preparation of Medical Equipment and Supplies:

The success of surgical procedures heavily relies on the sterile processing (SP) workforce’s reprocessing expertise. After the decontamination process, SP staff often take the surgical instruments into an assembly area/preparation & packaging area. Unfortunately, this area is characterized by packaging errors that may cause patient safety issues. Common packaging errors include packing incomplete materials, packing damaged equipment, and inaccurate assembling. Zhu et al. (2019) indicate that identifying and correcting these issues will help improve patient safety and service quality. This paper aims to identify the impact of these packaging errors on patients and operating staff and discuss the instrument preparation process.

The Impact of Packaging errors on safe and efficient patient care

Assembly and packaging errors hinder patient safety and quality surgical care practices. The primary goal of packaging is to maintain the sterility of surgical items after sterilization. Therefore, packaging or preparation errors can lead to sterilization failures and increase infection risks (Zhu et al., 2019). For example, rigid containers without filters could result in patient infection.

Typically, filters in rigid containers serve as a protective barrier against microorganisms and allow air and sterilizers to pass through. Therefore, the absence of filters may cause microorganisms to penetrate the container and contaminate items. If these items are used on the patient, they might get infected. Assembled Poole suction devices in sterilized sets are an example of assembly errors. These errors can cause surgery delays or cancellations because the surgical team will need to wait for a replacement set before proceeding with the surgery.

Instrument Preparation Process and Approaches to Ensure Correct Preparation & Packaging

Inspection & Function Testing

The preparation process starts with inspection and function testing (post-cleaning). Once cleaned and dried, the instruments are inspected for their functional utility. The SP team inspects all instruments for cleanliness, sharpness, integrity, movement, alignment, and edges (Spry, 2016, p. 47). Those instruments that do not function as expected should be discarded or sent to repair. Each instrument is examined separately, and all devices on the set are examined to confirm free movement and functional utility.

Assembly

Assembly is the next step in the preparation and packaging step. The goal of assembling is to ensure that all instruments are present. All devices are assembled correctly per the manufacturer’s instructions. During assembly, instruments’ placement, handling, and positioning are done to limit damage and optimize the sterilization process. Once all items have been organized in the trays, the SPD staff counterchecks them against a list specific to the tray being assembled. Staff document and report non-conformance if they discover any missing or extra devices on the set.

Spry (2016) recommends placing an absorbent towel at the bottom of the instrument tray to expedite the drying process and help absorb the condensates during sterilization. Staff can ignore this recommendation if the manufacturer prohibits it. Racks or stringers help to organize and secure the instruments in the container. Heavy instruments must be at the tray’s bottom, and delicate items at the top. According to Spry (2016), the instrument set should not exceed 25 pounds because heavy sets have too much metal mass and could compromise the drying process.

All hinges and joints should be opened, while detachable parts need to be disassembled for sterilization (Spry, 2016, p.53). Likewise, bowls, cups, and basins should be placed vertically in the container, while nested items should face the same direction to prevent air pockets from forming. Impervious materials or rubber sheeting should not be folded because the resulting density hinders sterilizer circulation.

Wrapping & Sealing

The next step in the preparation & packaging processing is wrapping. Sterile processing technicians must comply with the general wrapping & labeling principles to ensure all items are prepared & packaged correctly. These principles include ensuring the packages match the devices being prepared. The choice of packaging material will depend on the nature of the instrument. For example, plain paper bags or peel-apart pouches are used for small loads or single instruments, while metal or plastic containers are ideal for larger instruments and multiple items (WHO, 2016). The devices can be placed in packaging materials such as sterilization wraps, rigid reusable containers, and a sterile barrier system. Staff should ensure that the selected material matches the instrument’s characteristics.

The packaging material should also be appropriate for the sterilization method. Some packaging materials might prevent adequate steam penetration or allow too much penetration, compromising the sterilization process. Therefore, the selected packaging material must allow the sterilizer to penetrate, protect against contact contamination, provide adequate seal integrity, maintain sterility of reprocessed instruments after sterilization, and provide an effective barrier against microorganisms (WHO, 2016). Sterilization wrap, transparent pouches, and rigid sterilization containers are recommended, while metal drum trays, recycled material packaging, and newspapers/brown bags are prohibited (WHO, 2016). After the instruments have been wrapped, they are sealed. Glue and rubber bands are not allowed; technicians can use heat sealing or adhesive tape to fasten the wrap instead.

Labeling

Packages that require sterilization must be labeled. The label should contain the load number, sterilization date, sterilizer code, and the product’s name. The label should not be on the packaging material. Instead, it should be on chemical indicator tape. For paper/plastic pouches, the label should be placed on the laminate side to prevent ink from penetrating the plastic/paper (WHO, 2016). Water-based or sharp-tipped pens are also not allowed. The marking pen should be non-toxic, non-bleeding, and indelible. The labels should also be able to withstand the sterilization process. The last stage of the preparation & packaging process is monitoring the labels and maintenance of packaging systems. The packages should be constantly monitored and maintained until their use.

How does this situation impact the operating room staff?

This situation causes operational inefficiency in the operating room. According to Zhu et al. (2019), the quality of packaging directly affects item sterility and the quality of patient care. When the packaging of items in the instrument does not comply with industry stands, the operating room staff will need to request new instrument sets. For example, because rigid containers without filters have a contamination risk, staff would need to dispose of them and acquire new ones to prevent infections. These incidents can cause surgery delays or cancellations, which, in turn, increase operational costs. Packaging errors can also cause physical harm to the staff. According to Zhu et al. (2019), the weight of surgical trays must meet lifting and handling requirements. Otherwise, the heavyweights might harm staff during handling processes.

Conclusion

Packaging errors can result in safety issues and patient care inefficiencies. Organizations must comply with best practices to improve patient safety and service quality. The instrument preparation & packaging process involves the following steps: inspection & function testing, assembly, wrapping & sealing, labeling, and monitoring & maintenance of the packages. To prevent packaging errors, SPD staff must comply with this process, industry guidelines, and manufacturers’ specifications.

Case Study 4: Inventory Control and Distribution:

The primary goal of any inventory system is to reduce inventory costs without compromising service quality. According to Neve and Schmidt (2021), inaccurate inventory records accounted for reimbursement losses amounting to approximately $2 million annually. These financial outcomes are risky, given that inventory and patient care issues significantly affect some hospitals’ cash conversion cycles. Inefficient inventory management can also affect an organization’s service quality, underscoring the importance of effective inventory management.

Perpetual Inventory System

Perpetual and periodic inventory systems are the predominant inventory systems in the healthcare system. A study by Park and Dickerson (2009) indicated that a perpetual inventory management system is superior and more effective than a periodic inventory management system. The perpetual inventory system is a continuous inventory management system that tracks each item’s supply individually.

Replenishment occurs whenever an item’s inventory level goes below a certain set point (Ahmadi et al., 2018). The assigned staff creates an inventory card and uses it to track and record all transactions made for each inventory item. In computerized systems, technicians update the inventory based on utilization patterns on preference cards. Preference cards typically detail the equipment and supplies each surgeon prefers to use for each case type. When a case is scheduled, the database generates the preference list, and the SPD stocks the case cart with the appropriate supplies and instruments.

The bin-level RFID-enabled tag is an example of this continuous inventory system (Ahmadi et al., 2018). The bin-level RFID-enabled system optimizes the number of empty bins that need replenishment through information technology. It uses RFID and barcodes to capture supplies’ data at the point of use and shares it with the database. This system reduces delivery delays, labor costs associated with restocking unused items, and inventory wastes and encourages data sharing between relevant departments (Ahmadi et al., 2018). The system can also capture utilization patterns, allowing the SPD to easily identify frequently used items in various case types.

Despite these advantages, perpetual inventory systems also have limitations. First, it creates an additional workload because staff needs to make time to scan the items (Ahmadi et al., 2018). Staff may also need to perform manual cycle counts to match the inventory level displayed by the system. Secondly, these technologies are capital-intensive and require heavy technological infrastructure investments (Ahmadi et al., 2018).

The Periodic Inventory System

The periodic inventory system has a fixed interval for placing orders. Staff check the inventory levels at specified intervals and replenish supply if an item’s inventory falls below the base level. In each review cycle, if an item’s inventory level is less than a certain reorder point, staff would replenish the item and increase it up to a specified level (Ahmadi et al., 2018). The two-bin system is an example of this periodic review system and is commonly used at the point of use (Ahmadi et al., 2018). In this system, inventory staff evenly distribute the supply required at the point of use (POU) in two separate bins. The clinical practitioners utilize the front bin until it is entirely exhausted. Once exhausted, the bin is placed on the shelf for replenishment in the following review period (Ahmadi et al., 2018). The clinicians then proceed to consume the second bin.

Accounting for inventory in periodic sytems is done manually at defined intervals. Any data discrepancies or inaccuracies will affect the inventory level’s validity and credibility. These issues can also result in operational and financial problems due to stock-outs or excess inventory resulting from data inaccuracies (Ahmadi et al., 2018). Without data accuracy, inventories will be duplicated, increasing the overall supply cost. Order quantities tend to exceed what is required, leading to overstocking.

Items in periodic inventory systems are often grouped using the ABC classification system. Class A items consume the highest budget, approximately 70% hence, are highly prioritized by the system (Ahmadi et al., 2018). Class B items account for 20% of the budget, while class C consumes 10% of the budget. Ahmadi et al. (2018) recommend combining this ABC classification with VED analysis. The “V” in VED analysis represents “vital items,” items the hospital heavily relies on to operate effectively. “E” stands for essential items that affect service quality, while D represents desirable items that would help prevent hospital constraints. This VED analysis should be used as an extension of the ABC classification to help the organization account for usage frequency, criticality, and cost.

Economic Order Quantity (EOQ) system

Economic Order Quantity (EOQ) system focuses on historical data to prevent over-ordering. According to Ahmadi et al. (2018), EOQ only considers the cost to determine the optimum item quantity. According to the authors, this approach is unsatisfactory because the goal of inventory management is to reduce costs without compromising care quality. However, EOQ considers cost only and does not account for service level, demand variability, storage space, etc. Hence, this model is not recommended.

Integrated Inventory Management systems are computerized inventory systems. These systems store receipt data, process & update information, and track the utilization of each inventory item. Other sophisticated inventory systems can interface with the organization’s financial system and other departmental systems, allowing departmental data sharing.

How can distribution be affected by excessive inventory?

Excess inventory takes up storage space for other items, possibly leading to inventory level discrepancies. If an instrumentation set has excessive inventory, it is highly likely that another set is missing an item(s). Decision-makers often use inventory-level data to guide their replenishment cycles. Any inaccuracies at the POU can result in significant operational hurdles and compromise service levels (Neve & Schmidt, 2021). For example, if an item is missing because other unnecessary items were included in the instrument set, the surgical team would need to delay surgery to acquire the missing item. Such incidents can cause delayed patient care and might also reduce patient satisfaction.

Neve and Schmidt (2021) also indicate that inaccurate inventory records can lead to unexpected delays in demand fulfillment. Demand fulfillment issues mean that surgeons need an item, but the organization does not have any inventory at hand to respond to this demand. Similar to shortages at the POU, item shortages at the organization level also affect service quality.

Conclusion

Inefficient inventory management can increase unnecessary healthcare costs, cause revenue losses, and impact an organization’s service quality. Effective inventory management can help resolve some of these issues. Perpetual inventory systems, periodic inventory systems, two-bin systems, bin-level RFID-enabled tag systems, and economic order quantity are standard inventory management systems in healthcare systems. Each system has advantages and limitations, and organizations must conduct an internal analysis to determine which system best suits their needs. However, EOQ is recommended against because it does not account for service quality. The bin-level RFID-enabled system is recommended, but it is costly, requires heavy technological infrastructure investments, and creates an additional staff workload. However, its numerous advantages can offset the costs associated with these challenges. The perpetual inventory system is preferred over a periodic inventory system.

References

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Belay, E. D., Blase, J., Sehulster, L. M., Maddox, R. A., & Schonberger, L. B. (2013). Management of Neurosurgical Instruments and Patients Exposed to Creutzfeldt-Jakob Disease. Infection Control & Hospital Epidemiology, 34(12), 1272–1280. https://doi.org/10.1086/673986

Fast, O., Fast, C., Fast, D., Veltjens, S., Salami, Z., & White, M. C. (2017). Limited sterile processing capabilities for safe surgery in low-income and middle-income countries: experience in the Republic of Congo, Madagascar and Benin. BMJ Global Health, 2(Suppl 4). https://doi.org/10.1136/bmjgh-2017-000428

Klacik, S., Breadmont, L., & Crcst, A. (2010). CRCST Self-Study Lesson Plan Lesson No. CRCST 155 (Technical Continuing Education -TCE) LEARNING OBJECTIVES. https://www.eventreg.purdue.edu/info/central-service/pdf/crcst/CRCST155.pdf

Laranjeira, P. R., Bronzatti, J. A. G., Souza, R. Q. de, & Graziano, K. U. (2019). Pacotes molhados: o aumento do tempo de secagem aumenta o consumo de água (recurso natural escasso)? Acta Paulista de Enfermagem, 32(1), 101–105. https://doi.org/10.1590/1982-0194201900014

Neve, B. V., & Schmidt, C. P. (2021). Point-of-use hospital inventory management with inaccurate usage capture. Health Care Management Science, 25(1). https://doi.org/10.1007/s10729-021-09573-1

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