What is patient safety in healthcare?
Patient safety is a fundamental responsibility that sits at the very core of hospitals and surgical centers.
The healthcare environment is an increasingly complex, highly stressful environment, where staff have to deal with conflicting demands under high pressure. Additional challenges include longwinded workflows, unintegrated technology and the reliance by some on manual systems that are inefficient and error-prone. Within this complicated backdrop, patient safety has to remain at the heart of every system, process, workflow and action.
Despite the best intent by all, patient safety compromises happen on a regular basis.
The World Health Organization reports that:
‘It is estimated that one in every 10 patients is harmed while receiving hospital care. The harm can be caused by a range of adverse events, with nearly 50% of them being preventable.’
Inventory management is a key healthcare process where patient safety guidelines need to be incorporated at every stage to offer optimum patient safety and protection.
In this article we will look at the measures that can be taken to bolster patient safety, mitigate risks and reduce errors relating to the usage of medical supplies, narcotics, consumables and implants.
We will start by looking at the hospital inventory supply chain and see how this needs to respond to clinical demands.
Nurses face severe challenges with Supply Chain issues
Nurses face challenges everyday and many of these are beyond their control. However some issues – admin, procedural, system-related – CAN be addressed in order to improve supply chain workflows and make the day-to-day jobs of busy nurses that bit easier.
Perioperative nurses have to deal with a range of supply chain issues in their day-to-day practice including:
- lack of automation and reliance on time consuming item documentation systems
- unreliable supplies – stock outs and stock surpluses
- out of date, inaccurate physician preference cards
- having to leave procedures to hunt down stock items
- lack of time/simply system to check expiry and recall prior to product usage
Let’s take a look at some of the specific problems attached to these issues.
Examples of hospital inventory supply chain fails that compromise patient safety
When medical supplies management fails the results can be costly and devastating. Examples of medical inventory management fails are:
- Stock outs – Every nurse’s nightmare. Stock outs have a direct impact on the provision of timely care. What’s more, fear of stock outs also has an impact – with nurses hoarding stock, distorting inventory levels and contributing to over-ordering.
- Surplus stock – storage space in hospitals is already limited, but when supply rooms become overstocked the problem isn’t just messy supplies spaces – surplus inventory slows down product selection and seriously hampers stock control.
- Stock Control – the effective rotation of stock ensures that the soonest to expire items are used first. When this goes wrong, risk levels rise.
- Expiry Management – making sure that every item used is within its expiry period is a crucial element to the delivery safe patient care.
- Recall Management – there are two factors – discarding all recalled batches to prevent usage, and easy identification of patients who received a recalled batch following an alert.
- Usage Itemization – there need to be final safeguards in place at the point of use to check that the correct product has been selected, and to prevent usage of any expired or recalled items. This means the individual checking of each item prior to usage in the procedure room. Missing out this vital stage is a big red flag. It’s like walking the high wire without a safety net.
- ‘Never Events’ – never events should never happen but unfortunately, they do. Patients can suffer a range of medical complications due to the use of an expired or recalled item. The results could be devastating, and costly litigation is sure to follow.
Every one of these frustrations is a patient safety red flag. At each stage the difficulties that nurses face could result in errors that impact on patient wellbeing.
Patient safety in surgery is an extremely high-risk area.
The World Health Organization states that:
‘Unsafe surgical care procedures cause complications in up to 25% of patients. Almost 7 million surgical patients suffer significant complications annually, 1 million of whom die during or immediately following surgery.’
Surgical care procedures are therefore a key workflow that hospitals and surgery centers need to focus on. There is a drive to simplify the admin burden on clinical staff, automate processes and create leaner workflows. Within this review and improvement of inventory management workflows, special care needs to be taken to boost patient safety at every stage.
The role of supply chain in patient safety
As the old adage goes, prevention is always better than cure.
Medical inventory risks can be reduced by ensuring that supply chain workflows contain in-built safeguards that result in:
- the right stock being available, in the right place, at the right time
- the correct storage and stock rotation of products
- safety checks being made prior to product usage
Achieving these goals is not as simple as it may seem. Hospitals and large surgery centers store hundreds of thousands of products, all of which need to be carefully managed.
Gaining full control of this vast quantity of supplies requires a well-organized supply chain, but all too often hospitals have overly complicated workflows that become a burden to busy nurses and hamper effective inventory management.
With high stakes at play, healthcare organizations need to address these workflow failures and find a way to add built-in protection to their systems and processes. To support them with this task there are several regulatory guidelines and standards that support improved patient safety.
Patient Safety Guidelines and Regulations
There is already a framework in place for healthcare organizations to use to improve their systems, workflows and practices that impact on patient safety. The three biggest organizations are the FDA, The Joint Commission and GS1. We’ll have a look at each of these and establish their specific role in supporting patient safety.
FDA UDI Regulations
The FDA has issued regulations that all healthcare organizations need to comply to – the UDI system focuses on the tracking of medical devices. This Unique Device Identifier needs to be logged electronically for every single medical device, at all stages of its passage through the supply chain. The system is designed to track all medical devices and implants, which is crucial for swift patient contact following a product recall.
Healthcare organizations are bound by these regulations and need to log specific product information in their systems and against the patient’s record, in order to comply.
Data logged on the UDI code covers:
– Lot or batch number within which a device was manufactured
– Serial number of a specific device
– Expiration date of a specific device
– Date a specific device was manufactured;
– Distinct identification code
Capturing the full data listed above is required in order to be compliant. But in reality supplies come from different countries and a wide range of suppliers. They are the beginning of the supply chain and so how they code this data will affect how easily it is collected through the entire supply chain that follows.
Many hospitals use barcodes to log inventory but since the introduction of UDI they have become aware that many barcodes do not contain the full UDI data required by the regulations.
Another problem is the maintenance of item lists, these are notoriously hard to keep up to date, particularly as the batch/lot number changes over time. Another issue is barcodes, which are commonly used as the item traceability system. Issues here include suppliers not working to a consistent standard and products containing a confusing number of barcodes, many of which do not contain full UDI data. Logging item details is supposed to be a quick task, but in order to maintain compliance nursing staff often need to undertake additional inputting and workarounds to get the job done and this is a drain on their precious time.
The Joint Commission
The Joint Commission evaluates, accredits and certifies US health care. It is the largest body in the sector that sets standards and provides accreditation.
The Joint Commission has National Patient Safety Goals designed to which include:
- Improve staff communication
- Identify patient safety risks
- Prevent mistakes in surgery
- Use medicines safely
These are very relevant for the improvement of inventory management systems and workflows.
The use of medical inventory needs to be communicated, via inventory management systems, so that materials management staff can maintain adequate stock levels.
Patient safety risks such as stock outs and expiry issues need to be addressed.
Mistakes such as the usage of expired or recalled consumables or narcotics simply have to be avoided and it is robust systems that prevent errors and ensure safe usage of medicines.
Adhering to the Joint Commission (JC) guidelines will have a big impact on reducing risk and improving patient safety.
GS1 is another resource designed to boost patient safety in hospitals and surgical centers. The GS1 Standards for healthcare are designed to improve patient safety by driving supply chain efficiencies that result in better tracking of drugs and medical devices. The standards are designed to identify, capture and share supply chain data for better visibility, control and practice. Sharing data across the supply chain keeps all parties fully informed and aids better decision making, improving the control and efficiency of hospital medical inventory management.
Healthcare organizations are looking to embrace the regulations and standards in order to improve their supply chain efficiencies and operate compliantly. The GS1 helps them to review their systems, procedures and workflows to make sure that they are following best practice and supporting outcomes such as patient safety.
Let’s take a closer look at the hospital inventory management workflows that drive the supply chain forward.
The role of data in hospital medical inventory workflows
As we have discussed, medical inventory workflows need to embrace the relevant regulations and standards by including preventative measures to avoid patient safety lapses. Workflows need to capture inventory data as items move through the supply chain. It is this data that informs supply chain decisions. If we compare the supply chain to a car then data is the gas.
Patient safety is a cross cutting theme for every department and every workflow. It needs to be ever-present and ever-paramount.
The World Health Organization reinforces this:
‘To ensure successful implementation of patient safety strategies; clear policies, leadership capacity, data to drive safety improvements… are all needed.’
Data is certainly a key factor in medical supplies management and increasingly technology is being used to automate medical inventory workflows.
A good system will:
– give full medical inventory visibility
– track hospital supplies usage
– control/rotate medical supplies and consumables
– have safeguards in place for recall and expiry management
– ensure that only pre-checked items are used in surgery
– log item utilization at point of use
– integrate with MMIS, ERM and EHR systems
– restock based on demand
– avoid stock surpluses and stock outs
If any of these steps above are not followed, then cracks appear in the system that open the organization, nurse and patient up to higher levels of risk.
Inventory visibility in the post COVID era
Medical inventory shortages have become more common in the post COVID era, with delivery timescales becoming less predictable. This means that the stock carried by healthcare organizations needs to be managed even more carefully, as prompt, automatic restocks cannot be assumed on all items.
Healthcare organizations with robust systems and workflows in place are most likely to have good an accurate picture of their inventory at hand and therefore be able to make informed procurement decisions that ensure efficient and safe inventory management. Better budgeting decisions can be made with clear inventory visibility with purchasing being focused solely on areas of need.
Having visible medical inventory is the key to gaining control of all of hospital materials management processes. Visibility needs to be across the whole supply chain loop, from delivery through to usage, billing and restocking. It is inventory tracking that provides visibility. And that is driven by data.
How IT can support patient safety in surgery
Surgical suites in hospitals, ambulatory surgical centers (ASCs) and outpatient surgery centers (OSCs) are complicated settings where it can be difficult to create and implement admin procedures. IT automation is the natural response to address workflow inefficiencies, with a view to making processes simpler and quicker. In the dynamic and fast-paced surgery setting, any system needs to integrate well into clinical workflows without adding the the admin burden.
Clinicians require the right inventory, in the right place, at the right time in order to undertake successful surgeries. Patient safety is ultimately dependent upon the supply chain meeting the clinician’s needs.
Healthcare leaders are certainly aware of the issue and the support that IT can play in adding efficiency into inventory management and supply chain systems. Technology is increasingly being used by US healthcare providers to achieve workflow automation that tracks and controls medical inventory throughout the supply chain cycle.
Hospital IT teams will lead on the planning and implementation of new systems, working with suppliers to ensure full interoperability with existing hospital IT infrastructure. However, solutions need to be planned with the involvement of a clinical lead too, to ensure that workflows and IT processes are practical at the user-end.
Inventory management in the perioperative setting
An ineffective medical inventory supply chain has a negative impact on efficiency and income. But more importantly it is a patient safety issue for several reasons:
Stock outs of surgical supplies
Poor inventory management can lead to missing surgical supplies. This is not in any way a rare occurrence and commonly causes:
- delayed cases
- cancelled cases
If the case goes ahead and stock is required during surgery which is not readily available this causes:
- in-surgery delays
- perioperative nurses searching for supplies and being absent from surgery
- possible medical complications caused by the delay
Inventory management systems need to result in stock levels that match demand. Anticipating demand is more accurate with data insights.
Usage of expired or recalled products in surgery
Even if the items are in stock, risks remain at the point of use. Without adequate safeguards in place there is the danger of unsuitable products remaining on the storage shelves and ultimately being used, items such as:
- expired products
- recalled products
Use of either of these products can lead to:
- a potentially disastrous ‘never-event’ for the patient
- non-compliance by clinical staff, risking their registration
- bad publicity expensive litigation for the hospital.
Inventory management can therefore be seen to be a crucial safety issue for the patient, the clinical team and the healthcare organization.
Ensuring adequate stocks that are controlled and checked are the basic fundamentals that any hospital or surgery center needs to get right.
Effective operating room inventory management
Effective inventory management for the operating room has four key aspects to it:
– full visibility of medical inventory
– demand-lead procurement
– full item utilization during surgery
– prompt re-stock
For most healthcare organizations, each of these has its own challenges but likely, all would agree that the biggest challenge is logging all items during surgery.
It is difficult to anticipate every need during surgery, the surgeon often does not know the size of many of the items he needs until the surgery has commenced. Surgery is very unpredictable, there may be medical emergencies within the surgery or other complications that arise, which require the usage of unforeseen products.
Perioperative Nurses need to ensure the supply of unplanned items as well as those pre-planned and on the pick list. Once they have managed to obtain these items, each needs to be logged. However, in the tense surgery setting, with all eyes on the patient, item tracking isn’t the main priority for clinicians.
Logging the products may seem like a nicety but it is far from that. Item utilization tracking at the point of care in a surgery setting is a patient safety issue.
Protecting patient safety in the surgery environment is not just about direct patient care.
It’s about medical inventory being well organized and having systems in place to pre check each item prior to usage.
It’s about ensuring the patient record is fully up to date, not least in case of future recalls.
It’s about informing materials management of item usage so that replacements products can be ordered.
Patient safety risks posed by Trunk stock
During complicated surgery a vendor’s rep is often on site with a trunk full of products that could be called upon at any time. As the surgery progresses, if an item is needed that is not in stock then the rep can collect the product from their trunk, which this is then immediately prepared and used in the surgery.
Trunk stock can present hidden dangers in procedural rooms. Items are not in the hospital’s stock list; they are often not even on their item list, so logging each item is not a simple matter for the perioperative nurse.
The item is completely outside of the system. The product is needed for immediate use. In the heat of the moment mistakes can happen and a recalled or expired item can be used, compromising patient safety.
To make matters worse, if the item wasn’t logged there is no record of this item ever having been used on the patient.
Patient safety in surgery impact factor
The impact of patient safety lapses in surgery can be devastating. Most healthcare organizations are aware of the risk areas and steps need to be taken to tighten up loose workflows in the operating room setting. Healthcare organizations need to prioritize preventing errors, lowering risks and reducing harm to patients during their procedures.
Addressing system and workflow issues is the way to tighten up procedures and improve patient safety and wellbeing.
How Hospital Supply Chains Impact Nurses, Patient Safety and Margins
Improving the medical inventory supply chain with automation, management systems and leaner workflows can help reduce risk as well as costs.
In order to make changes the following need to be addressed:
– review past safety lapses and develop a better picture of what went wrong and why
– identify the medical inventory risk factors in the surgery setting
– review workflows, systems, training, interoperability
– put risk reduction steps in place to avoid repeats of past fails
– add further protection into the surgery setting to optimize item utilization and prevent usage of recalled or expired products
– ensure each item is checked prior to use, even for trunk stock
How can patient safety in surgery be improved?
Patient safety in the operating room CAN be improved. There are no new issues. Just the same recurring red flags that can lead to catastrophic sentinel events. There does now seem to be a real will among hospital management to get to grips with improving patient safety in the operating room, in particular for inventory issues which have traditionally been tolerated and not dealt with.
The solution needs to be one that can be quickly and easily used by nursing staff. It cannot necessitate workarounds, multiple inputting per item or other time-sapping, non-clinical activities.
That’s why a bespoke solution, designed to easily integrate into existing workflows is the most likely to succeed on the ground.
Medical Inventory System for the Operating Room (OR)
IDENTI Medical specializes in helping healthcare organizations to gain better visibility of their medical inventory in order to gain control of their supplies, leading to enhanced patient safety.
Snap & Go is a new, innovative tool ready-made for the surgery setting. It uses patented image recognition technologies to make capturing item data at the point of care a quick and simple task.
Nurses simply hold the packaging under the sensor for 3 seconds.
It then captures ALL the information required, including full UDI capture.
The system flags up any recall or expiry issues at the point of use.
Snap & Go can even be used on trunk stock – addressing a known weak point for data capture.
Once ‘snapped’ at the point of care, our management system updates the MMIS, ERP and EHR. Automated restocking is triggered.
Snap & Go won the Frost & Sullivan 2022 New Product Innovation Award and is proving a big hit with clinical staff in operating rooms and procedure rooms.
A 3 second ‘snap’ is the simplest and most effective inventory management solution to boost patient safety at the point of care.
Find out more or book a demo to see how Snap & Go can be the patient safety boost that your hospital or ambulatory surgical center needs.