What happens when unexpected supplies arrive straight into the procedure room?
Getting inventory management right comes down to monitoring each individual product as it flows through the hospital inventory supply chain. All too often these trunk stock items remain invisible on hospital systems and ultimately this compromises patient safety and results in missed revenue.
With so much at stake, let’s take a closer look at the issue of trunk stock and review best practice in capturing non-stock items at the point of care.
When is Trunk Stock used?
The most common entry point of trunk stock is during complex cases, such as orthopedic and neurological procedures. These rely heavily on trunk stock, as physicians cannot anticipate all the products and item sizes they will need.
It’s not just regular stock items that end up being brought in directly to the procedure room. Vendors often introduce new and trial products to physicians that solve the medical issue at hand.
Trunk stock is like a safety net, but it’s a double-edged sword – protecting from one side while adding risks from the other.
While it’s surgeon-endorsed, with clear clinical gains, administratively it presents a challenge.
The perils of not being on the hospital’s item master list
The Item Master is king in inventory management, driving the whole supply chain process. Each item entered into the system at the POU then has its SKU checked against the item list, and once matched, the supply chain flows.
But trunk stock presents off-contract and non-file data issues.
It does not appear on the Item Master and has no prior data trail.
It may be a trial item, a non-stock item or a different size or batch of an item that is currently out of stock.
In any of these cases, attempts to scan the item at the point of use will result in an error. Kits, sets and small consumables such as screws are also problematic to capture.
Trunk stock is a burden on busy nurses
In procedure rooms the circulatory nurse is purely concerned with supporting the clinical team and the patient, so non-nursing tasks are not a priority.
In fact, 52% of items used in surgery are not recorded or charged.
We hold regular discussions with perioperative nurses who confirm it’s a big issue:
“There was almost a unanimous agreement that those items were not being captured or recorded, particularly because they were not on the item master”
At the point of care very few people know about the trunk item – just the rep, the surgeon, the scrub and the circulatory nurse. All are aware that non-capture of consumed items is a procedural violation. It falls on busy perioperative nurses to bring the item into compliance, but often information gaps prevent them from recording these items.
The reality is that dealing with the electronic capture of trunk stock is just too problematic and time consuming, they are routinely left uncaptured at the point of use.
What’s really needed is a quick and easy method to capture trunk stock during surgery.
Current workarounds to make trunk stock visible
As there is no quick fix during surgery it becomes a post-surgery task. There are two common workarounds; one with the perioperative nurse leading and the other with the back office being left to backtrack.
Nurse workaround – getting an item listed before entering on to the EHR:
In order to get a non-listed item on to the item master, the circulatory nurse needs to take the packaging to the Materials Management team so that it can be entered into their system.
Once entered the nurse will then have to go back into the EHR to manually enter the information into the patient’s chart.
This process cannot be done between surgeries, so the nurse will have to add this to the tasks at the end of her shift. Trunk stock may have been consumed during several procedures, so the post-surgery admin builds up and adds non nursing tasks to an already long and stressful work day. All too often, something more urgent comes up and the admin task slips by the wayside, leaving the items unrecorded.
Back-office workaround – getting a non-listed item on to the EHR:
The back-office workaround relies upon the vendor’s invoice reaching the OR General Business Manager. They need to get the item on to the hospital system, and then digitally associate it with the patient and procedure. The charge and invoice details will also need to be recorded.
When product SKUs from trunk stock does not appear on the Item Master, the process for updating the EHR is clumsy and convoluted for. It involves a series of screens, drop downs and data entry – it’s a manual, clunky, error-prone process.
Two different workarounds with the same result
Whichever way the hospital tries to deal with capturing trunk stock, clunky workarounds mean that there is a high big risk of it not getting recorded.
It’s clear that capturing utilization during surgery would be the ideal option, as there is no quick and simple workaround.
Failure to capture trunk items has serious implications, let’s take a look at these.
The risks of non-captured trunk stock
Patient safety and Compliance
Trunk stock goes from the vendor’s hands to the surgeon and is then implanted into the patient, all in quick succession. There is a lack of clarity over responsibility.
Who checks if the product has expired or was recalled prior to usage?
And if the item was not captured on the EHR, what happens if there is a subsequent product recall? How can the patient be quickly identified and contacted?
The sad fact is that UDI data is not routinely collected on trunk stock and many items are used unchecked, these are red flags for patient safety plus a potential non-compliance for clinicians and the organization.
Trunk stock is risky all around and many hospitals are seeking solutions that lower these risks.
It’s clear that capturing items at the POC, and making safety checks prior to consumption, is the model to aim for.
Capturing item usage at the point of care – Snap&Go by IDENTI Medical
Inventory Management
In order for Materials Management staff to accurately manage supplies for elective surgeries and to anticipate upcoming inventory requirements, data on historical usage is needed.
As trunk stock is routinely left outside of data-capture, there is a whole set of data that is invisible and cannot be factored into inventory planning.
This serves to create a viscous circle, whereby the same items will continue to appear as trunk stock only, as there was no record of it in the supply chain to prompt reorder.
Expiry management of these items also falls into no man’s land and remains outside of the hospital’s stock control activities.
For inventory management systems to work well, accurate stock predictions are necessary to ensure a balanced inventory and this relies on historical data. With trunk stock missing, this simply isn’t the case.
The cost of trunk stock
Unexpected, last-minute stock is charged at a premium, digging deep into the inventory budget.
It can be seen that by trunk stock remaining invisible, the toll on inventory management is the lack of accurate data for orders, inability to control this stock and inflated costs.
Filling in the data gap would give the hospital far better control of their inventory and enable data-driven restocking to take place.
Charge Capture
Let’s talk money!
Trunk stock tends to be high value chargeable items. The very items you really need to capture.
In a complex spinal case, the surgeon may use 100+ products and just 5% of these may be trunk stock. But these items may relate to 35% of the cost of surgery. It’s a big hole if it’s not captured.
Lack of item and charge capture on the EHR, leads to trunk stock being missed off billing and case reimbursement falling short.
Trunk stock costs money – both in terms of it being a last-minute item and then,
to add insult to injury, being absent from billing reconciliation.
With trunk stock throwing a curve ball on inventory management processes, it’s time to look at how to avoid the pitfalls and figure out the best solution to handling trunk stock.
How to capture trunk stock in surgery
At IDENTI Medical we find the gaps in hospital workflows and develop tools to bridge these gaps and strengthen the chain.
It is clear that the lack of a data record means that trunk stock becomes a slippery item and falls through system cracks.
Barcode scanning and direct data entry are ineffective so we have developed a failsafe way to capture all items at the point of care, including tricky trunk stock.
We use image recognition and AI technologies to capture all product information and digitally record this on the EHR in real time. Our system also flags up recall and expiry issues in seconds, so clinicians can be assured that all items are safe before usage.
Snap & Go provides 100% item and charge capture, including trunk stock not on the item list.
Our clever technology can also digitally capture manually completed count sheets in just a few seconds.
Snap & Go is your all-round solution to trunk stock – bringing it onto hospital systems in real time, providing pre-consumption safety checks and ensuring billing reconciliation.
