Influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: a case of Rwanda Southern Province

BACKGROUND

Stock-outs of some life-saving drugs, such as emergency obstetric drugs, are evident in many health facilities and have been reported to be the leading cause of maternal mortality and morbidity for women from low and middle income countries (LMICs). For many cases, this situation is associated with poor inventory management practices. The aim of this study was to investigate the influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: case of the Rwanda Southern Province. Moreover, to gain a better grasp of the problem and to suggest possible areas for improvement.

METHODS

An institutional-based cross-sectional study was carried out in all ten district hospitals (DHs) providing maternal health care and dispensing emergency obstetric drugs namely; Kigeme DH, Munini DH, Kabutare DH, Kibilizi DH, Gakoma DH, Nyanza DH, Ruhango DH, Gitwe DH, Kabgayi DH and Remera Rukoma DH. Both quantitative and qualitative data were collected and analyzed. Oxytocin injection, Misoprostol tablet and Magnesium sulphate injection as recommended emergency obstetric drugs by WHO, UNFPA and Rwanda Essential Medicines list were included in the study.

RESULTS

The study revealed that keeping logistics management tools up to date is the backbone of inventory management practices in the availability of medicines and medical supplies. The results showed that hospitals with up-to-date logistics tools for their pharmaceutical management were 33.25 times more likely to have their emergency obstetric drugs in stock at all times compared to those that do not regularly update their logistics tools. The proper use of bin cards and electronic software (e-LMIS) contributed greatly to reducing the stock-out rate of emergency obstetric drugs by 89.9% and reduction of unusable to usable stock ratio by appropriate use of simple techniques such as the Min-Max inventory control model by 79%. Over an 18-month period, misoprostol tablet had the highest average days (32) of stock-outs (5.9%), followed by magnesium sulphate injection with an average of 31 days (5.7%), and oxytocin injection with an average of 13 days (2.4%).

CONCLUSION

Proper use of pharmaceutical management tools within hospitals premises positively influence the availability of life-saving drugs, such as emergency obstetric drugs. Adequate supply chain staffing in health facilities is the most important key to improving inventory management practices and medicine availability.

Understanding the problem of digital medication inventory visibility in health systems

PURPOSE

This project describes and quantifies the perceived degree of digital visibility to medication inventory throughout 6 large health systems.

METHODS

In this project, 6 large health systems evaluated their physical medication inventory for digital visibility, or the degree to which physical medication inventory information is viewable in electronic systems, during a 2-year period (2019-2020). Inventory reports included medication items with either a National Drug Code (NDC) or a unique institutional identifier. Physical inventory reports contained the medication item name and a corresponding NDC or identifier, the quantity on hand, and the physical locations and the storage environments of the inventory items at the time of the audit. Investigators independently reviewed physical inventory reports and categorized medication line items by degree of digital visibility: (1) no digital visibility, (2) partial digital visibility without accurate quantities, (3) partial digital visibility with accurate quantities, or (4) full digital visibility. Data were anonymized, aggregated, and analyzed to characterize the degree of digital visibility across the health systems and to identify locations and storage environments where the greatest improvement is needed.

RESULTS

Overall, less than 1% of medication inventory was judged to have full digital visibility. The majority of the evaluated inventory items were categorized as having partial digital visibility, with or without accurate quantities. Analysis by both units of inventory and inventory valuation indicated that only 30% to 35% of inventory had full digital visibility or partial digital visibility with accurate quantities.

CONCLUSION

Most of the medication inventory within 6 large academic centers is either not digitally visible or partially digitally visible but without accurate quantities. Full digital visibility of inventory is rare. Better digital visibility can minimize disruption from recalls and decrease waste. Technology vendors and health systems must collaborate to develop improved automation and systems to make medications on hand more digitally visible.

Potential challenges faced by blood bank services during COVID-19 pandemic and their mitigative measures: The Indian scenario

The current pandemic caused by SARS-CoV-2 virus is going to be a prolonged melee. Identifying crucial areas, proactive planning, coordinated strategies and their timely implication is essential for smooth functioning of any system during a crunch. Addressing the impact of COVID-19 on transfusion services, there are 4 potential challenges viz. blood/ component shortage, donor/ staff safety, consumable supply/ logistics and catering to the convalescent plasma need. In this review article, we will be discussing about these potential challenges in detail along with the necessary mitigative steps to be adopted to tide over the COVID-19 crisis in an Indian set up.

Hospital Pharmacy Service: Facing the logistics of medicines procurement

COVID crisis has abruptly broken into our hospitals, and many difficulties have  emerged, including those related to supply logistics. A huge number of new  patients, a fast internal reorganization process and many other changes were  suddenly established. These circumstances revealed the need to increase stocks  of drugs, both for basic treatment as well as for specific SARS-CoV-2 infection  management. At the same time, other problems (shortages, new and complex  purchasing procedures, etc.) surfaced, so they could risk safety along the  pharmacotherapeutic process. The main objective was to develop and implement all the necessary measures within the logistics circuit in order to ensure the  availability of medicines for patients, as safely and effectively as possible, during the Coronavirus crisis. Firstly, two pharmacists were appointed to coordinate the whole process, and a preliminary analysis of the following aspects was carried  out an estimation of needs to make an initial drug provisioning, a storage  feasibility study and a global analysis of the logistics process to detect critical  points. Three different circuits for medicines supply were established as some  drugs were operated by Agencia Española de Medicamentos y Productos  Sanitarios (AEMPS) or Servicio Madrileño de Salud (SERMAS), and others were  under no restrictions. For stocks control, inventory was frequently reviewed and  monitoring of prescription trends was implemented. For all new medicinal  products, compliance with security standards was reviewed and relabeling was  carried out if necessary. Criteria were defined for the storage of overstocks and  it was placed an isolated area for quarantined drugs. Shortages inevitably  occurred but their effects were partly mitigated by AEMPS and SERMAS. After  all, we consider that the implemented procedure for logistics management may  be reproducible, and the key points we have identified are the following: to  enhance our quality management system, to develop an Action Plan for  Healthcare Emergencies and to ensure the adequate training for all pharmacy  staff. Furthermore, we also should address other aspects: to establish storage  optimization strategies, to focus on a more advanced logistics management  model, as well as to take advantage of the extraordinary multidisciplinary  network, which has been consolidated during this COVID pandemic.

Optimizing O-negative RBC utilization using a data-driven approach

BACKGROUND

O-negative red blood cells (ON-RBC) are a precious resource and the international blood banking community has become increasingly concerned with its inappropriate utilization. AABB recently made several recommendations to address the issue. Solutions must be multifaceted and involve donor centers, blood banks, and clinical departments. From the perspective of a hospital blood bank, it is difficult to rely solely on increased donor recruitment and ubiquitous blood typing of the entire in-patient population. We therefore focused on interventions within the blood bank to optimize inventory and policies to ensure appropriate ON-RBC utilization.

STUDY DESIGN AND METHODS

Transfusion data over one year was examined for the rate of out-of-group/inappropriate ON-RBC. Furthermore, we assessed whether that rate was related to product life on the day of transfusion. We also examined our stock inventory levels and how excess inventory can contribute to inappropriate ON-RBC usage.

RESULTS

The ON-RBC inventory level was decreased in order to reduce the rate of inappropriate transfusions while maintaining a safe level for optimal patient care. Compared to baseline, our intervention caused ON-RBCs to be transfused earlier in their shelf-life (9.27 vs. 11.15 days from expiration [DFE], p = 0.0012). This reduced the overall rate of inappropriate ON-RBC transfusions (67% vs. 54%, p = 0.0035), approximating 185 units of ON-RBC saved over the course of 6 months.

CONCLUSIONS

A data-driven approach to optimize stock inventory levels is widely applicable; it can be adopted by numerous institutions to improve utilization and establish a benchmark for the broader blood banking community.

Hospital inventory: the big little risk

Pharmaceutical inventory management as an ancillary concern presents a risk for hospitals and health systems. Healthcare leaders should look to prevent fraud as well as legal noncompliance. Leaders should consider not only how much inventory they need but also how to store it and who to assign to handling it.

The productive operating theatre and lean thinking systems

The concept of 'lean thinking' first originated in the manufacturing industry as a means of improving productivity whilst maintaining quality through eliminating wasteful processes. The purpose of this article is to demonstrate how the principles of 'lean thinking' are relevant to healthcare and the operating theatre, with reference to our own institutional experience.

Management of leaded PPE in the healthcare environment

Management of a quality assurance program for leaded personal protective equipment (PPE) can be a challenge for large healthcare organizations. A program has been developed to effectively manage hundreds of pieces of leaded PPE at a large health system in North Carolina. Physical identification of pieces is accomplished using a combination of durable serialized labels for identification of individual pieces, and a color-coded tagging system for instant visual identification of inspection status. This process, coupled with maintaining routine quality assurance records using standard spreadsheet software, resulted in an effective leaded PPE management program with minimal capital overhead.

Time to raise the bar

The Department of Health wants all products supplied to the NHS to carry bar codes by the end of 2012. The stock control system uses handheld scanners similar to those found in supermarkets to track equipment. It has been taken up by nurses at a Leeds hospital trust, where it has saved 500,000 sterling pounds in its first year.

Hospital blood inventory practice: the factors affecting stock level and wastage

To analyse the Issuable Stock Index (days worth of stock) and wastage in relation to data continuously collected by the Blood Stocks Management Scheme (BSMS) with aspects of blood inventory management practice determined by the 2006 hospital inventory practice survey (IPS). The BSMS collects blood inventory data from hospitals and blood services in England, Wales and Northern Ireland. Data sets were constructed from information obtained from the 2006 IPS, which included questions on the crossmatch reservation period, methods for calculating the blood order and stock share relationships between hospitals. Two of the Scheme's measures that can indicate a hospital's blood inventory management performance were used to present blood stock and wastage data in a comparable format. Data were analysed using the Student's t-test. The results showed significantly lower inventory and wastage in hospitals which used a 24-h reservation period compared with 48 h (P = 0.02 and P = 0.04, respectively), and for hospitals that used their computer for calculating the blood order compared with those that used a 'visual review' (P = 0.02 and P < or = 0.001, respectively). A strong correlation co-efficient (0.61) was found for a relationship between a hospital's stock level and wastage. The study showed that differences in stock management practice between hospitals are associated with significant differences in stock levels and wastage of blood. The paper identifies examples of best practice.

Time-based management of patient processes

PURPOSE

The purpose of this paper is to present a conceptual framework that would enable the effective application of time based competition (TBC) and work in process (WIP) concepts in the design and management of effective and efficient patient processes.

DESIGN/METHODOLOGY/APPROACH

This paper discusses the applicability of time-based competition and work-in-progress concepts to the design and management of healthcare service production processes. A conceptual framework is derived from the analysis of both existing research and empirical case studies.

FINDINGS

The paper finds that a patient episode is analogous to a customer order-to-delivery chain in industry. The effective application of TBC and WIP can be achieved by focusing on through put time of a patient episode by reducing the non-value adding time components and by minimizing time categories that are main cost drivers for all stakeholders involved in the patient episode.

RESEARCH LIMITATIONS/IMPLICATIONS

The paper shows that an application of TBC in managing patient processes can be limited if there is no consensus about optimal care episode in the medical community.

PRACTICAL IMPLICATIONS

In the paper it is shown that managing patient processes based on time and cost analysis enables one to allocate the optimal amount of resources, which would allow a healthcare system to minimize the total cost of specific episodes of illness. Analysing the total cost of patient episodes can provide useful information in the allocation of limited resources among multiple patient processes.

ORIGINALITY/VALUE

This paper introduces a framework for health care managers and researchers to analyze the effect of reducing through put time to the total cost of patient episodes.

Managing hospital supplies: process reengineering at Gujarat Cancer Research Institute, India

PURPOSE

Aims to give an overview of the re-engineering of processes and structures at Gujarat Cancer Research Institute (GCRI), Ahmedabad.

DESIGN/METHODOLOGY/APPROACH

A general review of the design, development and implementation of reengineered systems in order to address concerns about the existing systems. Findings GCRI is a comprehensive cancer care center with 550 beds and well equipped with modern diagnostic and treatment facilities. It serves about 200,000 outpatients and 16,000 inpatients annually. The approach to a better management of hospital supplies led to the design, development, and implementation of an IT-based reengineered and integrated purchase and inventory management system. The new system has given GCRI a saving of about 8 percent of its annual costs of purchases, and improved the availability of materials to the user departments.

ORIGINALITY/VALUE

Shows that the savings obtained are used not only for buying more hospital supplies, but also to buy better quality of hospital supplies, and thereby satisfactorily address the GCRI responsibility towards meeting its social obligations for cancer care.

Bone-anchored hearing aids: results of the first eight years of a programme in a district general hospital, assessed by the Glasgow benefit inventory

Objectives: To report the clinical results of a bone-anchored hearing aid (BAHA) programme in a district general hospital, compared with those in an established, large, university teaching hospital centre.

Design: A retrospective postal questionnaire sent to BAHA patients, with two month waiting time and one reminder, combined with case note analysis. Results compared by appropriate statistical tests with published outcomes data from the largest UK series.

Setting: Public sector (National Health Service) district general hospital, England. Catchment population: 300 000 (mixed rural and small towns).

Participants: Case note analysis of sixty-three patients implanted between 1994 and 2003 (age range, six to 88 years). The commonest indication was chronic otitis media, with inability to wear a conventional hearing aid. Otitis externa, otosclerosis and sensorineural hearing loss were other indications. The questionnaire was sent to 59 patients who had worn their aid for at least six months; it was returned by 41 (69 per cent).

Main outcome measures: Glasgow benefit inventory (GBI, change in health status following otolaryngological intervention); incidence of complications.

Results: Bone-anchored hearing aid implantation significantly improved quality of life as measured by the GBI (p < 0.001). The degree of improvement was similar to that achieved in Birmingham by Proops et al. (p > 0.05, chi-squared test). Minor temporary skin infection was common (33 per cent). Thickening of the skin around the implant occurred in 17 per cent. One implant (2 per cent) failed. There were no serious complications.

Conclusion: The BAHA is a safe, reliable and effective treatment for selected patients. A successful BAHA programme can be run in a district general hospital.

Relationship between product demand, tibial polyethylene insert shelf age, and total knee arthroplasty survival: retrospective review of total knees of one design

Shelf aging of gamma-irradiated-in-air polyethylene tibial components has been associated with increased articular surface wear and an elevated risk for revision. Nine hundred fifty cruciate-retaining inserts of one design were implanted between 1987 and 1996 (shelf age, 1.0 +/- 1.2 years). Less frequently used inserts (smallest/largest sizes, thicker thicknesses, supplemental articular constraint) had longer shelf ages (means ranged from 1.2 to 2.6 years). Survival analysis showed that shelf age (P < .01) and gamma-sterilization in air (P = .01) elevated the risk for revision. Surgeons must remain attentive to identify the shelf-aged gamma-irradiated-in-air polyethylene tibial component while following designs from the era when this sterilization method was used. Recognition is expedited by understanding how shelf life is related to product demand and can be of aid when diagnosing the painful knee.

Advancing health system integration through supply chain improvement

Collaboration is a key element to success in the provision of sustainable and integrated healthcare services. Among the many initiatives undertaken to improve service quality and reduce costs, collaboration among hospitals in Ontario has been difficult to achieve; however, voluntary collaboration is vital to achieving transformation of the magnitude envisioned by system leaders.

Blood inventory management in the type and screen era

BACKGROUND AND OBJECTIVE

Previous models on the management of hospital blood inventories have mostly dealt with the optimization of variables related to the assigned, cross-matched inventory. Because the type and screen (T and S) procedure allows blood banks to manage surgical reserves with only unassigned inventories, it becomes necessary to gain insight into the factors that determine the efficiency of this kind of blood inventory.

STUDY DESIGN

Stochastic model that simulates the routine operation of a hospital blood bank inventory over a finite number of days was used. Factors that were analysed for their influence on outdate and shortage rates included the mean (MEAN) and variation (CVAR) in daily transfusion, the remaining shelf life of blood units shipped from the blood supplier (RSL) and the number of days between consecutive shipments (INT).

RESULTS

Outdate and shortage rates grew exponentially with CVAR, an effect that could be partially counterbalanced by increasing RSL. The variables, MEAN and INT, had little influence on the inventory, provided that blood stocks shipped from the supplier are targeted at the expected average demand for transfusion and RSL is greater than INT.

CONCLUSIONS

In hospitals that do not hold cross-matched inventories, CVAR is the major parameter in determining the blood inventory performance. Hospitals with large CVAR must be supplied with young red blood cell (RBC) units, whereas hospitals with smaller CVAR perform well with older stocks. These results advocate for using each hospital's CVAR as the leader parameter in regional optimization policies based on recycling blood units among participating hospitals.

Building an efficient supply chain

Realizing at last that supply chain management can produce efficiencies and save costs, hospitals are beginning to adopt practices from other industries, such as the concept of extended supply chains, to improve product flow. They're also investing in enterprise planning resource software, radio frequency identification and other technologies, using quality data to drive standardization and streamlining processes.

10 proven strategies for reducing equipment costs

It is essential to consider your organization's equipment acquisitions in light of your business strategy. In negotiating the financing, share your business objectives with a preferred list of financing sources that can be counted on to recommend alternatives in addition to quoting on the specified financing.

Managing Equipment and Instruments in the Operating Room

In most health care institutions, it is difficult to obtain budget approval for personnel or equipment expenses, but there are effective approaches to reducing expenses without compromising operational excellence, patient satisfaction, or staff member satisfaction. This article describes a quantitative methodology used to determine appropriate inventories of equipment and instruments in an OR and shows how expense reduction initiatives can have a positive effect on operational performance and staff member and patient satisfaction.

An economic evaluation of the costs and benefits of heparin rationalisation in a hospital pharmacy

AIM

To estimate the costs and benefits for a UK hospital pharmacy of stocking a single low molecular weight heparin (LMWH), enoxaparin, compared to stocking unfractionated heparin (UFH) and stocking both UFH and multiple different LMWHs.

METHODS

A decision-tree model was developed which considered the use of heparins for five indications: prophylaxis against venous thromboembolism (VTE) in major orthopaedic surgery; VTE prophylaxis in major general surgery; VTE prophylaxis in acute medical inpatients; treatment of diagnosed VTE; and anticoagulation for patients with unstable angina and non-ST-elevation myocardial infarction (UA/NSTEMI). Previously published cost-effectiveness analyses for each indication were combined into a single model and updated to 2002 prices. The number of patients given heparin in each indication was estimated from the pharmacy records of a large UK teaching hospital. The model estimated the use of drugs, staff time, clinical events and resource use resulting from anti-coagulation. Costs were estimated from the perspective of the hospital and the UK National Health Service.

RESULTS

Total annual cost was estimated to be pounds sterling 3.2 m (single LMWH), pounds sterling 4.4 m (UFH only) and pounds sterling 3.7 m (multiple heparins). The largest expected cost savings from using a single LMWH compared to UFH only resulted from reduced hospital stay for DVT treatment, reduced revascularisation in UA/NSTEMI and fewer VTE events in orthopaedic surgery. Expected cost savings from using a single LMWH compared to multiple heparins were more modest

CONCLUSION

Sub-optimal choice of anticoagulants may result in substantial excess costs elsewhere in the hospital.

Streamlining the supply chain

Effective management of the supply chain requires attention to: Product management--formulary development and maintenance, compliance, clinical involvement, standardization, and demand-matching. Sourcing and contracting--vendor consolidation, GPO portfolio management, price leveling, content management, and direct contracting Purchasing and payment-cycle--automatic placement, web enablement, centralization, evaluated receipts settlement, and invoice matching Inventory and distribution management--"unofficial" and "official" locations, vendor-managed inventory, automatic replenishment, and freight management.

Healthcare Financial Management Association. Achieving operating room efficiency through process integration

As healthcare organizations look for ways to gain new efficiencies and reduce costs, they are examining surgical services with a critical eye. In many cases, the operating room (OR) was not included in enterprisewide reengineering efforts, thereby limiting the positive impact of those efforts. Healthcare organizations are recognizing that every point along the patient care continuum is interrelated. To truly maximize reengineering efforts, they need to integrate the entire process and information flow within the OR and across the enterprise.

Performance evaluation of quality improvement team in an anesthesiology department

BACKGROUND

In health care community, quality improvement pathway has always been treated as critical index to control cost, improve efficiency and promote service quality, particularly in the last decade. From theoretical standpoint, clinical practice as well as research data, quality improvement team has been demonstrated to play an important role in the adaptation to the changing health environment and enhancement of the competition through the improvement process. The purpose of this study was to explore members' job satisfaction, morale, organizational commitment and inventory management through quality improvement team intervention in a department of anesthesiology.

METHODS

This study was of a quasi-experimental and longitudinal design. The subjects involved 45 nurse anesthetists (the experiment group, intervention of quality improvement team) and 50 operation room nurses (control group) in a general hospital. The quality improvement team had been initiated and implemented pursuant to the quality improvement process for 8 months. GEEs (Generalized Estimating Equations) model was used to examine the differences in job satisfaction, morale, organizational commitment, and the inventory management was also examined between two groups.

RESULTS

After control of all variables, except education background, such as age, marital status, education, position and nursing experience, a natural growth effect was observed on quality improvement team. The results revealed that the experimental group showed significant positive effects on both job satisfaction and organizational commitment after the intervention. The morale scale did not differ significantly between two groups. In the inventory management, the experimental group successfully decreased the monthly consumable materials stock with a descending rate of 24.8%, while in the control group, the inventory was increased 16.9% in the basal stock instead.

CONCLUSIONS

As other previous reports did, the present study also demonstrated that intervention of the quality improvement team improves the nurse anesthetists' job satisfaction, such as promotion of autonomy, organizational policy and positive member interaction. Moreover, it improves work efficiency, service quality as well as control of the stock inventory.

New approaches toward the fully digital integrated management of a burn unit

In this paper, the design of an application that allows the integrated management of a burn unit is reported. Starting with the problems associated with the current procedures, technical solutions are found from the requirements demanded by the specialists. The major design considerations and implementation details are outlined. Special attention is devoted to the prescription of drugs and inventory control, as well as reducing the time that healthcare professionals spend in administrative tasks. The developed implementation is an example of a low-cost system suitable for adoption in a wide range of units in a hospital organization.

Blood rhetoric exceeds supply. As observers gauge severity of shortage crisis and blood suppliers grasp for solutions, blood banks try to motivate confused donors

Mixed and murky messages have bombarded the popular consciousness recently when it comes to the nation's blood supply. Blood banks are still wrangling with how to find ways to appeal to blood donors as they also try to understand why they couldn't harness the outpouring of people responding to the terrorist attack of Sept. 11.

Simulation studies and the alignment of interests

Chemotherapy patients are treated with cytostatic drugs. Cytostatic drugs can be produced if ordered or they can be produced to keep in stock. The time that cytostatic drugs can be kept in stock before being spoiled is limited. It is always possible that the patient cannot receive chemotherapy because he/she is not in the right condition. A simulation model is presented which allows to calculate for each combination of patient type and cytostatic drug type the effects on waiting times and costs. In practice actors will behave not as recommended by the simulation model. The cause of the latter is analyzed and solutions are proposed.

Prescription for concern

As U.S. medical care relies more heavily on prescription drugs, hospitals are caught in an increasingly painful situation. Shortages of critical pharmaceuticals often leave hospitals empty-handed and, according to clinicians, endanger patient safety. Soaring drug costs account for a huge proportion of burgeoning health care spending, and strategies to control costs, including pharmacy benefit managers and drug discount cards for seniors, so far have had limited or negligible success. Direct-to-consumer advertising has increased demand for expensive--and according to some experts, unnecessary or inappropriate--prescription drugs. In this special report H&HN examines the pressures that these factors put on hospitals.

Supply chain vulnerable in many ways

The specter of terrorism has reached the materials management department, now that a supply room worker in a New York hospital has died from anthrax. At the same time, the tragedy of the Sept. 11 attacks has led hospitals and their vendors to realize that "partnership" is not just a trendy word for business association anymore; it is a strategy for survival.