Change the ‘hoarding’ culture

Nov. 24, 2015
Doug Duvall, MBA, Lead IST Systems Analyst, PeaceHealth

We had a problem at PeaceHealth’s Sacred Heart Medical Center at Riverbend here in Oregon. It’s one I experienced firsthand in my previous life as an operating room (OR) anesthesia technician. It can be summed up with these conversations, which happen multiple times every day between departments at hospitals everywhere:

OR Tech to Distribution: “I need an IV pump for this case.”
Distribution: “We don’t have any.”
Tech: “This is Distribution. You don’t have any IV pumps?”
Distribution: “Check with ICU, they keep taking them all.”
The OR Tech treks over to the ICU …
OR Tech to ICU Nurse: “I need an IV pump for this case.”
ICU Nurse: “We don’t have any.”
Tech: “This is ICU. You don’t have any IV pumps?”
Nurse: “Well, we need them for here.”
Tech: “But this patient is coming to you.”
Nurse: “I’m sorry, you can’t have an IV pump.”

Then the tech goes to the secret storage place where the ICU has hoarded about a dozen pumps, looks to make sure no one’s watching, and runs off with an IV pump for his case.

IV pumps
The impact of hoarding

Hoarding is a real issue that causes friction between departments, not to mention wastes time due to searching and having fruitless conversations like the ones above. This time could be much better spent caring for patients.

It also hinders a hospital’s ability to find equipment for preventive maintenance and recalls, creating a patient safety and liability hazard. During this process, technicians spend inordinate amounts of time searching a hospital’s nooks and crannies for the things they need.

Then there’s the sense of scarcity that can negatively impact capital budgets. Hospitals typically buy or rent 20 to 30 percent more assets than they actually need, just to make up for the equipment that’s being hidden from view. What’s more, many hospitals write off hundreds of assets per year, simply because they can’t be located.

The root cause behind hoarding

This sense of scarcity at Riverbend led to pressure to lease or buy more IV pumps. Instead, we decided to question whether we actually needed more pumps, and determine the root cause of the perceived scarcity.

The root cause is not hoarding, as some may have guessed. The root cause is the reason nurses hoard and hide equipment – our nurses didn’t have pumps available to them when they needed them. They don’t have time to waste looking for IV pumps and can’t run the risk of not having a pump for a patient who needs one.

So the problem we set out to fix was not to get nurses to stop hoarding; it was to support nurses by making sure they always had IV pumps ready and available.

The solution to hoarding

Riverbend set out to leverage our existing Versusreal-time locating system (RTLS) to implement a just-in-time periodic automatic replenishment (PAR) model for IV pumps. The RTLS was already in place as part of our nurse call system. We had expanded its use to improve patient flow in the

PeaceHealth’s Sacred Heart Medical Center at Riverbend

emergency department, so leveraging the RTLS investment for yet another process improvement initiative was an easy decision.

Engaging a multi-disciplinary team including executive leadership, improvement engineers, IT, nursing, distribution, biomed, and others involved with managing assets, we formed a plan to decentralize our distribution process for IV pumps. I know, “decentralize” seems like a scary word, but it proved to be hugely successful on multiple fronts. Here’s how it works:

Every floor in our Riverbend hospital is divided into north and south units. Each unit has a central supply closet – this is where we house clean IV pumps for every unit on every floor. By placing an RTLS sensor in each closet and tagging all the IV pumps, we have an automated tool to see in real time how many pumps each unit currently has.

Next, we set the PAR levels for each wing by doing internal observations and consulting with other hospitals. It’s also possible to first tag your pumps, then use RTLS reporting software to determine how many pumps are typically in use (i.e., in a patient room) at any given time on each unit. For example, we determined that the labor and delivery unit should ideally have 15 available IV pumps on hand, and that a count of five available IV pumps would qualify as a “critical low” that needs to be immediately addressed.

Through the RTLS PAR-level asset management software, our distribution department can see a color-coded count of all IV pumps in every unit, indicating whether each unit is below its PAR level, at a critical low, or critical high – which allows overstocked IV pumps to be distributed elsewhere.

For dynamic communication across multiple departments, the system also automatically sends alerts to workstations and text messages to mobile phones when critical lows and highs are reached, so distribution can address the situation in real time.

Real-time locating systems can monitor the number of assets in certain areas and send alerts to central supply or distribution based on configurable PAR levels. While these areas may be a dirty or clean supply closet, the RTLS could also monitor all assets across the entire unit or, depending on the RTLS accuracy, even different sides of one supply closet or different areas of a hallway.
Changing the culture with proof

This process wasn’t without its bumps in the road. Nursing was highly suspicious that we were going to make do with the pumps we had, instead of purchasing more. Distribution wasn’t sure nursing could give up the practice of hoarding. But by engaging nursing throughout this process and fully committing to the PAR-level concept that would always make pumps available, the initiative gained nursing’s trust.

Today the system works really well, and hoarding is a problem of the past. With the cooperation of different departments and the use of technology, we were able to change the culture of our practice.

Return on investment

Using this system produced an immediate, long-term, and ongoing return on investment. We immediately avoided a capital expenditure of $600,000, which is what Riverbend had planned to spend on additional IV pumps. We were also able to reduce the number of pumps in our existing fleet by 26 percent, eliminating the need to lease pumps altogether. The savings from these reduced rental costs totals up to $2.7 million over a 10-year period.

However, this project wasn’t just about saving money. It also reduced frustrations for staff, saved valuable time, broke down barriers between departments, fostered a culture of trust and collaboration, and ultimately allowed us to enhance the care we provide to patients.