From the Frontlines: One Nurse’s Perspective on the Healthcare Community’s ‘Inventory Management’ Problem (and How to Fix It)

During the pandemic, we were inundated with news stories about healthcare providers who had to get creative when treating patients because they couldn’t get the necessary medicine, supplies and equipment. Demand outweighed supply. But, for the most part, the supply chain has now stabilised, and nurses and doctors can source what they need to resume treatments and surgeries as normal.

So, I was shocked when nearly three-quarters of hospital leaders in the UK and U.S. agreed in Zebra’s Hospital Vision Study that cancellations of procedures or surgeries due to out-of-stock, low-stock, or lost supplies are a significant problem for their organisation.

If there aren’t shortages in the supply chain and every hospital could be fully stocked, why is anyone still reporting frequent out-of-stocks or having to stretch low-stock levels? Why are we hearing from nurse managers, divisional chiefs, and other healthcare leaders that they’re under pressure every day to chase down equipment or supplies? Why are nurses searching high and low, near and far, for what they need…having to make numerous phone calls to reps or sending taxis (and colleagues) to other hospitals to get the items they need to care for patients? And why are clinicians settling with ‘second best’ alternate medication, medical device, or equipment options when what they want, what is preferred, is available somewhere in the supply chain or perhaps stashed in a random supply closet? We’re no longer at that point where they should feel they have to ‘make do’.

When my colleagues and I started digging into this issue more with clinicians in both countries, it became apparent that the healthcare community as a whole suffers from a huge inventory management/material management problem. (No, it’s not just happening at your hospital.) This can’t be considered an acute pain point that came about during recovery from the pandemic, either. It’s been lingering unresolved for years, albeit flaring up now.

Why?

Some of the nurses we spoke with say it’s because the onus is being put on them and other clinicians to manage stock. They’re the ones having to count inventory, locate and log equipment, check expiry dates, rotate inventory, place orders, process items when they arrive, and more.  

Why?

Because they need the items most. They must ensure the theatre, lab, or ward is stocked for whatever kind of patient treatment is needed that day – often not knowing what will be needed. If you can relate, I’m sorry.

It shouldn’t be this way. The burden shouldn’t fall to nurses. It’s not a good use of your/their time and skills. Yet, this is the way it is in (too) many hospitals.

Not in the Hull University Teaching Hospitals here in the UK, though.

Fed up with the status quo, the nurses at these NHS Trust facilities went ‘against the grain’ and insisted on changes. Actually, they initiated the changes and drove them through to completion. They didn’t defer to administrators, IT or non-clinical operations colleagues to figure out how to make their jobs easier. They put their heads together and mapped out exactly what was needed to properly manage stock levels. They detailed the manual efforts they believed could be automated, then worked with technology experts to figure out which hardware, software and systems components could get things working the way they wanted.

If you didn’t have the pleasure of hearing Rachael Ellis speak at HIMSS 2024, this video is the next best thing:

Of course, even after spending nearly the entire show by Rachael’s side, learning more about what improvements she has compelled at the Hull University Teaching Hospitals, I had questions. Lots of them.

I wanted to know…

• If the Hull team ever reached a point when they had to cancel procedures or surgeries because they didn’t have, or couldn’t find, the equipment and supplies they needed.
  
• Who the nurses leaned on to help solve their asset management challenges. Who was involved in the project scoping, solution design and testing efforts? (We know that non-clinical staff play a role in asset and inventory management, too.) Who did they call first? And how did they know who to call?
  
• Why the Hull nursing team ultimately took what was then considered ‘an unconventional approach’ to asset tracking and inventory management. Why focus on the patient pathway rather than the theater like most other healthcare systems do?
  

And that was just the start. So, I reached out to Sarah Atkins, a Scan4Safety and RFID charge nurse with the NHS Trust, to get her take as she was deeply involved in – and impacted by – the implementation. She was gracious enough to join me on an episode of the Clini-Chat podcast, and I must say her insights were enlightening. So, whether you’re a nurse, a nurse manager, hospital administrator, logistics or inventory manager, or just someone seeking to increase patient care capacity, improve patient care and safety, or make nurses’ jobs easier, you’ll want to hear what Sarah shared in this episode…

Your Take?

I don’t know about you, but I found it interesting to learn…

• Whether Sarah and others at Hull believe that a barcode-only system could be used to facilitate the same experience and achieve the same outcomes as the combined RFID+barcode system they’re using. Could barcode technology by itself help clinical staff maintain a steady (full) stock level and quickly locate needed supplies and equipment (knowing that in some hospitals, there isn’t any technology used for these things today)?
  
• Whether the Hull team found it more important to have an intuitive software app or a device that’s familiar and easy to learn and use as they started designing, testing and fully using the asset tracking and inventory management system. Should other hospitals’ nursing and IT teams focus on the software they need first? Or find hardware – mobile devices, barcode scanners, RFID readers, etc.– that work well and then develop the software to enable the desired user experience?
  
• How well the technology system – the ‘solution’ – the Hull team had designed on paper came together as they started to physically install and connect the components in their hospitals. Did it all come together nicely? Or did they have to make adjustments during the implementation before they could even turn it on? Was there anything that had been forgotten to consider in the design phase that they had to pause to work out during implementation?
  
• If there have been other positive changes they’ve seen or perhaps other nurses have reported, since putting these new inventory management and asset tracking processes and technology tools in place.
  
• Whether the Scan4Safety and RFID tracking systems they put in place also enables doctors and nurses to report – and hospital leaders to track – when patient safety is compromised because of inventory or equipment issues. If something goes missing – there’s a recall, someone forgot to restock certain supplies, or there’s a shortage in the supply chain and therefore low shelf stock – can that be reported easily? And, just as importantly, can that be addressed immediately? Does the info get routed to someone who can take action on it? (This was something cited by hospital leaders as a big issue in Zebra’s latest Hospital Vision Study, so I was hoping Hull might have found a solution that I could share with you.)
  
• How they measured success. The Scan4Safety and RFID-based asset tracking and management systems put in place at Hull have become the gold standard for hospitals around the world. But do the clinical and non-clinical teams have tangible KPIs or metrics tied to waste, replenishment or something else inventory-related? Or is success more about the sentiment among clinical staff and the capacity they gained to serve more patients?
• How much work it really took to make these changes happen. From the outside in, it seems like this was a significant undertaking. Not only did the nurses have to find a new way of working to ensure patient care wasn’t hindered by low stock, out-of-stocks, or lost supplies and equipment, but they had to get the entire hospital staff working in this new way. So, I wonder if there are things they feel made the process harder than it had to be? Things they would suggest others in your position keep in mind as you start down a similar path? Or is there something they think made this process less painful than it could have been from the ‘people, policy and tech system’ perspectives?
  

If you don’t have time to watch the episode now, I’ve also shared the transcript here if you only have a few minutes to skim through our conversation.

I’m grateful for Sarah’s transparency, as I know that you’re probably in the same position she and the Hull team were a few years back, just trying to fix a broken inventory management process and give nurses a bit of a break. I hope the steps they took to introduce lasting changes help you know what steps you need to take to do the same. Material/stock management shouldn't be so difficult, and it certainly shouldn’t hinder your patient care capabilities as much as it probably does today. So, check out the conversation with Sarah, watch the video with Rachael, and let me know if you’d like to connect with either of them to get more guidance on how your hospital’s clinical team can get to where the Hull team is today.  

Don’t have time to watch/listen right now?

You can download the MP3 for later or keep scrolling to read the transcript of the full interview.

Zebra Your Edge Podcast: Clini-Chat Episode Transcript 

Host:
Lorna Hopkin, International Marketing Manager, Zebra

Guests:
Sarah Atkins, Scan4Safety and RFID Charge Nurse, Hull University Teaching Hospitals, NHS

Transcript

Lorna
Welcome back to our Clini-Chat podcast series. I thought we could spend some time today talking about some of the non-clinical challenges being reported across the global healthcare community right now, because the issues at hand directly impact the ability of clinical teams to do their jobs. Zebra just released the results of a new Healthcare Vision Study that focused on material management in hospitals. Specifically, this study was aiming to uncover the crucial link between digital inventory management and improved patient care. I know that I haven’t been immersed in the inner workings of healthcare as long as most of you, but I feel like I’ve got a grasp on some of the problems that physicians, nurses, and other practitioners face day to day. I mean, we all got to sort of have a reality check during the pandemic, when the veil was pulled on how things work and how well they sometimes don’t work. But I admit, I was shocked when I saw some of the stats coming out of Zebra’s latest vision study. For example, nearly three-quarters of hospital leaders in the UK and US acknowledge that procedures or surgeries are sometimes being canceled due to out of stock, low stock, or lost supplies, which is a significant problem. As digitally mature as we are as a society, one wonders how this can still be a problem. There’s all sorts of technology available to help track down what you need in a building, or even a supply chain. You can even automate orders when items start running low, alert someone when items are reaching expiry dates, and quickly activate retrieval procedures for recalled items. So with most in the healthcare community still challenged in these situations, that’s what I’m hoping to get to the bottom of with my guest today. Sarah Atkins is the Scan4Safety and RFID charge nurse at Hull University Teaching Hospitals here in the UK. And she is in the minority in that she and her team have figured out how to easily locate and manage items across their campus. They successfully solved the problem that three-quarters in the healthcare community still face, which is clinical staff spending too much time locating medical equipment, materials, and/or supplies when needed. As I understand it, the reason why the clinical staff at Hull aren’t struggling anymore is because Sarah and her team decided to go against the grain, so to speak, in their approach to asset management and material management. So, Sarah, before we talk about what you did to solve what is clearly a very big problem, why don’t you take us back to the beginning of your story? What were the early days of your nursing career like? What issues did you experience in caring for patients?

Sarah
Hi Lorna, nice to speak to you today. I’ve been a nurse for 20 years. I spent 18 years working in the operating theater environment where I was a scrub nurse. Then I did my anaesthetic nurse training so I was able to help put patients to sleep. Then I worked a bit as a charge nurse, and I was the nurse lead for the robotics suite center implementing robotic surgery into the trust. Before Scan4Safety and RFID, the way we used to do things in theatre was to order our sets and instruments from Sterile Services. We used to do that by telephone or by sending an email the day before, notifying them of what sets we’d like for the following day and also including any sets for unplanned emergencies for out of hours at Castle Hill. We had patient sticker books which we used to put patient labels into and document - put the CDU sterile tray label stickers in that - and then we also had an implant register book, which again had a patient label. And then any stickers that came with that implant, whether it be a stent, a heart valve, or orthopaedic implant for a knee or a hip. So until we got Scan4Safety, if there was a product recall or anything, we would have to physically manually search through the books to find that patient and when that patient was operated on.

Lorna
Okay. Interesting background to hear about. So like most clinical staff these days, you were clearly spending too much time searching for medical equipment, materials, or supplies. But was your team ever at the point where you had to cancel procedures or surgeries because you didn’t have or couldn’t find what you needed?

Sarah
As an anaesthetic nurse, we used to set up our theatre for the following day. We would get a pump and a pod ready to start the kit. Quite frequently, we’d go on shift the next day, and the theatre would have been ransacked and most of your equipment would have been taken, whether it be positioning aides for the operating table or like I said, a pump and pod to go with that patient. So you would spend a lot of time looking for equipment in the morning. We’ve never had to, in my experience, we never canceled a patient because we didn’t have the kit. But sometimes surgery was delayed. Maybe until we found a pod or a pump to put that patient to sleep safely with. To get around that, we…if there was any patients that were having local anesthetic cases…we would often sort of move the list around. Fairly rarely, but there were those were the challenges that we had, Lorna.

Lorna
Yeah. So quite stressful for you guys I guess.

Sarah
Yeah.

Lorna
So how did you end up spearheading what we can now say is one of the best and admittedly untraditional solutions to healthcare’s asset management problem. How did you personally get into a position to implement such a huge change?

Sarah
I first met Rachael Ellis, who’s the program director for Scan4Safety at Hull, when she came to implement Scan4Safety in the department that I was managing at the time. Had a really good working relationship with Rachel and the Scan4Safety team, and I saw a job offer came up. I got in contact with Rachael as a big Scan4Safety advocate and champion of it. I just thought I’d see what the role entailed. She mentioned about the RFID project, which I was really excited to hear about. I applied for the job. I got the job. I’ve now been doing it two years. Oh, wow.

Lorna
Time flies. So your nurses, not technologists. So when your team at Hull started down this path to figure out a better way, where did you start? Did your team instantly pick up the phone and call tech companies? Did they do some online research? Talk to others in the healthcare community? I mean, where do you even begin when you’ve got such a big problem to solve? And it seems to be so many different approaches, or maybe just one preferred approach to solving it.

Sarah
You just hit the nail on the head there, Lorna, when you said about a problem. We knew we had a problem with missing kit - our other theatres, our other departments borrowing theatre equipment - so we knew we had that problem to solve. We reached out to different companies to see what solutions were out there. The NHS…things will have to go out to tender. So it was a case of for us finding a company that we were comfortable working with that could provide a solution to the problem of disappearing assets that we wanted to work with.

Lorna
So Hull ultimately took what was quite an unconventional approach to asset tracking. It focused on the patient pathway rather than the theatre. How did the Hull team arrive at the conclusion that this was the best approach? And did it take a lot of convincing that this was best when you were making the case to the people signing off on the spend and resources required for the approach?

Sarah
Yeah. So six demonstrator sites that originally implemented Scan4Safety, they were the ones that just did the theatres. But for us at Hull, the patient is at the heart of everything that we do. So we wanted to put the patient in the middle. Quite frequently, when a patient leaves an operating theater, they will go to the recovery with a syringe driver attached or a pod. So what’s following that piece of kit, following that patient from their journey from the theater to the ICU or to the recovery unit, and then from the unit into the ward which is really valuable to us because that same piece of kit stays with that patient. So for us, it’s about following the patient’s journey, putting the patient at the heart of everything that we do at Hull. That’s great.

Lorna
So as a daily user of RFID now and someone who had to use a barcode system previously, how big a difference has it been? Do you think that you could accomplish the same thing using a barcode only system?

Sarah
With RFID, definitely not. No, we need the RFID because in the first month alone we had over a million moves. So if it was working on a barcode system, somebody would have to physically manage that barcoding system. Whereas the RFID, it’s all done instantly. It’s passive RFID, so when an asset moves under a reader or antenna, you get the last known location in real time location. So for us, if a patient in the middle of the night, needs a bladder scanner, and you can’t find it on the ward, all they have to do is look in the system, and they can find their bladder scanner or a bladder scanner that was close to that department. So somebody can just slip off and get it. So that patient is not waiting in urinary tension for very long waiting for a bladder scanner.

Lorna
Wow. Some big numbers there. So, something that I’d love your perspective on as an end user is this notion of which should come first in the system build phase, a decision on which software to use or which hardware to use to accomplish the goal? Now, I know you weren’t in the room when decisions were made, but based on your use of the kit, do you have a strong opinion one way or another? Is it more important to have an intuitive software app, or a device that’s familiar and easy to learn and use, and which should lead the tech selection process? Should other hospitals’ teams focus on the software they need first, or find hardware devices that work well and then develop the software to enable the desired user experience?

Sarah
With us, Lorna, at Hull, one goes, ‘You can’t have one without the other.’ You need a tech company that offers the solutions as well as the software and hardware solutions. With us working with Zebra and Tagnos and the Barcode Warehouse, we were comfortable that you could provide us with the solutions to the problems that we wanted to solve. So for us, the tech and the hardware go hand in hand.

Lorna
Okay, that’s good to know. So the team had your tech system designed on paper. Then you started to put it all together in your hospital. Did it all come together nicely, or did you have to make adjustments during the implementation before you could turn it on? Was there anything that had been overlooked in the design phase that you had to pause to work out during implementation?

Sarah
There was quite a few learning curves, shall we say Lorna, for the implementation of the RFID as we had to know other hospitals to learn from. So if we was to roll this out again in another hospital, yeah, there was definitely key learning points for rolling it out. Definitely learning curves when we were learning RFID. We haven’t had to make too many adjustments to plans, but one thing we did learn was that RFID labels do not work on recycled paper. They don’t read. So, if you’ve got a piece of paper putting an RFID label on it, it will not read through that recycled paper. We also didn’t sort of think about cable labels for the tech that’s got cables. So we have to find a solution for cable labels. So we’ve worked with clinical engineering. We’d also work with key stakeholders. Again, get them involved in the very beginning, Lorna, the key stakeholders.

Lorna
Lots of learnings along the way. So obviously the ultimate beneficiary of what you’ve done is the patient. But as a nurse, how have all the processes and technology tools you put in place made your job easier? I know you spoke a bit about RFID versus the barcode area, but what are some of the other positive changes you’ve seen? Or perhaps other nurses have reported?

Sarah
So for Scan4Safety, for me with since I’ve been in post, we have to now go-live with Max Fax. We’ve just implemented a go-live in orthopaedics where we’ve just set up the green light system, which is where if you’re doing a left hip replacement and a right hip implant is scanned, it comes up with a warning to say this is an incompatible product. ‘Do not use that’. That has been a complete game changer because of […] down the country, wrong type surgery, etcetera, etcetera. Also when there’s been product recalls, we’ve been able to identify if the product’s being used on a patient and, if we’ve got any in stock, we’ve been able to notify the stock controllers. Notify the band sevens of their areas to take the affected stock, if we’ve had any affected stock, out of the system so they’re not used on patients or potentially not used on patients. We also had an MHRA recall for sutures. We were able to look in our system. To look previously in a manual patient record would take hours and hours and hours of nursing time, whereas I think within an hour we were able to identify what patients had had a suture. And it would…the clinicians are being emailed, the business managers are being emailed…all within that hour. Yeah, definitely. Also out of date products…products that have expired…when you scan them in a theatre, it comes up with a warning alert. Yeah, because programs are digitized, we are really able to sort of look at heart valves that have been used that are being affected from recalls, notify clinicians… It’s just saved so many hours of manual nursing time or clinical time to look through these patient records to find out. It’s been an absolute game changer has Scan4Safety. So patient care records and inventory management as well because we work with procurement as well. So it’s about having an up-to-date procurement catalog…working with other key stakeholders as well departments to ensure that they’ve got the right minimum and maximum level. So they’re not overordering… some products are going out of date…it definitely digitizes the way forward.

Lorna
Okay. That brings me nicely into the next question. So we know that non-clinical staff play a role in asset and inventory management too. So who else outside the clinical team was involved in the project scoping, solution design, and testing efforts? And what has their feedback been since the new tools were put into place?

Sarah
So key stakeholders, we work with clinical engineering an awful lot. We’ve recently, within the last six months, done an implementation, an integration with E-Quip, which is the database for our clinical engineering use. So when they commission a piece of medical equipment, they can automatically print a barcode label from their record because it’s integrated with Tagnos. We also work with IT closely because they’re the ones that connect the data and the power to our infrastructure. But when it comes to the privately funded investment buildings, we’ve currently got two on our site at the moment. You’ve got to work with those key stakeholders because you’ve got to raise purchase orders about their tech specs - connecting data and power to the readers. So again, just working with key stakeholders, IT, clinical engineering. The next phase we want to do is work with waste management and put an RFID reader and technically have an “off” bin sort of. So when an asset goes to waste compound, we know that it’s not going to be recommissioned or reused. And it’s either being for scrapping or it’s being donated to another hospital. So we know that when that piece of equipment reaches waste compounds, we know that then that kills the life of the RFID tag so that they so that the off switch. So that piece of kit’s life comes to an end. This project is forever growing because more and more departments are coming on board with it to see the benefits of it. and it’s just really, really good, Lorna.

Lorna
It’s great to hear that.

Sarah
Yeah, yeah, we’re getting positive feedback from end users as well of the system.

Lorna
Just a huge collaboration. So, you know, something else that came out of this study is that most clinicians don’t have a good way to report problems relating to out of stock, low stock or lost inventory, equipment or supplies. When patient safety is compromised because of inventory or equipment issues, they can’t easily report that or hospital leaders can’t easily track it at least. Is that something that was fixed with your Scan4Safety and RFID tracking system? If something goes missing, there’s a recall, someone’s forgot to restock certain supplies, there’s a shortage in a supply chain, and therefore load shelf stock cannot be reported easily and, just as importantly, cannot be addressed immediately. Does the info get routed to someone who can take action on it?

Sarah
Absolutely. Yes it does, Lorna, for this government safety platform. like I said earlier, we work with suppliers, we work with stock controllers, with everything being digitized from the point of care, whether it be anesthetics and theatre, all of those pumps. Everything we ever report, we pull a report for everything, Lorna. For expired stock, stock coming out of date. just teaching people about stock rotation if they don’t already know. It really has changed the way that we work at Hull regarding ordering stock, stock receipting, ensuring the maximum/minimum levels of sets so we’re not over ordering. If a department decides that they want to order more or have more stock on the shelf because of patient use, then it’s something we can do very easily on the system. It’s just up the level working with reps as well, because when we work with consigned stock, if the department wants to up the levels or have to work with reps so the stocks come down to a level at their end as well as ours. So it’s consigned rather than we don’t earn it as a trust. There are lots of benefits. to working with the Scan4Safety platform. We can recall patient information within minutes. You can find a sterile tray in the storeroom because we have a system at 12:00 midnight, a couple of minutes to 12, anything that gets put back in the storeroom that’s still sterile, it’s changed back to sterile. Say staff couldn’t find that tray easily, it’s all there. It’s all really good, Lorna. All very positive.

Lorna
It’s brilliant. So for all intents and purposes, the Scan4Safety and RFID-based asset tracking and management systems you put in place at Hull have become the gold standard. We want those people who say they can’t find what they need to follow your lead. So how do you measure success? Do you have tangible KPIs or metrics tied to waste, replenishment, or anything else inventory related? Or was it more about the sentiment among clinical staff and the capacity you had to serve more patients?

Sarah
We measure success by reporting and working with key stakeholders. If we can help somebody solve their problem, that is a success to us. It really is. And if somebody comes to us said, they can’t find it…because it’s digital, some people really thrive on change. Some people don’t like change. It’s about the individual staff member helping them make sure they’re comfortable with the system, helping them to find the way so they can use the system easily. And if we can develop somebody’s skills IT-wise, then yeah. So they’ve got the confidence to use the system as well, Lorna. Yeah. That’s how we measure. Yeah. That’s what we mentioned success as well by reports as well and activity at some of the sites for Scan4Safety and RFID as well.

Lorna
Yeah. No that’s brilliant. So from the outside in it seems like this was a significant undertaking. Not only did you have to find a new way of working to ensure patient care wasn’t hindered by low stock, out of stock, or lost supplies and equipment, but you had to get an entire hospital’s staff working in this new way. Are there things that you feel made the process harder than it had to be? Are there things you would suggest those in your position keep in mind as they start down their own similar paths? Or is there something you think made this process less painful than it could have been? And I’m curious from the three different people, policy and tech system perspectives, because I would imagine there are valuable takeaways relating to each.

Sarah
Yeah, well, one thing I learned a long way from this project was to listen to my gut more, when things wasn’t working that was expected to. You just got to listen to you. Go on, go with things, break things, talk to people. communicate with people. People. Some people don’t like change for people, for change. And again, it’s getting those people who are susceptible to change. So with, to get them on board and to get those people trained up, to get them comfortable using it. And also, another problem that we had was some staff were peeling the RFID labels off equipment. It was mainly anaesthetic equipment, and I could see why they were doing it. But by peeling the labels off equipment, it sort of doesn’t. You’re hiding equipment away which is for patient use, whereas if you’re hiding equipment and peeling RFID labels off, you don’t know where the equipment is and…the RFID can also highlight where there’s shortfalls of equipment. So if you can access Tagnos and you can look at what areas are stealing your… ‘borrowing’ your… equipment, you can then take this information and you can go to the business managers and say…or band seven of that area and say… And say, well I’ve noticed that your department keeps borrowing X, Y, and Z a lot, you know, have you thought about maybe buying your own, taking you know, using the information as an audit tool? as well as being really helpful. Yeah.

Lorna
Gives that visibility. So that’s all my questions for today. So I would like to thank you very, very much for your time. It’s been incredibly insightful to hear from someone who is actively involved in the implementation and the day to day running of such a major RFID installation. We wish you all the best as the project evolves in the future, and look forward to hearing a lot more about this project. So thank you everyone for listening. For more information and to see a video case study about the project, head to zebra.com. Thanks for now.

Sarah
Goodbye everyone. Thank you online. Bye bye.