“I always seem to have the supplies I do not need. I always seem to be missing the supplies I do need. Quite a balancing act is required to meet the needs of my patient.”
“I am away from the bedside looking for supplies.”
These were the comments I heard from staff even though we have a hardworking group in Procurement Services and order many supplies each week. So why does there seem to be waste … in too much inventory and too much time spent looking for the right item to provide patient care?
Recently, I was given a unique opportunity to work with the first Rapid Improvement Event (RIE) team to improve care at the bedside. The entire week was spent working in the McLeod Tower on 5 East and in the McLeod Pavilion on the 9th Floor. We worked with the staff on each unit to reduce the time spent hunting and selecting supplies involved with patient care. One aim was to reduce the number of times a caregiver leaves the patient care area to retrieve supplies.
The leader for the week’s RIE was Sabrina Capell. Our team was larger than the normal RIE team since we were looking for solutions on a pilot unit in both bed towers. The supply RIE team included: Sabrina Capell, NICU; Pam Elliott, 5 East;Pauline Fowler, Share The Care; Mary Joyner, Lab; Lashan Kennedy, 9S; Boyd “BJ” McCluskey, Procurement Services; Bobby McDuffie, IS; Lisa Neal, 5 East; Tangie Peoples, 9S; Donna Rotan, 9S; Carmen Winfield, Procurement Services and Rob Colones, Administration. Our guide and facilitator was Will McLeod, Operational Effectiveness.
This RIE was the first of twenty-four (24) RIEs to provide better methods, better solutions, and better care for our patients. With so many things vying for our attention, it is difficult to focus on administering the best care for each patient. So we want to cut through the chaos, simplify and stay focused on what is best for the patient.
One of our measurements at the beginning of the week was the number of times a caregiver leaves the pod or patient room assignment to find, scan, carry and gather the needed supplies for patient care. On average, a caregiver left their area 17 times per shift. We mapped and measured the distance for each step, each supply. We did not focus on forms or medications this week, as those will be improved in a separate RIE in the future.
Working together through several solutions, we used the PDCA cycle of: P – Planning a solution; D – Do, actually go out and experiment; C – Check, verify if the solution worked or needs modification; and A – Act, integrate the lessons learned from our check. Measure all along the way and try again. By the end of the week, we had reduced the seventeen trips for supplies to four trips per shift. As of today, the gains are holding and we will look for ways to ’spread’ this solution to each nursing unit in both the McLeod Pavilion and the McLeod Tower. In addition, we are piloting a different Omnicell solution on 9th floor, which will improve the current pause or delay in scanning supplies. (Note: The PDCA cycle is a never-ending cycle of learning and improvement utilized by Dr. Edward Deming, based on what he learned from his mentor, Walter Shewhart. Dr. Deming taught this cycle of improvement to the Japanese in 1950. He called it the “Shewhart cycle” and many today call it the Deming wheel since the steps in the PDCA are continuous).
In the future, I will give more details about the other RIE teams working on patient flow and rapid response. It was a exciting week. I learned a great deal from the staff on the team and in the nursing units. I remain convinced that Operational Effectiveness will help us solve our process problems and remove wasted steps and barriers in our work.