Factors effecting POU cabinetry utilization & supply availability on the Nursing unit

Factors effecting POU cabinetry utilization & supply availability on the Nursing unit

The use of point-of-use dispensing cabinets (e.g. Omnicell, Pyxis, etc.) for med/surg supplies on a hospital's nursing units represents an improvement on 'old' stocking methods. In these, generally, a Materials clerk would go to the unit and survey the stock. Using paper methods, or perhaps handhelds, the clerk would note the quantities of items on the unit, these would then be compared to the par quantity of each item (representing the amount of stock deemed necessary to be on the unit to support its patient care activities) to generate a list of which items need to be replenished. These would then be picked from an inventory location within the hospital and delivered to the unit, or alternately communicated to a distributor which would pick and deliver the product.
Installation of point-of-care dispensing cabinets on the units represents an improvement of the process. First, they partially automate the replenishment cycle - by having the capability of generating a restock order instead of having personnel traveling to the unit and visually inspecting stock levels they remove labor and some of the human element involved in this process. Secondly, they can automate the process of making sure that patients are charged for billable supplies (i.e. replacing manual-intensive, error-prone, traditional 'sticker and bingo card' systems). Thirdly they allow better reporting, which in turn allows optimization of the system (e.g. reports which compare usage to par levels can be used to tweak these to ensure appropriate availability of product, reports which provide an exact understanding of the dollars in inventory on each unit can be used to optimize inventory utilization, etc.)
However the mere installation of point-of-use cabinetry will not achieve this by itself. To avoid having these expensive units reduced to fancy cabinets and to ensure that the desired outcome - having supplies available on the nursing unit when they are needed - is achieved, a number of factors need to be addressed. These are shown on the Ishikawa (fishbone) diagram below. To achieve this outcome and then maintain it on a consistent basis it is necessary to address the root causes of all the factors that could prevent achievement of the outcome. (Note: the points below specifically reference the Omnicell system, but are valid for all point-of-use systems.)

Methods:

Alignment of replenishment with usage patterns: Replenishment of the Omnisuppliers needs to occur at the time that fits best with the usage of supplies on the unit. Replenishment should occur at ‘off peak’ hours not only so that the Omnisuppliers are full when the need for supplies is greatest, but also so that the Materiels staff performing the restock function do not need access to the machines at the same time that nurses are trying to withdraw supplies. This may mean that different units need restocking on different shifts, with the corresponding implications for staffing levels and patterns.
Replenishment cycles: In addition to the above, the possibility of multiple replenishment cycles for certain units should be looked at. In addition to the reorder point and maximum levels, critical levels can be set by item. In addition to the ‘normal’ restock it is possible to run a scheduled supplementary restock uniquely for items below the critical level. This could be done for selected units (e.g. high volume or critical units). An alternative to a regularly scheduled critical restock could be an ‘as needed’ critical restock. The OmniCenter Console shows in real time:
- The number of items in each Omnisupplier that are below the reorder point.
- The number of items in each Omnisupplier that are below the critical point.
- The number of items in each Omnisupplier that are ‘out’
Periodic visual monitoring of the Console would give a real time view of the Omnisupplier stock levels, and a critical restock could be generated for any Omnisupplier meeting certain pre-defined criteria e.g. set number of ‘outs’.
Synchronization between systems: In hospitals where the nursing units are restocked from a central inventory location the Omnicell restock information is passed to hospital's WMS. How this is set up can effect replenishment - if the units are set up as par areas in the WMS it will be these par levels that then control the quantity of supplies that are issued to the unit. As a result the synchronization of par levels between Omnicell and the WMS is essential to the smooth functioning of the replenishment cycle and any discrepancy between the two levels can result in incorrect restocking. Note: if the units are set up as requesting locations this is not an issue.
Cycle counts: Omnisuppliers should be cycle counted regularly on a set schedule to ensure that system on-hands are correct. The schedule should be dependent on the unit’s compliance levels. Cycle count accuracy results should be shared with unit leadership.

Machines:

Appropriate stock levels in Omnisuppliers: Supply levels in the Omnisuppliers need to be sufficient to meet the needs on the unit taking into account the length of the replenishment cycle. Stock levels should be re-evaluated on an ongoing basis using usage reports, including the Omnicell Par vs. Usage Report - this can be run by Omnisupplier and gives the par reorder point and critical level, as well as the minimum and maximum issues per day, the number of days the item fell below the critical level, and the number of days that the item actually ran out in the supplier.
Unused functions: Omnicell has many capabilities that potentially could help nursing better utilize the system and help ensure that all withdrawals are appropriately recorded. For example the 'alias' feature allows items in the Omnisupplier to have aliases (i.e. names that nurses are more likely to use for an item rather than the standard item description) set up at the Omnisupplier to help with the ‘Item Find’ feature in Omnicell. Similarly the 'kit' feature can be set up at the Omnisupplier, so that choosing a kit will light up all the component parts, that then may be issued. All such features should be utilized.

Personnel:

Staffing levels: Staffing levels need to be sufficient to be able to replenish the Omnisuppliers in a timely fashion, to minimize the span of time between the generation of the restock order and when the supplies are physically put into the Omnisuppliers.
Materiels staff training: All staff need to be conversant with all the functions of the Omniserver and Omnisuppliers.
Nursing staff education / training: Nurses play a critical part in ensuring the appropriate replenishment of the Omnisuppliers. If items are removed from or returned to the Omnisuppliers without the appropriate buttons being pushed then the system on-hand counts will be incorrect. This will result in inaccurate replenishment and consequent inadequate levels of stock. Ongoing nurse education and training is vital, both to inservice new staff and to reinforce correct utilization of the Omnisuppliers by current staff. Unit compliance can be calculated on a monthly basis using the Omnicell Consumption by Site per Hospital Area report and communicated to the unit nursing leadership. Additionally the Omnicell Null Transactions report can be run (either routinely, or triggered if compliance falls below a set target level) Both these reports can signal the need for education / training follow-up.

‘Environmental’ Factors:

Backorders / Supply availability: If necessary supplies are unavailable for any reason (manufacturer backorder, supply chain dislocation, etc.) it will adversely effect the ability to have the necessary stock, both in the hospital's Central Distribution and in the Omnisuppliers on the units. These situations need to be addressed and resolved (e.g. multiple sourcing, substitutions, etc.) on an ongoing basis by the hospital's Purchasing Manager.
Communication: Supply usage is not static but fluctuates due to many factors e.g. changes in practice, changes in census, etc. Good communications between Nursing and Materiels staff is essential to ensure that such factors do not cause disruptions in supplies. Measures that will improve communication need to be implemented - examples might include having a communication whiteboard on the unit where information can be put for Materiels staff, having a designated person for the unit to contact, regular meetings between Materiels and unit staff, etc.

If consistent action is taken to ensure that all of these factors are addressed the point-of-use cabinetry will be a success.