Equipment Planning Process: Organizing Purchases

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AORN J O U R N A L JANUARY 1988, VOL. 47, NO I Equipment Planning Process ORGANIZING PURCHASES Mariann L. Johnson, RN quipment planning, whether for a new facility or for an existing OR undergoing E renovation, is a relatively simple and straightforward process. Planning involves determining the utility requirements (eg, electrical, plumbing, heating, vacuum, air conditioning), the amount of space necessary to accommodate equipment, and an estimated cost of the new equipment. This article focuses on determining the equipment inventory and what additional equipment is needed. Equipment planning should involve the architect, hospital administrator, general contrac- tor, and equipment consultant as well as the medical and nursing staff. Taking Inventory he first step in equipment planning is determining who is responsible for plan- T ning, procuring, and installing the equip- ment. The parties usually involved are hospital administrators, contractors, architects, consultants, physicians, and nurses. Together, they devise an equipment checklist (Table 1). In Table 1, the owner represents the group or individual who is financially responsible for the project. This may be a multihospital chain, a private clinic, or a group of physicians. Various individuals may be assigned responsibility for planning, procuring, and installing equipment under the owner. These include individuals such as the hospital administrator, nursing supervisor, purchasing agent, and biomedical engineer. Likewise, the architect, consultant, contractor, and interior designer represent more than one individual. For example, the contractor represents individuals such as the electrical or plumbing contractors, and the architect represents the electrical, mechanical, and structural engineers. The interior designer can either be independent or associated with the architect. The purpose of a checklist is to define responsibility in the grey areas. In most building projects, a combination of all parties are responsible for the equipment and furnishings. For example, who is responsible for obtaining revolving stools in the OR? Is it the owner or Mariann L. Johnson, RN, MS, is president of Hospital Con Sult, Barrington, Ill, and an OR staff nurse, Northwest Community Hospital, Arlington Heights, Ill. She received her nursing diploma from Good Samaritan Hospital School of Nursing, Cincinnati, and both her bachelor of science degree in nursing and her master of science degree in nursing administration from the University of Illinois Chicago. 214 AORN J O U R N A L JANUARY 1988. VOL. 47, NO 1 -. Table 1 OR Equipmment Responsibility Checklist Equipment items I Planned I Procured [nstalled Remarks d- 215 AORN JOURNAL JANUARY 1988. VOL. 47. NO I Department: Surgery Identity # To room 200 1 4020 2002 4020 2003 4020 2004 4020 2005 4020 2006 4020 2007 4020 2008 4020 Table 2 Inventory List Room: OR #1 Item Manufacturer Light, OR, 120 volts, 60 Hz ABC Co Table, OR manual ABC Co Electrosurgical unit 120 volts, MedCo Worktable, stainless steel Smith Co Worktable, stainless steel Smith Co Prep table, stainless steel Smith Co Kick bucket, stainless steel Smith Co Kick bucket, stainless steel Smith Co 60 Hz 24 x 48 inches, broken caster 24 x 36 inches 16 x 20 inches Model Condition I000 3 Excel 2 IV 2 2 2 2 2 the interior designer? The hospital administrator believes the stools are the interior designers responsibility, but the interior designer may not even know of the need for revolving stools in the OR. To help determine responsibility, equipment used in an OR has been classified as either fixed medical equipment, major or minor movable medical equipment, or furnishings. Fixed medical equipment is permanently attached to the building. This includes warming cabinets, ice makers, medication stations, sterilizers, glassware washers, therapy tanks, and surgical and examination lights. It does not include master clocks, communication systems, elevators, or security systems. Major movable medical equipment is capable of being moved, but it has a relatively stable location and a life expectancy of more than five years. This includes carts, stretchers, and surgical and treatment tables. Computer equipment and data processing equipment are excluded. Minor movable medical equipment costs less than $300 and has a life expectancy of less than five years. This includes sphygmomanometers, revolving stools, foot stools, and waste receptacles. This does not include supplies, disposable items, or items stored in central supply. Furnishings include office and lounge furniture, seating, accessories, and draperies. Signs and fixed color schemes are excluded. Listing what you need. During the second step, all equipment that will be needed in the ORs is listed using a general description rather than a trademark or brand name. If the person making the list looks at the architectural blueprints, the potential equipment in all rooms can be listed easily. Some rooms, such as the anesthesia workroom, will have several of the same items (eg, anesthesia machines and cardiac monitors). If the proposed facility will have six ORs, at least six anesthesia machines and cardiac monitors would be listed in the anesthesia workroom. This allows for proper cost center accounting at the time of budget preparation. Likewise, during the inventory, those same items will be assets in the anesthesia department. Evaluating what you have. During an inventory, existing items should be categorized according to department (eg, anesthesia, surgery, or central processing). Each item or piece of equipment is identified according to location, name, manufacturer, model, color, size, distin- guishing marks, electrical requirements or other 218 J A N U A R Y 1988. VOL. 47, NO 1 AORN JOURNAL Table 3 Generic Equipment List Department: Surgery Room #: 4020 Room name: OR # I Quantity 1 1 1 1 1 2 2 2 2 3 1 2 Item Identity # Light, OR, dual 2002 Electrosurgical unit, with stand 2003 Worktable, stainless steel, 24 x 48 inches Worktable, stainless steel, 24 x 36 inches 2005 Prep table, stainless steel, 16 x 20 inches 2006 Kick bucket, stainless steel 2007 IV stand, 4-hook Table, Mayo, stainless steel, 16 x 21 inches, foot operated Stand, stainless steel, single ring Stand, stainless steel, double ring Stool, revolving Table, OR, manual, with accessories utility requirements, identification number (eg, asset number, serial number, or an inventory tag number), and condition. The condition of an item is noted to determine whether it will be relocated. The following coding system is recommended: (1) excellent-definite relocation, (2) good-probable relocation, (3) fair-marginal relocation, and (4) poor-will not relocate. The medical or nursing staff, biomedical engineer, or maintenance personnel should help with the coding process because they are the ones who are most familiar with the equipment. I have found that using a hand-held tape recorder speeds up taking inventory. Once completed, the tapes must be transcribed. After items have been included in the inventory, they should be tagged with colored tape, tag, or labels. This prevents them from being counted twice. Inventories that are conducted early in the planning process must be updated when new equipment is purchased or old equipment is retired. Integrating your haves and your needs. This is a two-step process: (1) First, the number of the room to which the reusable item is being relocated is noted on the inventory list, and (2) second, the inventory number of the item that will satisfy the needed item is noted on the generic equipment list. This integration procedure ensures that each reusable item has a designated place for relocation, and that the greatest number of items in the generic equipment list are satisfied by existing equipment. This procedure also ensures that no existing item wil be relocated in two different locations (Tables 2 and 3). Purchasing New Equipment fter the inventory integration, the hospital administrators or the OR director identify A the new equipment that has to be purchased. The medical and nursing staff participate in developing the new purchase specifications, and the purchasing agent is ultimately responsible for writing them based on need. The nurse manager and purchasing agent review the manufacturers literature, references, and reports of on-site evaluation of equipment that is being considered. The purchasing agent can develop specifications in one of two ways. Generic specifications may be developed by listing the generic name, size, construction material, function and performance, 219 JANUARY 1988. VOL. 47, NO 1 AORN JOURNAL and utility requirements. Generic specifications can be a time-consuming process for the purchasing agent if there are several items that need to be purchased. The second method is to list specific makes and models of each piece of equipment and its accessories. Usually, the phrase or comparable is included, which means that equipment of comparable quality is acceptable. The manufac- turer specifications are easier to develop, but when the manufacturer bids on an item of comparable quality, the purchasing agent needs to spend more time analyzing the bids. After either the generic or the manufacturers specifications have been developed, the purchasing agent sends them to manufacturers and/or distributors of medical equipment. If a manufac- turer specification is marked or comparable, the manufacturer or distributor knows to look at comparable models to the equipment that was specified. Information is also included on the specifications about deadlines for the bids to be received and delivery instructions. After the bids come back in, the purchasing agent follows general guidelines to determine which equipment to purchase. First, he or she closely analyzes all bids, especially if they are marked or comparable to ensure that the items quoted are of comparable quality. The Pareto principle, also known as the 20- 80 rule, is a guideline to consider when purchasing equipment. This means that 20% of the items will account for 80% of the dollar volume. From a time management viewpoint, the purchasing agent and others involved in the process should concentrate on analyzing those items that comprise 80% of the budget. After the items have been purchased and installed, the purchasing agent should make a punch list. This lists the exceptions to the specifications or any deficiencies in the items. The punch list is used as a guide by the owner when contacting the manufacturer/dealer to rectify the deficiencies; final payment is usually withheld until the punch list is rectified. It is best to complete the punch list after all equipment has been installed, but before any surgical procedures are per- formed-usually over a weekend. Summary quipment planning for a new or renovated OR space is an essential part of the overall E facility planning process. It can be accomplished by in-house staff or by outside equipment consultants. If outside consultants are hired to organize the process, it is important that the nursing and medical staff be involved because they use the equipment and will determine the 0 ultimate success of the new facility. Suggested reading Ayscue, D. Operating room design: Accommodating lasers.AORN Journal 43 (June 1986) 1278-1287. Fellows, G E. Ambulatory surgery design: A consultants perspective on facility planning. AORN Journal 45 (March 1987) 708-724. Papanier Wells, M Nicolette, L. Purchasing power: The perioperative nurses role. AORN Journal 42 (October 1985) 508-510.


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