maximizing space and time: organizational plan for supplies storage at delos santos medical center...

8/12/2019 Maximizing Space and Time: Organizational Plan for Supplies Storage at Delos Santos Medical Center 3rd Floor Nurses Station.

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Maximizing Space and Time: Organizational Plan for Supplies Storage at Delos Santos

Medical Center 3rd

Floor Nurses Station

Earl Clarence V. Coniconde, RN

Trinity University of Asia Graduate School


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Introduction

Nursing inpatient supply unit is an integralpart of the nurses station.In the event of life-

threatening emergencies (i.e. code blue), being able to immediately locate medicine and supplies

when it is needed helps nurses lessen stress in these highly pressured situations. The proper

arrangement and organization of the drugs and medical stocks is crucial in the delivery of health

care to patients as they become readily available and easily accessible. It saves a lot of time for

the nursing staff and even patients lives as this enables nurses will focus more on patient healing

rather than looking for the right tools.

Shellack (2010) has said that in the clinical practice setting, be it in a hospital or a

primary care facility, nurses are faced with the challenging task of managing drug preparations

and treatment on a daily basis. This entails a wide variety of activities, which include but are not

limited to the following: a) Evaluating and interpreting prescriptions, liaising with the

prescribing practitioners and other members of the multidisciplinary health care team, and

implementing and coordinating their prescribed treatment regimens; b) Ordering, receiving,

storing, issuing and reordering drug supplies (ward stock); c) Preparing and administering

prescribed medication to patients in their care; d) Monitoring these patients for the effects of

such medicines, as well as possible adverse reactions to the prescribed treatment; e) Monitoring

the patient for compliance (adherence) to the prescribed treatment regimen at regular intervals, in

settings where the prescribed treatment is not administered directly to the patient. He further

discussed the importance of stock management in the 6 Rs of Patients Give the Right medicine

in the Right quantity of the Right quality to the patient at the Right time in the Right place for

Right cost.

Proper stock management and drug control entails successful management of a nursing

unit as well as a health care facility as whole. Stock management involves various levels and

aspects, including the ordering of stock, receiving and storage of stock, receiving and storage ofstock in the health care unit (i.e. ward, department or clinic), issuing of the stock, and the

reordering thereof, according to the specific levels used for inventory management. When

equipment goes missing or supplies are gone, it is ultimately the patient that suffers. That loss of

one hour per day means hospital personnel have 60 fewer minutes to put into caring for their

patients. Lacking needed supplies delays care and can cause unnecessary discomfort for the very


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people the hospital is there to serve. Tracking equipment and supply levels, especially for larger

facilities, is vital in order to provide services in a timely and efficient manner (Knotts 2012).

Stock management follows a cyclic process and is illustrated in Figure 1.

Fig. 1: Ward stock management cycle

The stocks are procured at either the hospital pharmacy or Central Supply Room (CSR)

department. Centralization, as the term is used here, means the concentration of all equipment in

one place, under one head, where it may be cared for with the greatest efficiency and used to the

best advantage.

The department in which this important work is carried out has been given several names,

but the most common designation is Central Supply Room. It is then defined as a unit in the

hospital which issues sterile supplies and most of the special equipment needed in the care of

patients. The purpose of the Central Supply Room is to conserve time and material by reducing

the duplication of supplies and effort. Such duplication has heretofore existed when dressings

and sterile supplies were taken care of on the wards and floors, or in the dressing rooms in


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connection with each hospital department. The aim of the hospital in maintaining a Central

Supply Room is to render to doctor and patient the best and most efficient service in the interest

of each. The DOH (1994) stated that nurse plays key function roles in the CSR namely:

Requisition of Supplies; Receiving and Sterilization of Used Article; and Routine Preparation of

Supplies for Ready Use.

Before the inauguration of such service, it was the custom to issue all supplies from the

main storerooms to the wards, and replacements were made as needed. Gauze and cotton were at

one time included in these supplies, and dressings were secured from the operating room. This

may still be the rule in some hospitals where dressing rooms off wards are considered necessary..

With the advent of the Central Supply Room, this procedure has changed, and trays and solutions

for all these treatments are now provided through this central organization (Reilly 1945).

The DOH Hospital Pharmacy Management Manual (1994) clearly states the importance

of proper storage of medicines and supplies. Unless proper storage conditions are consistently

and strictly observed, the medications may accidentally reach the patient in deteriorated sub-

potent state. This will be hazardous to the patient because the desired therapeutic response will

not be achieved and an adverse effect may be produced by toxic decomposed products.

The presenting problem

The researcher has chosen the De Los Santos Medical Center 3rd

Floor Nurses Station as

the area of study. The De Los Santos Medical Center 3rd

Floor Nurses Station is located at the

3rd floor level of the hospital (Fig.2). It is a general private ward consisting of 24-bed capacity.

The station also includes a treatment room, nurses locker room and nurses lounge area. 16

hospital personnel in the area were surveyed about the storage of their supplies. Supplies were

not located in one place thus a lot of time is seen being wasted looking and locating supplies thatwere not arranged and organized set by the guidelines of the hospital. Several supplies are

considered to be overstocked. Hospitals and other medical facilities that experience the

frustrating phenomena of wandering equipment tend to have more of an issue with

overstocking supplies in order to make sure there are extras on hand. Not surprisingly, this can


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be a significant drain on hospital finances and has actually shown to lead to instances of hoarding

on the part of employees (Knotts 2012).

Fig. 2: De Los Santos Medical Center 3rd

Floor Nurses Station

Scope and limitations

The research was conducted at the 3rd

Floor Nurses Station. The scope of the research

study was confined in one area of the hospital only, thus unable to conduct further research in

other nursing units and special areas (i.e. Operating Room, ICU, Hemodialysis) for comparison

analysis. The number of respondents surveyed by the researcher seemed to be less than expected

whereas the researcher believed that all hospital workers with direct contact with the patient

should be included in the study. Financial and time constraints were also seen as two of the

limiting factors to improve the quality of the research study done.

Research questions

This paper aims to find the answers to the following research questions:

What is the standard operating procedure regarding handling and storing drugs, medicalequipments and supplies of the unit?


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The Likert Scale questionnaire utilized was made with seven questions each with a 5-

point scale. Each item in the scale was graded with corresponding points with 5 being the highest

(Very Much) and 1 being the lowest point (Not At All) (See Appendix A).

After the respondents have answered the Likert scale questions, the researcher has made

use of the Measures of Central Tendency data analysis, Mean (X). The type of Mean (X) used is

the weighted mean, which is similar to an arithmetic mean (the most common type of average).

Instead of each of the data points contributing equally to the final average, some data points

contribute more than others. The notion of weighted mean plays a role in descriptive

statistics and also occurs in a more general form in several other areas of mathematics. If all the

weights are equal, then the weighted mean is the same as the arithmetic mean (Bevington 1969).

Findings

The research study surveyed 16 respondents (11 of the respondents were females and 5

were males) both Pre-statistical and post-statistical treatment.

Table 1: Respondents profile: Gender

Fig 3: Respondents profile: Gender

5

31.25%11

68.75%

Gender MaleFemale

Gender Number

Male 5

Female 11

Total 16


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Table 1 (Fig.3) showed that the predominant respondents in the study are females representing

68.75% of the total population of the sample while 5 (31.25%) were males.

Table 2: Respondents profile: Work Shifts

Work Shift Number

Morning 10

MidShift 3

Night 3

Total 16

Fig 4: Respondents profile: Work Shifts

Table 2 (Fig.4) showed that the predominant respondents in the study are working during

daytime shifts (62.50%) and (18.75%) were accounted for both midshift and night shifts

respectively. This table also illustrates although stocks inventory are done throughout the 24-

hour period, the busiest time of the 24-hour shift occurs during day time likewise carrying out

doctors orders and pharmacy stock management process (ordering, transporting, storing,

securing, recordkeeping, and disposing). Chances of misplacing. loss or theft of medicines and

medical supply are also high during this time.

1062.50%

3

18.75%

318.75%

Shifts

Morning

MidShift

Night


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Question No. 1: Enough space to walk along the storage area.

Table 3 (Fig.5) showed that pre-test has a mean score of 2.31 which is graded Not Really

found in the reference values (See Appendix E), meaning the respondents do not believe there is

not enough space in their stock room. However, upon implementation and administration of

improvement interventions, post-test had gave a mean score of 4.38 which is graded Very

Much, showing there was a difference of 2.07.

0

2

4

6

8

10

12

1 2 3 4 5 Total

(Mean)

X

Pre-Tally 1 12 1 1 1 2.31

Post-Tally 0 0 2 6 8 4.38

1

12

1 1 1

2.31

0 0

2

6

8

4.38

Pre-Tally

Post-Tally


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Question No. 2: Supplies are easy to locate.

Table 4 (Fig.6) showed that pre-test has a mean score of 2.75 which is graded Undecided

found in the reference values (See Appendix E), meaning the respondents do not agree that the

supplies are easy to locate. But, upon implementation and administration of improvementinterventions, post-test had yielded a mean score of 4.63 which is graded Very Much, showing

there was a total difference of 1.88. The proper arrangement of supplies enables nurses to have

easy access when it is needed.

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 Total X

PreTally 0 9 1 4 1 2.75

PostTally 0 0 0 6 10 4.63

PreTally

PostTally


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Question No. 3: Supplies and stocks were properly arranged.

Table 5 (Fig.7) showed that pre-test has a mean score of 2.44 which is graded Not Really

found in the reference values (See Appendix E), meaning the respondents perceived the stocks

and supplies were not properly arranged. Yet upon implementation and administration of

improvement interventions, post-test had shown an improved mean score of 4.56 which is graded

Very Much, with a mean difference of 2.12.

0

2

4

6

8

10

12

14

1 2 3 4 5 Total X

PreTally 3 7 2 4 0 2.44

PostTally 0 0 1 2 13 4.56

PreTally

PostTally


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Question No. 4: Experiencing a hard time (difficulty) looking for a specific supply.

Table 6 (Fig.8) showed that pre-test has yielded mean score of 2.75 which is graded

Undecided found in the reference values (See Appendix E), which means respondents

experienced an undetermined level of difficulty. Yet upon implementation and administration of

improvement interventions, post-test had shown an improved mean score of 4.25 which is gradedVery Much, with a mean difference of 2.12.

0

1

2

3

4

5

6

7

8

9

1 2 3 4 5 Total X

PreTally 4 3 4 3 2 2.75

PostTally 0 0 1 5 9 4.25

PreTally

PostTally


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Question No. 5: Stocks are frequently checked every shift.


Undecided found in the reference values (See Appendix E), meaning respondents believed that

the stocks are checked but to an unknown degree. Upon implementation and administration of

improvement interventions, post-test had shown an improved mean score of 4.25 which is graded

Very Much, with a mean difference of 1.50.

0

1

2

3

4

5

6

7

8

9

1 2 3 4 5 Total X

PreTally 4 3 4 3 2 2.75

PostTally 0 0 1 5 9 4.25

PreTally

PostTally


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Question No. 6: Items are sorted into groups by type.


Undecided found in the reference values (See Appendix E) the respondents perceptionsregarding items sorted into groups by types is yet to be determined. However, upon

implementation and administration of improvement interventions, post-test had shown an

improved mean score of 4.75 which is graded Very Much, with a total difference of 1.69.

0

2

4

6

8

10

12

14

1 2 3 4 5 Total X

PreTally 3 3 2 6 2 3.06

PostTally 0 0 1 2 13 4.75

PreTally

PostTally


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Question No. 7: Satisfied with the overall setting and arrangement

Table 9 (Fig.11) showed that pre-test has yielded mean score of 2.44 which is graded Not

Really found in the reference values (See Appendix E), meaning the respondents were not

satisfied with the overall setting and arrangement. However, upon implementation and

administration of improvement interventions, post-test had shown an improved mean score of

4.56 which is graded Very Much, with a total difference of 2.12.

Conclusions

During the course of the clinical immersion of the researcher in the area of study, the researcher

provided an intervention of providing storage unit boxes that will segregate and group medical

supplies by types and that it can be stored away for later use. It saves a lot of nursing hours that

is usually spent on finding unorganized stocks and supplies. It is also concluded that the study is

a successful project as evidenced by a pre and post statistical treatment.

0

2

4

6

8

10

12

1 2 3 4 5 Total X

PreTally 4 6 2 3 1 2.44

PostTally 0 0 2 3 11 4.56

PreTally

PostTally


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Fig. 11: IV fluids are placed in opened boxes that are unorganized and untidy. Staff personnel in

the unit will spend a lot of time looking for the right materials especially under stressful

situations

Fig. 12: IV fluids are now placed securely in black storage boxes grouped by types with labels;

disposable gloves, IV lines and catheters are grouped together in a single storage box with labels;3-mL syringe, 5-mL syringe and 10-mL syringe have carton dividers segregating each syringe

type with labels for easy identification.


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Recommendations

The researcher would like to recommend the following measures:

FEFO (First Expiry, First Out) - Items with a shorter expiry date (shelf life) should beplaced in front of the same items with a longer expiry date (shelf life). First use the items

that are closest to their expiry date (items in front).

FIFO (First In, First Out) - New stock received should be placed behind the stock alreadyon the shelves. If there is a manufacturing date, put the items with the most recent

manufacturing date behind. First use the items in front (items that were received first),

followed by the second consignment.

Create an inventory checklist to hang on the inside the cabinet or closet door, listing allthe supplies currently in use. When stock gets low or it's time to reorder, check off the

supply that's getting low. This will make ordering and maintaining a steady inventory

simple and less time-consuming.

Open Communication - It is imperative for the ward staff to communicate with thepharmacy, especially when it comes to out-of-stock situations and problems with ward

stock management and the receivable of supplies. Establish and ensure open lines of

communication between ward staff and pharmacy staff, especially with the ward

pharmacist. Effective communication can identify and resolve problem areas and

improve the quality of care rendered to the patients.

Review of Hospital Standard Operating Procedures - Appropriate SOPs or guidelinesshould be in place. More important than having these policy documents in place, is

ensuring that all of the staff members are familiar with the stock and drug management

policies and procedures. This will ensure uniformity on the part of the ward staff and

lessen the likelihood of unnecessary mistakes. Conduct training on the use of SOPs for all

new staff, as well as refresher training for other staff members.


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Appendices

Appendix A: Survey Form

SURVEY FORM: STOCK ROOM

PROFILE

Gender

Male Female

Shift

Morning Mid-Shift Night

Please mark an (X) in the box that represents how you feel about the 3rd

floor nurses station stock room.

There is a enough space/room to walk inside the stock room.

(5)

Very Much

(4)

Somewhat

(3)

Undecided

(2)

Not Really

(1)

Not At All

The supplies in the stock room are easy to locate.

(5)

Very Much

(4)

Somewhat

(3)

Undecided

(2)

Not Really

(1)

Not At All

The supplies and stocks are properly arranged.

(5)

Very Much

(4)

Somewhat

(3)

Undecided

(2)

Not Really

(1)

Not At All

I am not having a hard time looking whenever I look for a particular supply in the stock room.

(5)

Very Much

(4)

Somewhat

(3)

Undecided

(2)

Not Really

(1)

Not At All

The supplies are checked frequently every shift.

(5)

Very Much

(4)

Somewhat

(3)

Undecided

(2)

Not Really

(1)

Not At All

The items in the stock room are sorted into groups by type.

(5)

Very Much

(4)

Somewhat

(3)

Undecided

(2)

Not Really

(1)

Not At All

I am satisfied with its overall setting and arrangement.

(5)

Very Much

(4)

Somewhat

(3)

Undecided

(2)

Not Really

(1)

Not At All


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Appendix B: Summative Table of Pre-Statistics Survey

Subject Gender Shift Q#1 Q#2 Q#3 Q#4 Q#5 Q#6 Q#7

1 F MS 2 4 2 2 1 2 2

2 F M 2 2 1 2 2 2 1

3 F M 2 4 4 4 4 4 44 F N 2 2 2 2 2 2 5

5 M N 1 2 2 2 1 1 1

6 F MS 2 2 4 4 5 4 3

7 F M 4 4 2 2 1 4 2

8 F M 5 3 3 3 3 3 2

9 M M 2 4 4 4 4 4 3

10 M N 2 5 4 4 5 5 4

11 F M 2 2 3 2 1 1 1

12 F M 2 2 1 2 3 3 4

13 F M 3 2 2 2 2 4 2

14 M MS 2 4 2 2 3 5 215 F M 2 2 1 5 3 1 1

16 M M 2 2 2 2 4 4 2

Appendix C: Summative Table of Post-Statistics Survey

Subject Gender Shift Q#1 Q#2 Q#3 Q#4 Q#5 Q#6 Q#7

1 M M 5 5 5 5 5 5 5

2 F M 5 5 5 5 4 5 5

3 M M 3 4 4 4 4 4 4

4 F M 5 5 5 4 5 5 55 F M 5 5 5 5 5 5 5

6 F M 4 4 5 5 4 5 4

7 F MS 3 5 5 5 5 5 5

8 F M 5 5 5 5 5 5 5

9 F M 4 5 5 5 5 5 5

10 M MS 4 5 5 5 5 5 5

11 F MS 4 5 5 5 5 5 5

12 M N 4 5 5 5 4 4 3

13 M N 5 4 4 3 4 5 5

14 F N 5 4 3 4 5 5 4

15 F M 4 4 5 4 3 3 3

16 F M 5 4 5 4 4 5 5


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Appendix D: Approved Letter of the Director of Nursing Service, De Los Santos Medical

Center


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Appendix E: Computations and Reference Values

For Question No. 1-7 of the Pre/Posttest, the researcher made use of the formula of the weighted

mean:

(X) = n(5) + n(4) + n(3) + n(2) + n(1)

No. of sample

To determine the Range,

Range = Ho(highest observation)Lo (lowest observation)

k (number of classes) = it is determined to be 5.

To determine the class size (CS),

Range = 4 = 0.80K 5

Reference Values:

4.215.00 Very Much

3.414.20 Somewhat

2.613.40 Undecided

1.812.60 Not Really

1.00

1.80 Not At All


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References

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10, 2013.

Flavier, J. et al. (1994) DOH Manual of Procedures For Hospitals. Department of Health

http://library.doh.gov.ph/doh_publication/doh017/MANUAL%20OF%20PROCEDURES%20F

OR%20HOSPITALS.pdf.Date accessed: May 28, 2013.

Flavier, J. et al. (1994) DOH Hospital Pharmacy Management Manual. Department of Health

http://library.doh.gov.ph/doh_publication/doh017/HOSPITAL%20PHARMACY%20MANAGE

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Reilly, C. (2003) Central Supply Room Handscrabble Farm,

http://www.hardscrabblefarm.com/ww2/. Date accessed: May 20, 2013

Schellack, N. & Meyer, H., (2010) Pharmaceutical Ward Stock Management for Nurses,

Professional Nursing Today, Vol. 14 No. 5, University of Limpopo, South Africa.

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http://www.ehow.com/how_5844104_build-storeroom-medical-supplies.html., Date accessed:

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