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

Introduction Nursing inpatient supply unit is an integral part of the nurses station. In the event of lifethreatening 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 of stock 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

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

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 subpotent 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 that were 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

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, medical equipments and supplies of the unit?

What is the level of satisfaction of nurses with regards to their storage unit? What are the storage devices seen in the unit?

Researcher objectives At the end of the Performance Improvement Project (PIP) with hospital immersion ranging from 150-200 hours, the researcher aims to: Identify a solution to the problem of the nurses-on-duty regarding their supply and stock management and its storage. Explain the importance of adherence to the DOH Standards and Guidelines about medicine storage and supplies. Increase the number of nursing hours spent by the nurses with the patients Increase the quality of nursing care service rendered by the hospital staff nurses.

Methodology The research study was conducted using pre-statistical and post-statistical analysis tool. In utilizing pre and post-statistics, the researcher specifically made use of the Likert scale of measuring attitudes and perceptions of the respondents. After initial interview, handing out of survey questionnaire was executed. Likert scale is a psychometric scale commonly involved in research that employs questionnaires. It is the most widely used approach to scaling responses in survey research. When responding to a Likert questionnaire item, respondents specify their level of agreement or disagreement on a symmetric agree-disagree scale for a series of statements. Thus, the range captures the intensity of their feelings for a given item. A Likert item is simply a statement which the respondent is asked to evaluate according to any kind of subjective or objective criteria; generally the level of agreement or disagreement is measured. It is considered symmetric or "balanced" because there are equal amounts of positive and negative positions. Often five ordered response levels are used, although many psychometricians advocate using seven or nine levels; a recent empirical study found that a 5- or 7- point scale may produce slightly higher mean scores relative to the highest possible attainable score, compared to those produced from a 10-point scale, and this difference was statistically significant.

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

Gender Male Female Total

Number 5 11 16

Gender
11 68.75% 5 31.25%

Male Female

Fig 3: Respondents profile: Gender

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 Morning MidShift Night Total Number 10 3 3 16

Shifts
3 18.75% 3 18.75% 10 62.50% Morning

MidShift
Night

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 24hour 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.

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

12 12 10 8 6 4 2 0 1 0 1 2 0 3 4 5 Total (Mean) X 2.31 4.38 1 2 1 1 6 4.38 2.31 Pre-Tally Post-Tally 8

Pre-Tally Post-Tally

1 0

12 0

1 2

1 6

1 8

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.

Question No. 2: Supplies are easy to locate.

10 9 8 7 6 5 4 3 2 1 0 PreTally PostTally 1 0 0 2 9 0 3 1 0 4 4 6 5 1 10 Total X 2.75 4.63 PreTally PostTally

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 improvement interventions, 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.

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

14 12 10 8 6 4 2 0 PreTally PostTally 1 3 0 2 7 0 3 2 1 4 4 2 5 0 13 Total X 2.44 4.56 PreTally PostTally

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.

Question No. 4: Experiencing a hard time (difficulty) looking for a specific supply.
9 8 7 6 5 4 3 2 1 0 PreTally PostTally 1 4 0 2 3 0 3 4 1 4 3 5 5 2 9 Total X 2.75 4.25 PreTally PostTally

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 graded Very Much, with a mean difference of 2.12.

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

9 8 7 6 5 4 3 2 1 0 PreTally PostTally 1 4 0 2 3 0 3 4 1 4 3 5 5 2 9 Total X 2.75 4.25 PreTally PostTally

Table 7 (Fig.9) showed that pre-test has yielded mean score of 2.75 which is graded 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.

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

14 12 10 8 6 4 2 0 PreTally PostTally PreTally PostTally

1 3 0

2 3 0

3 2 1

4 6 2

5 2 13

Total X 3.06 4.75

Table 8 (Fig.10) showed that pre-test has yielded mean score of 3.06 which is graded Undecided found in the reference values (See Appendix E) the respondents perceptions regarding 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.

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

12 10 8 6 4 2 0 PreTally PostTally

PreTally PostTally

1 4 0

2 6 0

3 2 2

4 3 3

5 1 11

Total X 2.44 4.56

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.

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.

Recommendations The researcher would like to recommend the following measures: FEFO (First Expiry, First Out) - Items with a shorter expiry date (shelf life) should be placed 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 already on 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 all the 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 the pharmacy, 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 guidelines should 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.

Appendices Appendix A: Survey Form

SURVEY FORM: STOCK ROOM PROFILE Gender Male Shift Morning Mid-Shift Night Female

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

Appendix B: Summative Table of Pre-Statistics Survey Subject Gender Shift 1 F MS 2 F M 3 F M 4 F N 5 M N 6 F MS 7 F M 8 F M 9 M M 10 M N 11 F M 12 F M 13 F M 14 M MS 15 F M 16 M M Q#1 2 2 2 2 1 2 4 5 2 2 2 2 3 2 2 2 Q#2 4 2 4 2 2 2 4 3 4 5 2 2 2 4 2 2 Q#3 2 1 4 2 2 4 2 3 4 4 3 1 2 2 1 2 Q#4 2 2 4 2 2 4 2 3 4 4 2 2 2 2 5 2 Q#5 1 2 4 2 1 5 1 3 4 5 1 3 2 3 3 4 Q#6 2 2 4 2 1 4 4 3 4 5 1 3 4 5 1 4 Q#7 2 1 4 5 1 3 2 2 3 4 1 4 2 2 1 2

Appendix C: Summative Table of Post-Statistics Survey Subject 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Gender Shift M M F M M M F M F M F M F MS F M F M M MS F MS M N M N F N F M F M Q#1 5 5 3 5 5 4 3 5 4 4 4 4 5 5 4 5 Q#2 5 5 4 5 5 4 5 5 5 5 5 5 4 4 4 4 Q#3 5 5 4 5 5 5 5 5 5 5 5 5 4 3 5 5 Q#4 5 5 4 4 5 5 5 5 5 5 5 5 3 4 4 4 Q#5 5 4 4 5 5 4 5 5 5 5 5 4 4 5 3 4 Q#6 5 5 4 5 5 5 5 5 5 5 5 4 5 5 3 5 Q#7 5 5 4 5 5 4 5 5 5 5 5 3 5 4 3 5

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

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 = 0.80 K 5 Reference Values: 4.21 5.00 3.41 4.20 2.61 3.40 1.81 2.60 1.00 1.80 Very Much Somewhat Undecided Not Really Not At All

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