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Catheter Labs - Bar Code Scanning and New Service Arrangements
Leeds Teaching Hospitals NHS Trust
October 2003
Supplies Best Practice Guide
The following is extracted from a best practice guide documented by Simon Heywood . To download a copy in word format, please click here.
Contents Page
1.0 Leeds Supplies Team
2.0 Catheter Labs
3.0 Before the Catheter Lab Project (bar code scanning) was started
4.0 Reasons for the Catheter Lab project (bar code scanning)
5.0 Setting up Bar code scanning and the new service arrangements
5.1 Background Information
5.2 New Service Arrangement
5.3 Bar code scanning at point of use
5.4 Storage Solutions
5.5 Product coding and SPAMMIS
5.6 Stock Management
5.7 New Items & Product Rationalisation
5.8 Special Arrangements
5.9 Management Information
6.0 Customer Feedback
7.0 Benefits/Savings from the Catheter Lab Project
8.0 Acknowledgements
1.0 Leeds Supplies Team
The supplies team consists of 80 staff with 60 directly involved with logistics (materials management and the physical movement of products). Within the supplies team there is a dedicated IT development team, which have proved instrumental in the implementation of material management and bar code scanning within the Catheter Labs.
As part of the ‘e-Commerce in Action’ programme at Leeds, the supplies team are continually working with suppliers and internal customers to improve the supply chain. One of the areas the supplies team have developed is the Catheter Labs, where the new service arrangement and bar code technology have been introduced.
As recognition for the success and improvements of the ‘e-Commerce in Action’ programme Leeds were rewarded with the ‘Improving Care with E-Technology’ award at the 2003 Health Journal Awards.
For more information about the ‘e-Commerce in Action’ project please visit The Leeds Teaching Hospitals website (click www.leedsth.nhs.uk/supplies ) or NHS Logistics Authority Knowledge Centre (click http://nww.logistics.nhs.uk:8080/index.jsp , then enter “e commerce” in the search box on the left hand side)
2.0 Catheter Labs
There are 5 theatres, which deal with speciality heart treatments using catheter technology, and these are referred to as Cardiac Catheter labs. They are located together within The Leeds Teaching Hospitals NHS Trust, based at the Leeds General Infirmary site. These 5 catheter labs are supported and supplied by a theatre central store and the supplies team.
Catheter labs use both speciality products, which are high tech and high value, and general med/surgical products. The speciality products are stored within the main theatre central store supported by the supplies team. The general med/surgical products are supplied from a separate location, which is maintained and monitored by the materials management team.
3.0 Before the Catheter Lab Project (bar code scanning) was started
The catheter labs were operating with a stock level of approximately £1.6 million – comprising of speciality and med/surgical products. Two Grade H nurses, who were responsible for the stock management within the catheter labs, raised orders twice daily on a paper-based system.
The paper-based system contributed to a number of problems including:
- Incorrect product codes/descriptions used when ordering – these could change from day to day, causing interpretation problems for the supplies team when ordering the products from the supply base.
- Lack of management information – no data on demand, stock levels, etc making it difficult to accurately set stock and ordering levels
- Reduction in the time spent by the two Grade H nurses on patient care and critical tasks
- Lack of budgetary control – due to the inability of the system to allocate spend to individual catheter labs/specialities
Within the catheter labs a large number of stents are used and stocked. These are high value products and inflate the stock value considerably; because of this the finance department performed a monthly manual stock take on the stents. Although time consuming, the stock take enabled the Trust to monitor spend and stock levels of stents.
Catheter labs also use many speciality products, which are continually being redesigned and updated as new technology is developed, resulting in a high level of new products being introduced on a regular basis. There were no procedures or standard processes in place to deal with the introduction of new products, thus causing difficulties setting appropriate stocking levels and storage locations.
Historically, a large number of reps had been allowed to visit the nurses in the Catheter Labs, on an ad-hoc basis, to discuss new items. This resulted in the nurses spending a disproportionate amount of time on supplies issues and reducing their availability for patient care and clinical tasks.
4.0 Reasons for the Catheter Lab project (bar code scanning)
The supplies team have established a good reputation, based on previous implementations of materials management in other departments throughout the Trust. The clinicians within the Catheter Lab recognised the need for change and approached the supplies team for help.
Together the clinicians and supplies team identified the following aims of the project within the catheter labs:
- Reduce the Stock Levels, which the clinicians and supplies team recognised as being higher than necessary
- To release nursing time away from supplies issues and re-deploy clinical staff back into patient care
- Improve budgetary control and enable spend to be allocated to individual catheter labs/specialities
5.0 Setting up Bar code scanning and the new service arrangements
5.1 Background Information
The new system, incorporating bar code scanning, and new service arrangements between supplies and the catheter lab clinicians was implemented in the Catheter Labs at end of 2000/beginning of 2001.
The Catheter Labs are now operating with a stock level of approximately £700k, consisting of 983 products lines. The average spend per day is £30k, which amounts to approximately 4.5 weeks cover and 11 stock turns per year.
During the implementation stage the supplies team carried out a full stock check. This enabled the supplies team to assess whether the levels of stock were accurate and still required. £200K of stock was identified as “no longer in use” and written off.
5.2 New Service Arrangement
An important aspect of the new system and service arrangement, between the catheter labs and the supplies team, was to redesign processes and reallocate responsibilities to enable clinicians to spend more time on patient care and clinical tasks instead of supply issues.
The Catheter Labs funded a supplies post, undertaken by Joanne Woolhouse, to provide the required supplies expertise for the implementation and continued support of the new system and service arrangements.
Within the new arrangement the supplies team now manage the stock in the theatre central store. The clinicians take the products as required for the planned operations into the catheter labs, using the carousel trolleys, figure 10, for high usage products. The free movement of catheters and stents within the lab environment enables the consultants to have immediate assess to the product range at the patients side. These products are still on stock in the inventory system until they are used during an operation, at which point they are immediately bar code scanned by the clinical staff to provide a “real time” picture of stock levels.
The carousel trolleys do not have locations set up on the inventory system, but act as an extension of the theatre central store. This method works effectively because of the good working relationship built up between the supplies team and the Catheter Lab clinicians. The movement of stock is illustrated in figure 1.
The supplies team have taken over the responsibilities for ordering stock, as illustrated in figure 2, which involves analysing demand patterns, outstanding order quantities and gaining information from the clinicians concerning any unexpected increases in future demand. Circumstances, which can affect the future, demand requirements include weekend working, special cases, etc. By having her own desk in the theatre central store, Joanne Woolhouse has become part of the Catheter Labs team and achieves a greater level of communication, which has proven essential in the success of the project.
5.3 Bar code Scanning at point of use
There is a bar code scanner connected to a PC in each of the catheter labs, figure 3. As products are used they are bar code scanned, which automatically updates WESSIS.
To reduce time and effort a list of bar codes for high use products, illustrated in figure 4, is located next to the PC to enable the clinicians to scan the products more quickly.
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| Figure 3: PC and Bar Code Scanner | Figure 4: High usage product bar code list |
On occasions the clinical staff do not have time or are unable to scan the barcodes due to IT or bar code label problems, etc and there is a danger that stock levels may not be updated. The supplies team have introduced a simple, but highly effective, solution to this problem by placing a bin, as illustrated in figures 5 & 6, into each theatre. If the clinical staff experience difficulties when scanning they simply drop the product packages into the bin, which are then manually updated or scanned into WESSIS by the supplies team later in the day to ensure that the loop is closed and stock is accurately updated on the system.
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| Figure 5 & 6: Bar code bin within theatre | |
Bar code scanning the products into WESSIS at point of use has enabled the Trust to monitor products and gain management information on their usage.
By introducing bar code scanning at point of use in the Catheter Labs, Leeds now have a fully electronic system that captures demand, updates stock levels and given the Trust greater visibility of management information so that product usage can be monitored.
5.4 Storage Solutions
To provide a better storage area, the existing storeroom, which supports the five catheter labs, was redesigned, to improve the flow of goods and provide better location labelling.
The new storage solution, as seen in figure 7, enables the clinicians to locate and pick products quickly and efficiently. This is particularly important if different sizes of catheter and stents are identified during an operation and need to be obtained as quickly as possible.
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| Figure 7: Theatre Central Store |
The catheters used within the catheter labs are stored on hanging rails, figures 8 & 9, within the theatre central store. These hanging rails help to protect the catheters from bending and damage, whilst ensuring the vast range of similar looking products are located correctly. On the end of each rail is a label listing the various types and sizes of catheters on the rail, helping the clinicians to locate the required products.
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| Figure 8: Catheter Rail | Figure 9: Catheter rail labels |
The carousel trolleys illustrated in figure 10 allow high usage products to be taken into the Catheter Labs and eliminates the need for clinicians to be continually moving between the Catheter Labs and the theatre central store during the operation. The locations on the carousel trolleys are not on the system and act as an extension to the theatre central store.
Products used during an operation are bar code scanned by the clinicians to record usage and the remaining products are left on the carousel trolley and returned to the theatre central store.
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| Figure 10: Carousel Trolleys |
5.5 Product Coding and SPAMMIS
All the products, which are stored within the theatre central store, have been allocated a product code from the local catalogue which is maintained by the supplies IT team and are also identified on WESSIS by the suppliers/manufacturers part number. The introduction of product codes in conjunction with the bar coding system has enabled the Trust to build up more detailed management information. It also eliminates the previous problem of duplicated records and the use of incorrect product codes when ordering.
The product codes are cross-referenced and made consistent between WESSIS and Oracle using SPAMMIS, which as proved to be and essential aspect of the project. If Leeds did not have SPAMMIS or a similar system, they would be unable to cross-reference the information from WESSIS and Oracle. This would increase the need for manual intervention and therefore reduce efficiency.
SPAMMIS is a computer system developed at Leeds Teaching Hospitals, which provides a single central integrated system for supplies management information and enables product data to be shared between various supply systems, such as WESSIS and Oracle.
5.6 Stock Management
A minimum stock level is set for each product by the supplies team in conjunction with the catheter labs clinicians. Due to the nature of the products and operations clinicians advise the supplies team of any special cases to ensure sufficient stock is available.
Changes in the stock levels and other stock management issues are highlighted and discussed at the Catheter Labs Operation Meeting, which are held on a monthly basis.
In order to help with stock rotation the catheter labs use a system of putting away on the right and taking products for use from the left. This initiates a flow of products in date order – First In First Out (FIFO).
Stock Checks and date checks are carried out twice per year. If a product’s expiry date is within the next 12 months period, the product is identified as potential obsolete by attaching a Yellow sticker (Colour Coding) to the product, figure 11. If products have a yellow sticker the clinical staff aim to utilise these first. Any products colour coded are also identified as potential obsolete on the system.
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| Figure 11: Products in central store identified as potential obsolete |
5.7 New Items & Product Rationalisation
The Catheter Lab user Group, which is attended by the supplies team, formally agrees introduction of new items. A new arrangement has also been introduced to reduce the problems of reps visiting the Trust on an adhoc basis. Any rep wishing to visit the Trust must contact the supplies team to explain why they are visiting before a meeting can be arranged between all interested parties.
These measures have led to a reduction of new items being introduced unnecessarily.
A rationalisation program was also agreed between Supplies and the clinical staff during the latest tender process, as a result, the number of main suppliers is reduced from 9 to 5. The duration of this tender was 2 years with an optional 2-year extension.
5.8 Special Arrangements
On occasions, consultants need to take products from the Catheter Labs stocks to use in operations at other trusts. When this happens the supplies team have implemented a system where these products are recorded in a book (for signing in and out products). Using the records in this book the supplies team can update WESSIS, which amends stock levels, raises an order against the trust, or other organisation, the products were taken to and raises an invoice.
Stock, which is used in other departments, is dealt with in the same way. The products are signed out in the book, entered into WESSIS and then charged to the department, through WESSIS, where the product was used.
Visiting consultants from other trusts who are using the lab facilities are set up with accounts and a req point, This enables the products consumed in a procedure to be accounted for and charged back to the respective trust.
5.9 Management Information
The level of management information now available from the new system has proved a major benefit to the trust. Visibility of usage information allows the supplies team to raise order quantities based on known demand.
Real time physical stock levels and stock value are now available through WESSIS. If a product has been bar code scanned into stock on receipt it will be physically held within the theatre central store locations, or on the carousel trolley, unless it has been bar code scanned at point of use or there is a packaging label in the Catheter Lab bin awaiting manual input into WESSIS.
The spend by each speciality can now to identified and allocated appropriately, therefore leading to tighter budgetary control.
The supplies team download information into a excel spreadsheet detailing the spend and stock levels of stents, which is transferred through to the financial ledgers on a monthly basis. Consequently, there is no longer any need for the finance department to perform a monthly manual stock take.
6.0 Customer Feedback
Stacey Hunter, Cardiac Cath Lab Manager says:
The new barcode system in the Cardiac Cath Labs at Leeds Teaching Hospitals has helped make significant improvements to materials management. It is one of the largest centres in the UK and carries out around 5000 procedures per year. The range and value of stock that is needed to support this work is phenomenal and had always been very difficult to manage.
This system ensures that we have an easy to use and robust way of ensuring that this is done as effectively as possible. It has improved our understanding of many things about the trends in stock usage and enables the team to use this and other information to be more efficient.
In addition to this, it has freed up a lot of nursing time that was previously needed in a laborious paper based system. We work in very close conjunction with the material management team and have built good relationships, which help us all.
7.0 Benefits/Savings from the Catheter Lab Project
The following are a list of benefits and savings, which have been achieved as a result of the new bar coding system and service arrangement.
The following are a list of benefits and savings, which have been achieved as a result of the new bar coding system and service arrangement.
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8.0 Acknowledgements
Steve Barker, Supply Chain Manager
Email: steve.barker@leedsth.nhs.uk
Tel: 0113 206 4617
Joanne Woolhouse, Materials Manager
Email: Joanne.woolhouse@leedsth.nhs.uk
Stacey Hunter, Cardiac Cath Lab Manager
Case Study documented by:
Simon Heywood, Supply Chain Analyst
NHS Logistics Authority
Email: simon.heywood@logistics.nhs.uk
Tel: 01773 724134