James Leaver and Stavros Ballas share the benefits of introducing barcode tracking technology at Royal Cornwall Hospitals NHS Trust
Searching for stock can be time consuming. It takes on average one hour per day on every nurse shift, according to the Department of Health and Social Care (DHSC).
In 2016, six NHS trusts bid for their share of a £12m ‘Scan4Safety’ project which, using barcodes, allows clinicians to track patients through their hospital journey and manage stock effectively.
According to the DHSC, the NHS could save £1bn over seven years if the programme is rolled out across the NHS acute sector.
Royal Cornwall Hospitals NHS Trust was one of six hospital sites selected to implement the project in 2016. Since going live with the programme, the trust has successfully released 1,300 hours of clinical time for staff working in the cardiac catheterisation department.
Chief procurement officer James Leaver and procurement inventory manager Stavros Ballas tell Healthcare Leader how they achieved this result.
In 2016, we reviewed the trust position in inventory management. We found that in most of the areas, we were overstocked and that we had procedures in place that had become obsolete. This resulted in waste and space not being utilised correctly.
In addition, clinical time was used to instead perform stock-control tasks, using basic inventory management systems and, very often, manual processes. It would also take our clinicians hours or days for to recall a faulty product, as they had to look through the patient’s records.
In October 2017, the trust ran a selection process and adopted the Ingenica 360 inventory management system (IM) [a system used for inventory management in healthcare, which enables the management, tracking and tracing of products and supplies] to support the implementation of the Scan4Safety project.
This allowed us to use the barcodes defined by the GS1 standards [global standards that allow to identify, capture or share information] – like the ones you use in the supermarket. The technology allows us to track the stock using these barcodes, from the time we receive it to when we use it on a patient.
At present, we only scan implants as part of the Scan4Safety project.
Our staff use a handheld scanner to scan the implant’s barcode, capturing all the information contained in that barcode and storing it on the system.
When a patient is taken to the operation theatre, they wear a wristband that has the patient’s identifiable barcode on it. That barcode is then scanned to allow the system to identify the patient. Our clinicians also scan the barcode of the operating theatre in which the patient is being operated.
That makes it easier for us to track down who performed the operation, when it was and where and with which product.
From an inventory management point of view, we scan products as soon as we receive them. That lets us know what is on our inventory so that when a product is scanned at point of use, the system knows that it has been used and will reorder it for us.
The order will automatically go through the system without any buyer intervention.
The biggest challenge with introducing anything is people. Staff are used to working in a certain way and when you introduce change, people can become very nervous.
The key for us has been communication, being able to mark down what benefits the Scan4Safety would bring and why it has been introduced. Where people understood that and got on board with that, the implementation has been relatively straightforward.
We are only part way through the implementation of Scan4Safety, and we are learning lessons with time. The single biggest lesson we have learned is making sure we communicate with the right people early so that they ‘own’ the system. Although the inventory management team can support and facilitate the introduction of Scan4Safety, we need the buy-in from clinicians, as they are the ones scanning the products at point of care.
We are currently live with the system in cardiac catheterisation, cardiology, interventional radiology. We are part way to introducing it to operating theatres – we are live in breast, ear nose and eye – and we are about to go live in our orthopaedic department.
The ambition is to continue to roll this out across all theatre areas and then into our emergency department, medical assessment units and endoscopy department.
We initially provided some training to clinicians on how to use the scanners. Our inventory management dedicated team has taken all the responsibility for stock and maintaining storage from the clinicians, which helped release time for them to focus on frontline care.
The system also helps us with product recall. We can type the product GS1 code and the lot number in and within seconds we are able to track down patients with that type of implant.
Another thing that the system enables us to find out is when a product is going to expire. The system records expiration dates with lot numbers and then we can be proactive to try to use them before they go out of date if possible. Even when they go out of date, we can look at patterns to understand why we wasted those products. If someone tried to scan a product that was out of date, the system would send an alert to warn the person that the item is out of date.
The system also looks at what products we use and recommends how much we should order accordingly. In that way, we use what we buy, and we reduce waste. This function has also allowed us to reduce stockholding to just under three weeks.
Since going live with Scan4Safety in 2016, we have managed to reduce product spend by 15% and we are on track to reducing waste by 50% by completion of third year since launch.
We have also done some time measurements and we have found that, in a year, we saved 1,300 hours of clinical time by shifting inventory management tasks from the clinicians to the inventory management team.
We are now looking into incorporating the system in our patient administration system. When we scan the patient’s wristband, the system would associate that with the operation on the booking system. This means that, if someone tries to scan products that are not suitable for the operation, the system would give an alert, which would help us reduce never events.