Sharing Good Practice
NHS Board: NHS Greater Glasgow & Clyde
Ward: SGH
Details of Improvement:
What was the particular problem that this case study isabout?
Ward stock control. SCN reported continuing issues around stock control/management with Procurement.
How was this identified?
During the Directorate Waste Walk, SCN highlighted her issues and could provide visual examples of existing problems. Procurement was represented on the waste walk and discussions took place around current processes. A detailed dialogue occurred and areas for adjustment, action and reviewwere put in place.
What were the implemented improvements (whattools/techniques did you use)?
- Using the 10 point checklist tool from the Well Organised Ward module as a process guide for the SCN, it was suggestedthat she again work closely with the ward product manager and review the ward order sheet to ensure all the items of and number of stockmatches demand is correct and he was is aware of what is an acceptable substitute if an item was not available. (This being a recurrent theme that if no item available and unsuitable supplement was provided which was not fit for the ward’s needs).
- Also in accordance with the10 point checklist tool she revisit all areas to ensure/assess that the ward met with the criteria of the 3 second rule for identification of items and that by writing a ward Standing Operational Policy that all staffs who work and could potentially work in ward 26 can clearly see the process for stock ordering/control/management.
- During a 1:1 facilitation session using the pre- RTTC photographs of the ward storage areas as a basis, storage labelling and visual identification was discussed. The SCN had already identified labelling could be improved further and agreed to carry this out.
- The ward Pharmacy technicians were also asked to re-organise their stock into one cupboard. To rearrange and label into area of drug families, usage levels etc and to crucially appropriately label the shelves.
- SCN also placed laminated signs on her external cupboard doors. Signage is categorised into families /areas of highest usage.
- The SCN also decided to produce a ward guide,forall areas of orderingwhich will be easily accessible to staffs. This she felt would reduce staffs time when she was not available if they had issues with ordering. It became evident staffs had difficulties dealing with deficient stock deliveries, this came to light again when working to the 10 point checklist in the KHWD module. The SCN incorporated an updated procurement guide which was agreed as an action from the directorate waste walk.
- Discussed process mapping as a useful tool and this was used when looking at what type of signage should be used.
What is the situation now?
- Reorganisation and Labelling of All CSSD storage cupboards and pharmacy stock cupboard.
- New ward level quick reference procurement folder available for staffs to trouble shoot with.
- Improvements being seen in the stock received/stored.
Nursing staff save in total 7mins /day looking for stock
Pharmacy technician saves 10mins when x 2 weekly when reordering stock.
10minsx7=70 + 20minsx2=20 overall saving
How is the change sustainable?
SCN has extended the labelling into other areas i.e. laundry room. By extending and continuing this process she is ensuring all the ward complies with the 3 second rule for identification. Instilling this pattern ensures that compliance will be easier to sustain as the whole ward is following the same process.
She is also closely monitoring the situation and regularly is assessing its effectiveness.
Second procurement meeting to be scheduled to see if further process changes are possible to stream line systems more.(Date to be scheduled)
Measurable outcomes
What are the patient benefits?
Reduces staffs time spent in indirect care activity having to Search for items or equipment. This is reduced as quicker identification of stock is now achievable. As well as the items required is now more likely to be in stock. (Potential to see this in re-tracking of ward)
What are the staff benefits?
- Cuts down the need for sourcing out of stock items with other wards.
- Prevents wasteful walking to other areas to borrow items.(Potential to see this in re-tracking of ward, date to be scheduled)
- Increases staff satisfaction staffs reporting improvements to SCN( Measurable in incident crosses)
What are the organisational benefits?
- Nursing staff Save in total 7mins /Day looking for stock
- Pharmacy technician saves 10mins when x 2 weekly when reordering stock.
- Linen store labelling: 15mins/day
10minsx7=70 + 10minsx2=20 + 15x7=105
Overall saving 3.5hrs per week.
How did staff feel before the improvement/during theimprovement and after the improvement?
Before improvement:
A level of frustration and feeling no one was willing to listen to their ordering problems. This was not only Ward staff’s but also the SCN.Frustrated at out of stock items/items not being available or mismatched substitutes.
Post improvement:
Pharmacy staff delighted - stock ordering time now significantly reduced.
Nursing staff’s ease of carrying out daily job, happy that linen is now monitored.
Emptying the linen bags to their labelled stock area since labelling occurred.
Acknowledge the time this saves them daily.
What are the lessons learnt and what would you dodifferently next time?
- Lessons learnt the 10 point checklist is a crucial tool and encompasses all the areas that require to be reviewed for efficiencies.
- The link between WOW and KHWD modules are integral to each other.
- Multi agency working is highly effective to ensure you complete your process mapping fully.
Introduce the process mapping tool exercise earlier into the facilitation sessions for maximum effect.
What plans are there to spread the improvement?
All other areas in ECSM directorate are similarly going through the same process and most have completed the 10 point checklist to ensure they similarly can share this benefit.
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