1. Implementation of Proximity to Care Model for Inventory Improvement
Final Presentation
IOE Team 6 - W17
Andrea Fungueirino, Orlando Gonzalez, Jessica Sirias
Date: December 12th, 2017

2. Support Team
Clients:
Kristine Komives - Associate Director of Supply Chain/Materiel Services
Adam Haab - Supply Chain Analyst
Ab Bustillo - Warehouse Supervisor
Tim Bates - Nurse/Supply Room Support
Nurse managers and staff of 5A, 5B, 5C
Coordinators:
Arnold Yin - Industrial Engineer Supply Chain Specialist
Yuting Ding - Industrial Engineer Fellow
Mary Duck - Industrial Engineer Expert
IOE 481:
Dr. Van Oyen - Instructor
Mary Lind - Instructor
Joy Chang - GSI

3. Agenda Introduction Background Goals and Objectives Methods
Findings & Conclusions
Recommendations
Expected Impact

4. Introduction

5. Problem
Standard approach created for determining where supplies should be located in proximity to patient care has not been implemented
Lack of resources to gather and analyze data after the new bed algorithm changed
Key Issues
Change in patient population of 5th floor UH
Change in medical supplies used by the 5th floor
Time is wasted retrieving medical supplies that are used frequently
ORlando

6. Background

7. Current State Units: 5-A, 5-B, and 5-C 32 beds per unit
160 nurses staffed daily on all three units
New patients: urology surgery, urology, colorectal, and overflow
Four possible supply locations:
Warehouse
Unit clean room
Intermediate carts
Nurse Servers
Nurse Server

8. Proximity To Care
Framework to determine where supplies should be located
Clean Room
Nurse Server

9. Current Layout - 5A
Max: ft
Min: 12.5 ft
Clean Room

10. Current Layout - 5B
Max: ft
Min: 12.5 ft
Clean Room

11. Current Layout - 5C Max: 131.25 ft Min: 12.5 ft Clean Room
need to add all the others

12. Goals & Objectives

13. Goals & Objectives
To determine the optimal location for each medical supply:
Observing nurses to obtain data for the usage of medical supplies
Analyze the data to determine frequency of use of each product
Compare time it takes nurses to retrieve supplies
Recommendation for:
The best location for each type of medical product
The implementation of the proximity to care model

14. Project Scope Includes: Fifth floor units 5-A, 5-B, and 5-C
Two out of four areas to locate supplies:, unit clean room and nurse servers
Supplies used for all 5th floor patients
Excludes:
Intensive care unit 5-D
Storage facilities outside the two mentioned above

15. Project Approach Literature Review Data Collection Data Analysis
Recommendations
Data Analysis

16. Methods

17. Literature Review
The Management of the Supply Chain for Hospital Pharmacies: A Focus on Inventory Management Practices [1]
Provided insight on how to develop a scale for medical items in terms of criticality
Optimal inventory policy within hospital space constraints [2]
Provided insight on the formulation of a constraint program in a Hospital environment
Orlando

18. Linear Program Order Frequency Unit Frequency Usage Frequency6 1 2 4
Order Frequency
Obtained from: Order Data
Weight: 50
Unit Frequency
Obtained from: Nurse Interviews
Weight: 7 5
Usage Frequency
Obtained from: Nurse Observation Weight: 30
Criticality
Obtained from: Nurse Interviews Weight: 4
Inputs
Variability per Patient
Obtained from: Nurse Interviews
Weight: 2 3
Medical Event
Obtained from: Nurse Interviews Weight: 2
Output: Items to place in Nurse Server

19. Variability per Patient
Nurse Interviews
Surveyed 4-5 nurses per unit (5A, 5B, 5C), surveyed on of most ordered supplies
Frequency
Of total patients, how many use the supply?
Percentage
Criticality
How critical is the supply?
Scale: 0 -10
0 = not critical
10 = life-saving
Medical Event
Is the medical event known or unknown?
0 = known
10 = unknown
5 = could be either
Variability per Patient
Is the amount used for each patient low or high variability?
0 = high
5 = medium
10 = low

20. Nurse Observations 80 hours of nurse shadowing 2-3 hour shifts
Equal amounts of time in all units
Unit Name
Item ID
Location
Quantity
ANdrea

21. Order Data Time team spent shadowing
Received Order Data from May - November 2017
Used data only from October 2017 because:
Time team spent shadowing
Most appropriate representation
Item ID
Quantity
Transaction Date
Description
Month Ordered
Andrea

22. Time Study
Time study determined time wasted from retrieving medical supplies per day for each unit
Limits
Nurses observations could not accurately determined
Walking distances
Walking times
Assumptions
One item type retrieved at a time
Quantity of one per item type was retrieved
Question, should i show this in 50 ft instead
fix table

23. Time Study - Metrics
Maximum and minimum distances from nurse servers to respective unit clean rooms
Floor layouts determined distances in feet
Units
Max Approx Distance to Clean Room
Min Approx Distance to Clean Room
Avg Approx Distance to Clean Room
SD Approx Distance to Clean Room 5A ft
12.5 ft
57.81 ft
36.83 ft 5B
54.17 ft
34.90 ft 5C ft
62.50 ft
38.68 ft

24. Time Study - Metrics
Daily average amounts ordered per medical item for each unit
Ordered data gave order quantities for October 2017
Averages up rounded to account for whole items

25. Time Study - Metrics The team conducted a time study
100 trials
10 feet were walked per trial
Feet per seconds concluded from time study
10 Feet per Second
Foot per Second
Feet per Minute
Average
4.63
0.46
27.82
Standard Deviation
0.473
0.047
2.835

26. Findings & Conclusions

27. Nurse Observations 5A
Medicine Cups, Gauze Sponges, and Lubricant Jelly were most used by 5A

28. Nurse Observations 5B
ABD Pads, Blue Pads and Medicine Cups were most used by 5B

29. Nurse Observations 5C
Saline Flushes, ABD Pads and Luer-lok Syringes were most used by 5C

30. Findings & Conclusions: Order Data 5A
Most Ordered: tissues, tape, pink swabs
Least Ordered: alcohol wipes, cream moisture barrier, dale foley holders
Andrea

31. Findings & Conclusions: Order Data 5B
Most Ordered: tissues, 32oz graduate, and specimen container
Least Ordered: antibiotic ointment, cotton applicator, patient bag
Andrea: write assertions

32. Findings & Conclusions: Order Data 5C
Most Ordered: sterile ABD, drain sponges, IV caps
Least Ordered: safety pins, small bedside bags, band aides
Andrea: write assertions

33. Findings and Conclusions: Nurse Surveys 5A
Breakdown into table (1 and 10)
Blue pads, Suction Liners, Large blue nitrile gloves, and luer-lok syringes are the most critical supplies for 5A

34. Findings and Conclusions: Nurse Surveys 5B
Blood test glucose strips, IV pump tubing, gauze sponges, saline syringes and NACL IV Bags are the most critical supplies for 5B

35. Findings and Conclusions: Nurse Surveys 5C
Blood test strips, NACL bottles, all purpose sponges, suction tubing and NACL bags are the most critical supplies for 5C

36. Linear Program 5A Yellow: Added Supplies maximize: Unit frequency
Criticality
Usage frequency
Order frequency
Jessica - make two columns with larger font

37. Linear Program 5B Yellow: Added Supplies maximize: Unit frequency
Criticality
Usage frequency
Order frequency
Jessica

38. Linear Program 5C Yellow: Added Supplies maximize: Unit frequency
Criticality
Usage frequency
Order frequency
Jessica

39. 5A Findings from Time Study
Findings for Max distance of 5A: ft
Orlando change average to sum
Order data used: 10/1-10/31/2017

40. 5A Findings from Time Study
Findings for Min distance of 5A: 12.5 ft
Orlando
Order data used: 10/1-10/31/2017

41. 5B Findings from Time Study
Findings for Max distance of 5B: ft
Orlando
Order data used: 10/1-10/31/2017

42. 5B Findings from Time Study
Findings for Min distance of 5B: 12.5 ft
Orlando
Order data used: 10/1-10/31/2017

43. 5C Findings from Time Study
Findings for Max distance of 5C: ft
Findings for Min distance of 5C: 12.5 ft
Orlando
Order data used: 10/1-10/31/2017

44. Recommendations

45. 5A Nurse Server Recommendations
Green: Removed and placed in clean room
Yellow: Replaced Green

46. 5B Nurse Server Recommendations
Green: Removed and placed in clean room
Yellow: Replaced Green

47. 5C Nurse Server Recommendations
Green: Removed and placed in clean room
Yellow: Replaced Green
Higher Quantities of:
White hats
Graduated cylinders

48. Recommendations for Proximity to Care Model
Strengths
Flexible, allows for extra factors to be added in
Involves nurse input, nurses can rank the criticality based on experience
Areas for Improvement
Not all factors applicable to acute services
Guidelines should be added for what is allowed and can fit in nurse server
Factors/measures are vaguely defined
add space constraints

49. Recommendations for Future Implementations
Method
How to Implement
Nurse Surveys
Continue method of nurse surveys
Obtain more nurse input
Explain definitions and measures clearer
Nurse Observations
Useful for model, but time consuming
Recommend having barcode scanning or requiring nurses to record usage when charting
Order Data
Useful for model, recommend to continue method
Linear Program
Continue use of linear program
Weights may need to be adjusted per unit
Constraints may need to be added

50. Expected Impact

51. Expected Impact Improved proximity to care in terms of supply needs
Increase time spent caring for patient
Improved patient and nurse satisfaction

52. Expected Impact Assumptions 30 days a month 365 days a year
New screen shot

53. Thank you!

54. References
[1]
Beier, F. J, “The Management of the Supply Chain for Hospital Pharmacies: A Focus on Inventory Management Practices”, Journal of Business Logistics, 16(2), 153, 2011.
[2]
Little and B. Coughlan, "Optimal inventory policy within hospital space constraints", Health Care Management Science, vol. 11, no. 2, pp , 2008.