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Article Outline
Abstract
Practice Changes
o Talcum Powder
o OR Basins
o Prep Kits
o OR Attire
o Towels
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Conclusion
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Abstract
Hospitals continue to be challenged by rising expenses in an environment of moderate
reimbursements. Health care costs have increasingly come under scrutiny and, with the advent of
health care reform, will continue to be scrutinized. Perioperative nurses play a key role in
evaluating product safety, effectiveness and efficiency, environmental concerns, and cost and
how these factors affect patient care. Cost-saving opportunities that a hospital product evaluation
committee can consider include choosing less expensive but equivalent supplies, comparing the
expenses associated with disposable versus reusable products, limiting the use of custom
supplies, determining ways to reduce linen use, and changing practices to eliminate products that
are found to have little clinical value. Adopting effective product evaluation and purchasing
practices can lead to reduced costs without affecting the quality of patient care.
Key words: health care cost, health care reform, cost reduction, perioperative cost control
The need to reform health care, provide equal access, and reduce costs is currently a prominent
political topic. At a press conference on June 23, 2009, President Obama stated,
When it comes to health care, the status quo is unsustainable and unacceptable. So reform is not
a luxury. It's a necessity, and I hope the Congress will continue to make significant progress on
this issue in the weeks ahead.1(p2) if we start from the premise that the status quo is
unacceptable, then that means we're going to have to bring about some serious changes our
top priority has to be to control costs.1(p5)
Although there was considerable debate in Congress over various health care reform proposals,
there has been no controversy around the president's premise that health care is too expensive
and that the continued increase in health care costs is unsustainable under our present system.
President Obama has since signed a health care reform bill, and implementation is pending.
Regardless of how health care reform is implemented, RNs have a professional responsibility to
consider how cost affects the planning and delivery of patient care. Hospitals will continue to be
challenged by rising expenses in an environment of moderate reimbursements. On a daily basis,
perioperative nurses can significantly affect supply management practices by encouraging and
implementing strategies that promote a safe and healthy environment. Cost considerations have a
fundamental place in our professional performance. The strategies should be cost effective and
conserve resources.2(p535)
Many hospitals have effectively reduced the cost of medications through pharmacy and
therapeutic evaluation programs. The actions of these pharmacy programs have resulted in
standardization of medication purchases to specific vendors through the use of group
purchasing organizations (GPOs);
use of therapeutic equivalents (ie, generic medications);
management of medication dispensing through the use of unit doses; and
reduction of costs through practice changes (eg, review of antibiotic usage, standardization of
medication protocols).3
Pharmacy practice evaluation groups make their decisions based on research data and published
recommendations. In my experience as a consultant, however, purchasing committees have been
less successful in reducing costs related to medical-surgical supplies. It is important for nurses on
product evaluation committees to exercise the same level of professionalism as their pharmacy
colleagues when considering the selection of supplies. The pharmacy evaluation processes can
provide an effective model on which to base medical-surgical supply evaluation, selection, and
implementation activities.
Back to Article Outline
Evaluating Implants
Members of a physician-based technology committee should evaluate all implants before they
are ordered for the hospital to determine whether one type or certain types can be used that are
more cost-effective. For example, several brands of total joint prostheses may be stocked for use
in the OR without any consideration for the cost, function, and level of use. Varying types of
catheters in the cardiac catheterization laboratory are often stocked as well when perhaps one or
two types would work quite well.
Quantity
Item description
Obstetrical pack
1
Placenta basin
1
Receiving blanket
1
Umbilical cord clamp
Drapes
1 each
abdominal cover, back table cover, reinforced under-buttocks drape
Dressings
2
perineal pads
1
vaginal packing sponge
1
Impervious reinforced obstetrical gown with one hand towel
10
X-ray detectable sponges
1
Impervious, reinforced gowns
1
Absorbent towel
Quantity
Item description
2
Leggings
1
20-oz bulb syringe
Standard arthroscopy pack
1
6-inch elastic bandage
1 each
#11 and #15 knife blades
2
32-oz bowls
2
2-oz medicine cups
2 each
7-quart containers and emesis basins
1
Specimen container
Drapes
1 each
half sheet, extremity drape, U-drape
1
impervious stockinette, extra large
1
reinforced back table cover
1
reinforced Mayo stand cover
2
large reinforced gowns
1
extra large, extra long impervious specialty gown
10
X-ray detectable sponges
1
Absorbent disposable towel
3
Cloth towels
1
12-ft nonconductive suction tubing
Table 2. Examples of Laparotomy Packs
1
4
1
1
1
1
1
4
1
1
1
7
Most hospital's linen vendors can supply, free of charge, a review of linen use report.
Perioperative personnel should analyze this report to identify where opportunities exist for
reduced linen use. This review can be undertaken by RNs who are also able to help the hospital
determine reasonable targets for reducing linen use based on the hospital's geography and other
variables.
Back to Article Outline
Practice Changes
All products used in the hospital should be assessed for the clinical value they provide to patients
and whether there is evidence to support their use. If there is no added value or clinical reason to
justify their use, they should be eliminated.
Talcum Powder
Talcum powder, for example, has been eliminated from use in the newborn nursery. In the past,
it was common to use talcum powder to protect a baby's skin and absorb excess moisture.
Physicians no longer recommend this, however. Inhaled talcum powder can irritate a baby's
lungs.6 Unfortunately, talcum powder is still being used on adult patients, especially those who
are elderly, obese, or confined to bed. Talcum powder poses a similar respiratory risk to those
patients without providing any clinical benefit. Nurses specializing in skin care can offer
individual patient assessment and better solutions to managing the skin concerns of these
patients.
OR Basins
Basins that are used during surgical or invasive procedures to organize nonliquids should be
considered for elimination. Only basins needed for liquids should be used. This could
significantly reduce the number of basins purchased and/or reprocessed.
Prep Kits
The long-standing practice of shaving surgical or invasive procedure sites has been eliminated
because of its connection to surgical site infections (SSIs). The Centers for Disease Control and
Prevention in its Guidelines for the prevention of surgical site infection states,
Preoperative shaving of the surgical site the night before an operation is associated with a
significantly higher SSI risk than either the use of depilatory agents or no hair removal Other
studies showed that preoperative hair removal by any means was associated with increased SSI
rates and suggested that no hair be removed.7(p257)
Thus, eliminating preoperative shave kits and razors for surgical preps is an excellent cost-saving
tactic.
OR Attire
Many items of OR clothing have undergone scrutiny in regard to their use in infection control.
For example, AORN states that the use of cover apparel should be determined by the individual
practice setting. The value of cover apparel worn in the institution is unsubstantiated. The use of
cover apparel has been found to have little or no affect on reducing contamination.8(p68) The
practice of wearing a cover gown outside the OR should be evaluated and eliminated if this will
reduce costs and does not affect patient safety.
Perioperative Product Selection Guidelines1
Evaluating products for use in the perioperative setting requires input from all stakeholders and
is best handled by a committee chosen for this purpose. Committee members should be
representative of personnel from the surgical services, anesthesia, nursing, and central processing
departments. Committee members from outside the perioperative department may include, but
are not limited to, personnel from the infection control, administration, pharmacy, biomedical
engineering, radiology, laboratory, and risk management departments.
Committee members should evaluate all products proposed for use in the OR for safety, function,
and cost-effectiveness. Members of the team may be required to participate in or initiate clinical
evaluation of proposed products or devices. When evaluating products or devices, committee
members must assess ease of use, processing, and sterilization. It is important to ensure that
proposed products are compatible with the ability of facility personnel to comply with product or
device requirements for use or processing. Proposed products should be compatible with existing
equipment and supplies, have a positive effect on patient care, and be under regulatory control.
Products selected for use should be evaluated for liability issues. Clinical evaluations of certain
products may be needed to ascertain their appropriateness for use in the individual facility. To
facilitate this process, management personnel should write appropriate policies and procedures,
review them at specified intervals, and make them available to staff members and members of
the committee.
Eliminating the traditional skull-type surgeon caps is an effective cost-reduction strategy. These
caps usually do not adequately cover the hair or prevent shedding of hair or skin cells,8 the sole
reason for wearing a head covering, and they have a higher cost. Standardizing hair covers to
bouffant caps, or hoods for staff members with facial hair, provides better hair coverage, is more
effective for infection prevention, and reduces cost.
Towels
In the OR, woven cotton towels are commonly used during surgical procedures. This type of
towel has a very loose weave; it readily absorbs liquids and wicks moisture. It is not an effective
barrier, however, and should not be used for patient draping in surgical or invasive procedures.
There are nonwoven, synthetic towels that provide a superior barrier at a lower cost.9, 10, 11 It
generally is less expensive to use a nonwoven, heavy-duty back table cover than to use cotton
towels for padding on the back table. A nurse practice committee should review the use of these
towels and set a goal to eliminate them from the practice setting.
Back to Article Outline
Conclusion
Significant savings are available to most hospitals when ordering practices and patient care
practices are evaluated and amended. It is in the best interest of employees and patients that these
reviews be conducted on a regular basis. Depending on the size of the hospital, these savings
could reach millions of dollars. When done carefully and with patient care as a driving focus,
scarce health care money that is saved can be better spent.
Back to Article Outline
2.Supplies from vendors outside of the group purchasing organization are often used in the
hospital because
1.members of specialty departments may do their own purchasing.
2.supplies used in specialty departments are not generic to other units in the hospital.
3.ordering supplies outside of the group purchasing organization can result in significant cost
savings.
4.some of the items used specialty departments are nonstock items. a. 1 and 3 b. 2 and 4 c. 1, 2,
and 4 d. 1, 2, 3, and 4
3.When evaluating the cost of using reusable versus disposable products, personnel in charge of
ordering supplies must perform periodic cost analyses because
1.the costs of products change as new products are developed.
2.pricing practices change.
3.the cost of disposal increases.
4.Items included in a custom pack are often priced higher than the same items when purchased
separately. a. true b. false
5.Using bath blankets and pillows to position patients in the OR is a safe and inexpensive
alternative to using commercially available positioning aides. a. true b. false
6.To reduce costs associated with linen use
1.only disposable linen should be used.
2.linen should be assigned to each patient.
3.linen should not be brought into the OR unless it is needed.
4.gowns with sufficient front and back coverage should be used to eliminate the use of a second
gown as a cover gown.
5.personnel should analyze the review of linen use report available from the hospital's linen
vendor. a. 1, 2, and 3 b. 3, 4, and 5 c. 1, 2, 3, and 4 d. 1, 2, 3, 4, and 5
7.Eliminating preoperative shave kits and razors for surgical preps is an excellent cost-saving
tactic. a. true b. false
8.The wearing of _________________________ is not supported by evidence and should be
eliminated if it reduces costs and does not affect care.
a.disposable hair covers
b.long-sleeved warm-up jackets
c.shoe covers that ground electricity
d.cover gowns outside the OR
2.function.
3.cost-effectiveness.
4.ease of use. a. 1 and 2 b. 3 and 4 c. 1, 2, and 4 d. 1, 2, 3, and 4
The behavioral objectives and examination for this program were prepared by Helen Starbuck
Pashley, MA, RN, CNOR, clinical editor, with consultation from Susan Bakewell, MS, RN-BC,
director, Center for Perioperative Education. Ms Pashley and Ms Bakewell have no declared
affiliations that could be perceived as potential conflicts of interest in publishing this article.
Back to Article Outline
4.To what extent did this article increase your knowledge of the subject matter? Low 1. 2. 3. 4. 5.
High
5.To what extent were your individual objectives met? Low 1. 2. 3. 4. 5. High
6.Will you be able to use the information from this article in your work setting? 1. Yes 2. No
7.Will you change your practice as a result of reading this article? (If yes, answer question #7A.
If no, answer question #7B.)
7A.How will you change your practice? (Select all that apply)
1.I will provide education to my team regarding why change is needed.
2.I will work with management to change/implement a policy and procedure.
3.I will plan an informational meeting with physicians to seek their input and acceptance of the
need for change.
4.I will implement change and evaluate the effect of the change at regular intervals until the
change is incorporated as best practice.
5.Other: _____________________________
7B.If you will not change your practice as a result of reading this article, why? (Select all that
apply)
1.The content of the article is not relevant to my practice.
2.I do not have enough time to teach others about the purpose of the needed change.
3.I do not have management support to make a change.
4.Other: _____________________________
8.Our accrediting body requires that we verify the time you needed to complete the 1.6
continuing education contact hour (96-minute) program: ___________
This program meets criteria for CNOR and CRNFA recertification, as well as other continuing
education requirements.
AORN is accredited as a provider of continuing nursing education by the American Nurses
Credentialing Center's Commission on Accreditation.
AORN recognizes these activities as continuing education for registered nurses. This recognition
does not imply that AORN or the American Nurses Credentialing Center approves or endorses
products mentioned in the activity.
AORN is provider-approved by the California Board of Registered Nursing, Provider Number
CEP 13019. Check with your state board of nursing for acceptance of this activity for
relicensure.
Event: #10506; Session: #4053 Fee: Members $8, Nonmembers $16
References
1. President Obama's press briefing. The New York Times. June 23,
2009;http://www.nytimes.com/2009/06/23/us/politics/23text-obama.htm?
pagewanted=1&_r=1Accessed June 28, 2010
o View In Article
4. AORN guidance statement: Reuse of single-use devices. In: Perioperative Standards and
Recommended Practices. Denver, CO: AORN, Inc:649-655.
o View In Article
5. Phillips GP. Linen use in an era of managed care. Health Facilities Manage.
December 1,
1996;http://www.hfmmagazine.com/hfmmagazine_app/jsp/articledisplay.jsp?
dcrpath=AHA/NewsStory_Article/data/HFMMAGAZINE356&domain=HFMMAGAZI
NEAccessed July 28, 2010
o View In Article
7. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention
of surgical site infection, 1999 (Hospital Infection Control Practices Advisory
Committee). Infect Control Hosp Epidemiol. 1999;20(4):250
278http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/SSI.pdfAccessed June 29, 2010
o View In Article
o CrossRef
10. Belkin NL. The new barrier standardwhose interests does it serve?. AORN J.
2004;80(4):647651
o View In Article
o Full Text
o Full-Text PDF (435 KB)
o CrossRef
12. Recommended practices for product selection in the perioperative practice setting.
In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc;
2010;p. 189192
o View In Article
Janice Hoeksema, RN, BS, MA, was the director of the Perioperative Department at Spectrum
Bodgett Memorial Medical Center, Grand Rapids, MI, and worked as a sales representative and a
senior consultant in cost reduction/supply chain management for Cardinal Health, Dublin, OH,
before retiring. Ms Hoeksema has no declared affiliation that could be perceived as posing a
potential conflict of interest in the publication of this article.
indicates that continuing education contact hours are available for this activity. Earn the
contact hours by reading this article, reviewing the purpose/goal and objectives, and completing
the online Examination and Learner Evaluation at http://www.aorn.org/CE. The contact hours
for this article expire December 31, 2013.
PII: S0001-2092(10)01056-2
doi:10.1016/j.aorn.2010.04.020
2010 AORN, Inc. Published by Elsevier Inc. All rights reserved.