Part way to Lean in the SICU

Here is an in-progress report from Jean Campbell, nurse manager of our surgical intensive care unit, to all of the people in those units on the status of her Lean team's rapid improvement event in the SICU supply rooms.

Hi Team,

As you could see, there was a lot of activity in the clean supply room this week. The Lean team from the President’s Office, Distribution plus Anna (PCS), Sabrina (Health Care Quality), Martha (11 Riesman), Tim (MICU), (Fin4), and Kristin Russell worked with the SICU team to redesign the clean supply room for better flow.

We received training on key Lean principles and Smart Placement which taught us that spending time searching and fetching items means less time spent on real work – time with our patients. Even when we can easily find an item, does it make sense for us to put items out of reach, i.e. too high or too low? Why not imitate the supermarkets that place frequently purchased items, like bread, at eye level!

Lean calls these non-value added steps, “waste”. We spent the week removing as much waste out of the clean supply room process as possible. A few weeks ago we counted the par stock right after it was fully stocked, then counted again the next day before it was restocked. This gave us a single day usage quantity and was used to determine the amount needed on your supply room carts (called the par number). Our aim was approximately a 3-day supply (for weekends). We realized we had more stock than we needed in some cases and not enough in other cases based on this count, so we removed all excess stock as well as added additional stock where needed.

Once we regained additional space, we organized the stock logically by function and for flow. For example, you will see we now have carts for IV/Lab/Syringes/CRRT; GI/GU/Wound Care, ADLs, Procedures, and Respiratory. We then placed the most frequently used items at eye level to reduce bending and reaching and items used together are placed together. For example, you'll find benzoin on the respiratory cart because it's used when securing ET tubes. Most items are now in bins and the bin sizes indicate the amount of stock needed. The bins have 3 labels: the “common name or AKA (also known as) label” on the front of the bin – what most of you call the item, the “picture of the item label” on the bottom of the bin to tell you when that bin is empty what belongs there, and finally the “reorder label” also on the bottom of the bin that tells you the J number, cost & the ordering amount so when you are out of an item, you have the information needed when calling distribution. On the front of the shelves are the bar codes that distribution uses to facilitate reordering.

Some examples of changes:
Procedure supplies that were formerly housed in cabinets in front of the nurses' station are now on the procedure cart (neuro on bottom shelf);
Oxygen delivery items now have pictures to clearly show which mask is in each bin so you don't have to search very long;
Wound care supplies were moved from the small carts in the middle of the unit to the supply carts. An added benefit is that it clears some of the corridor space - helping us meet CMS fire/safety guidelines;
By placing procedure supplies and wound care supplies on the carts in the back, the UCo and RN don't need to worry as much about inventory and restocking. The exceptions will be items with pink AKA labels. Those must be special ordered; they don't come from distribution;
IV Fluids with KCL have a highlighted AKA label to make it easier for you to find them;
Med rooms and kitchens have also been reorganized.

We'll be establishing a location for distribution pick-up and drop-off - more to come on this. It will be an area where distribution can place items that are special requests and we can place items that need to be returned. You'll have an alphabetical index by Friday. Names of the carts are on the wall above them, so that will help you figure out where to start looking. It's meant to be intuitive.

Please let us know if there are items that are running low; this will be especially important on the weekends. We'll be doing regular audits to help us identify items that may be over or understocked and adjusting levels accordingly.

Help us help YOU! There's a piece of paper inside the supply rooms where you can provide feedback. Please include the date and your name so we can follow up if we don't understand and to let you know what the Lean team decides re: suggestions.We're also soliciting ideas with what to do with drawers/cabinets cleared through this event. We're investigating the possibility of placing monitors on shelves and using drawers/cabinets to sort cables.

Any other brilliant ideas out there?

Sustaining the gains: Lean taught us that this is a continuous improvement process so please give us your feedback and we will continue to improve. All of us own this process and keeping the Clean Supply room neat and tidy depends on all of us.

Thanks to Anna Bratslavskaya, Barbara Buckley, Joanna Aseltine, Kelly Farren, Kristina Minahan, Marissa Kaslow, Mary Lavieri, Pat Sorge, Raysa Acosta, Ryan Erskine, Sabrina Cannistraro, Samantha Ruokis, Sophia Shoot, Sue Emerson-Nash, Suzanne Joyner, Tad Mendes, Tim Teves.