Figuring accurate monthly orders for anesthesia supplies can be as tricky as measuring a dose of anesthetic. In both cases, too much or too little can be a waste and may even jeopardize patient safety. With the help of daily checklists and constant reporting of supply and anesthetic agent levels, you can titrate your ordering to levels that will save money without compromising safety.

Identify trends
Exactly how you collect supply data depends on the size of your facility. Larger institutions often have computer systems to track supplies, while smaller ASCs may rely on pen-and-paper record keeping. Regardless of the means you use to reach an accurate supply count, ensure the entire staff takes ownership in the process.

A practical way to keep track of the supplies you use is to create a list of the items your anesthesia providers go through each month. Compiling this information may sound like a daunting task given the number of supplies needed during a typical case, but it's easily obtained by assigning tasks to staff that coincide with daily responsibilities.

Anesthesia providers can pitch in during their morning check of pre-op holding areas and anesthesia carts by recording supplies used during the previous day's cases. They can assess the supplies you have on supply room shelves and notify you if they notice depleted numbers when picking replacements for each day's cases.

To find out what you use in the OR for each case, start by making checklists of all the anesthesia supplies that you store (see "The Supply Essentials" on page 10). The anesthesia providers can put a check by each device they use, or a circle around the check if they use two of a particular item. To save time, you can design these checklists to record a week's worth of information.

After a month of collecting checklists following each case, you should have enough information to compile a list of supplies you used during that period. You may want to repeat the process month after month until you have a year's worth of data. Many surgery centers experience ebbs and flows in case volumes. The collection of checklists will help identify your busy ' and not-so-busy ' seasons and let you prepare for the series of months that require a larger supply cycle order.

These counts will also provide an idea of your anesthesia team's supply preferences, letting you focus on devices and drugs that will be used consistently instead of wasting valuable dollars and storage space on rarely opened items. Another benefit of using the checklist system: it provides a precise record of the devices, supplies and drugs used for each case, a document that can be reviewed by coding personnel and added to your paper trail for accurate and fast reimbursements.

Knowing how many supplies you use will make your ordering more accurate. But instead of ordering what your staff uses, consider stocking about 25 percent more of each item, whether that means holding a dozen spare devices or another week's worth of medications. Getting caught short is cause for concern with any supply, but the stakes are that much higher when anesthesia tools and drugs are involved.

It's possible that you may have some overstocking issues the first few times you try this technique because of inaccuracies in supply-level assessments. You can always roll extra supplies into the following month's needs. Over time you'll develop a better understanding of your facility's consumption and the supply levels you need to maintain.

Safety first, price second
The exact supplies you order will evolve from your case mix. If your surgeons perform many orthopedic procedures, for example, you'll need to have adequate amounts of block needles readily available. Facilities that specialize in cataracts will go through more sedating and topical anesthesia agents.

Cost-conscious facility managers may want to develop computer models of the supplies they need and look for ways to cut expenses. For administrators who don't have the training to determine the difference between essential and unessential supplies, it helps to have the chief CRNA or medical director review the checklists. They'll be able to spot high dosages, redundant supplies or anesthetics that could be replaced by less expensive agents.

Whether you have a CRNA, an anesthesia tech or a nurse with some anesthesia education placing the orders, it's best to have one person handling all supply matters. This will avoid duplicate ordering and make one person accountable with information and answers for solving supply issues that inevitably arise.

The person in charge of ordering supplies should stay in constant communication with each supply distributor and maintain an easily accessible list of the distributor's contact information. Unforeseen dilemmas are commonplace and the supply manager should know who to contact when cases are cancelled or last-minute additions to orders are needed. When things go wrong, a solid relationship with those responsible for getting supplies to your facility will get problems resolved quickly.

Keep an open mind to meeting with the representatives of manufacturers who come to your facility bearing free samples. Don't be afraid to use the devices and medications they dole out to make your existing supplies last a little longer. Besides, you may discover more cost-effective products that staff and anesthesia providers prefer.

While your first priority should be ensuring there are always anesthesia drugs and devices on-hand, be on the lookout for better deals.