Financial Management: Taming a Tangled Suture Inventory

There were boxes of suture hiding everywhere at AdventHealth Surgery Center Lenexa (Kan.), some opened and some outdated, some stored on the big suture cart and some stored on smaller suture carts, enough suture to stitch a thousand incisions and to sink a supply room budget.

"We had multiple open boxes of the same suture stored on 4 suture carts in multiple locations," says Valerie Heckmaster, MBA, BSN, RN, CNOR, the charge nurse who won the OR Excellence Award for Financial Management for taming the overstocked suture situation at her 4-OR facility.

When suture expired, as it often would, staff would remove and discard an average of 15-20 boxes at a time — some expired boxes were still sealed, says Ms. Heckmaster, adding that the vicious cycle would repeat itself when materials management automatically reordered the expired suture without investigating whether the ASC's 18 surgeons were still using that particular suture, or if there were more boxes already in stock.

The ASC was routinely stocking 145 different types of suture. Ms. Heckmaster set out to untangle the suture mess by decreasing suture inventory to a more reasonable and realistic level, storing all suture on one suture cart in one location, establishing a PAR (Periodic Automatic Replenishment) level inventory system based on usage levels and educating staff on first-in, first-out (FIFO).

The first step was evaluating the suture inventory. Ms. Heckmaster created a master suture list that itemized all the types of suture in stock, the names of the surgeons who used each type of suture and what the PAR levels should be. She referenced surgeon preference cards to determine what suture the surgeons used on each case.

"Suture not found on any preference cards was automatically removed from our stock," says Ms. Heckmaster, adding that they consolidated multiple types of the same suture into one and then updated the preference cards to reflect the change.

They removed 27 types of suture from the 145 that they stocked, an 18% reduction, but that was just the tip of the iceberg because there were multiple boxes of each of the 145 different suture types in the inventory, ranging from 2-6 boxes each, says Ms. Heckmaster. To recover some of the financial loss, AdventHealth Surgery Center Lenexa returned for credit any recently purchased unopened boxes. They sold or exchanged within its hospital system any unopened suture boxes they couldn't return. With multiple boxes of the same suture already opened, they labeled the boxes in order, based on expiration date, to notify staff from which boxes to pull.

"This prevented staff from pulling the same suture from multiple open boxes," says Ms. Heckmaster. "To further reinforce which boxes to use up first, we turned the other boxes around, so the opening was not facing the front."

Ms. Heckmaster didn't stop there. She knew staff would give materials management the empty suture box to indicate the need to reorder, so she wrote "DNO" (Do Not Order) on selected boxes to prevent the facility from reordering them. "We instructed staff to only open a new suture box once one became empty," she says.

It took months of painstaking work, but AdventHealth Surgery Center Lenexa is now home to an organized system with all 118 types of suture in the department located on a single suture cart in a single location. Suture is designated a PAR level to prevent over-ordering, and only 1 box of each suture is opened at a time.

"Not only did the solution to the suture management issue result in decreased cost and waste," says Ms. Heckmaster, "but also it increased staff satisfaction because, says everyone can easily find what they need." OSM