Looking to stop surgical supplies from walking out your door? Here's how we at Cypress Orthopedic Center in Houston have reduced supply loss by 20 percent.

1 Open your eyes. If you let Suzy take an item home, another staffer might see her take the item and, without knowing Suzy had permission, think she may also take items. Make it clear that no one takes supplies for any reason.

Look at physician preference cards and compare them to case records. You may see the preference cards call for supplies different than those actually used and that some items were thrown out or taken.

When we started trying to reduce supply loss, we found we needed to educate staff about disposables and re-usables, especially agency staffers. We also took digital photos of every surgical set and posted them so the instrument tech knows what goes in a set; when a surgeon needs one item, the photo provides easy reference. We're now cataloguing digital photos of our supplies so physicians can identify items they need from other surgical sets. This way, we can keep the item separate from the set so it's available when needed.

2 Involve physicians. Enlist your surgeons in reducing supply loss, because they're the primary consumers of supplies. It's very easy for a surgeon to slip a few packets of expensive sutures into his pocket for use at another surgical site (this happened to me) or simply walk off with some scrubs. If the surgeon isn't actually pilfering, he might simply be consuming supplies inefficiently. Don't be afraid to ask, "Why do you use five syringes?" or, "Why do you use this kind of suture?" Sometimes a doctor has a contract with a vendor and may promote or use products inappropriately, and you may be charged more for such products. We review all physician orders pre-, post- and intraoperatively and keep a log for items used that didn't appear on the pre-op order. If it's justified, we'll adjust the order in the future.

3 Take inventory monthly. This is the best step we've taken. We do inventory monthly, and everyone participates. Here's how we organize it. Select six to eight people on a rotating basis each month. These inventory team members will either work inventory on a light day or on the weekend. In a slow month, taking inventory may fill out their 40 hours; in a busy month it may be extra - but everyone is paid for his time. The group splits the work and each usually inventories a department other than her own, which helps keep the counts accurate. The side benefit is that our entire staff learns where everything is kept. Inventory takes about two hours and costs about $200 in staff time - but we decrease supply loss by more than that.

4 A no-nonsense policy. We have a no-nonsense policy that dictates immediate termination. We have terminated an employee for pilfering, but elected not to press legal charges (your center usually has little to gain by doing so). In this case, a manager saw a staffer stealing supplies. When confronted, the staff member denied it, but we felt we were on solid ground. Our actions were justified in the subsequent months when our supply cost decreased by 40 percent. We had known we were experiencing supply loss - but not to that extent. A note if you subcontract: Learn your payroll company's or staffing agency's policy on stealing, because it will be liable if its employee pilfers from your center.

5 Sense of ownership. If you foster a sense of ownership, employees will feel invested in the center's success. Our staffers are interested in cutting or containing costs because we've made it clear that if their suggestions save money without affecting quality of care, those savings will come back to them. Promote and reinforce a positive relationship with surgeons, too.

In the end, patients pay
When you stop to think about how many groups of people have unfettered access to your surgical supplies - physicians, manufacturers' reps, subcontracted employees, staff and patients - it's little wonder that supply loss is a problem that plagues many surgical facilities. The bottom line is that the patient pays the price for supplies and supply loss. It's our job to keep this price to an absolute minimum.