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Fine-Tune Your Medication Inventory
Working closely with distributors will help standardize and streamline your supplies.
Paul Santoro
Publish Date: April 10, 2011   |  Tags:   Anesthesia

When it comes to effectively managing your center's medication stock, you need to know which drugs work the best, at the best cost. Do your distributors value your business enough to assist you in making that determination? Find out by asking them for answers to these 6 important questions.

1. Can they helpstreamline your inventory?
There are some drugs that your facility must have on hand even though they're rarely — or, with any luck, never — used. Dantrium is a classic example of this type of sunk cost: Safety regulations require the purchase and periodic replacement of 36 vials of the drug to ensure preparedness for an incident of malignant hyperthermia.

Outside of such rescue situation essentials, though, are all of the drugs you buy absolutely necessary? Could you make your supply budget leaner and more cost-effective? Consider what types of cases your facility tends to host and what treatment situations your patients most often face. How many different anti-emetics do you need, for instance? While an acute care hospital may require 3 or more different non-depolarizing muscle relaxants, with short, intermediate and long durations, it's entirely possible that most ASCs won't need much more than the short duration's 30 minutes of effectiveness.

The aim of standardizing your medication inventory is to limit the amount of cash you're keeping on your storage room shelves and freeing some of it up for wiser use elsewhere. The most effective starting point for standardization is narrowing the number of products you stock in any given class of drug. You don't want to undertake this sort of effort unilaterally. Seek the input of the clinicians who administer the drugs, keeping in mind that this consolidation should not be based on personal preference, but on clinical effectiveness and cost.

Anesthesia providers in particular should be familiar with research on the efficacy of drugs and should be able to review the literature to make these evidence-based decisions. Your drug distributors should also be willing to help with your efforts and supply you with or point you toward a wealth of research on the medications you're reviewing.

2. Can they arrange drug trials?
You might also consider conducting your own quality assurance studies in-house. Work with your distributors to arrange a drug trial, and work with your clinical staff to define and measure the criteria by which the drug would be considered effective: pain control, discharge time, reported patient satisfaction and the like.

3. Will they find more affordable options?
Balance the clinical outcomes of your QI studies for each drug against their cost per use. Ideally, a drug should cover all the needed bases and provide optimal outcomes with economy. If a drug's performance is lacking, it goes without saying that the money it may be saving you is irrelevant. If, however, you find that 2 drugs have equal efficacies, it's likely that you can safely opt for the less expensive one. Once you've determined which drugs will remain on your shelves and on your purchase orders, consult with your distributor for the most affordable options and re-negotiate on the prices for the increased volume you'll be buying. Consolidating your medication inventory by establishing evidence-based practices not only streamlines your budget and reduces the risk that unused or expired products will end up wasted, it also has a patient satisfaction benefit in that you'll have a greater certainty that the drugs you're using are by and large effective for treatment.

4. Do they provide automated solutions?
The inventory tracking systems that some distributors offer their customers at low or no cost or through leasing arrangements can help to facilitate the regular reporting of drug utilization and costs. They employ a handheld bar-code scanning device with which staff members record the shelving and pulling of drugs and other supplies.

The software that collects these transactions can link to your facility's practice management or business operations software to track purchasing and usage, as well as to compile the information for reporting to staff. It can also set and enforce par levels to reduce the amount of inventory you're holding and automatically generate purchase orders when an item's stock reaches a set minimum. By ensuring that enough drugs will be on hand at all times, without fear of shortfalls (one of anesthesia providers' greatest fears), it can prevent staff hoarding and over-ordering.

5. Can they help you avoid shortages?
Over the last couple of years we've experienced an increasing number of medication shortages industry-wide: propofol, thiopental, ephedrine, succinylcholine and fentanyl among them. When consulting with your distributors, regularly inquire for details not only on a drug's availability and turnaround time, but also on whether practical alternatives exist and can be secured.

6. Do they provide value-added services?
You might not routinely report drug costs to the clinicians who administer them. It's understandable, but less than efficient. While you or your center's physician-owners probably stay on top of case-cost details, this information is not usually shared with anesthesia providers, who, being paid for their services independently, may not readily involve themselves in budgetary issues. And while they likely have a clear view of drug utilization, they may not have any idea what the drugs they're using cost.

Anesthesia providers can't offer much in the way of assistance to purchasing negotiations (you have stronger relationships and more buying power with distributors), and their strength tends to be in patient care, not materials management. But that doesn't mean they shouldn't be aware of drug costs. The medications they administer ultimately play a role in your facility's profitability, and if they can see their impact on the costs, they'll be more able to adjust their practices for greater cost efficiency.

Some distributors offer consulting services to assist in inventory management. Their representatives, having visited many facilities, understand the clinical issues they face and can direct their logistical logic toward efficient supply use and reducing waste in your center. While clearly it's not in their interest to advise you to buy less, building relationships with customers that can assist them in the optimal use of their products is nonetheless important.

Don't hesitate to get your distributor to compete for your business if there's the possibility of scoring a better deal with another. Send out your purchasing list to other distributors without telling them what you're presently paying and ask them for their best price. You might have compelling evidence to switch distributors or re-negotiate with your current one.

All for one
Keeping tabs on which medications have been bought and stocked can be overwhelming. But reaching out to your facility's medication suppliers, and to your physicians and anesthesia providers, and even making the connection between them, will ensure you're making the most of your medication inventory.