Peri-op 32-bed nursing unit uses LEAN to control costs of dressing supplies given at time of patient discharge. We increased RN satisfaction AND saved our unit money!

1. Operational Excellence Certification
A Cost Reduction
Process
Dressing Supplies at
Discharge:

2. • Home Team
– Morgan Cameron, BSN, RN
– Megan Dobbs, BSN, RN
– Melanie Scattone, BSN, RN, CMSRN Team Leader
• Project Sponsor
– Rose Whitney, BSN, RN, CNML
• 7 West Clinical Manager
• LEAN Support
– Kristen Wu MSN, NP-C
• Kaizen Coach

3. Reason for Action
• The current distribution of dressing supplies to
patients at discharge is wasteful, mindless, and
excessive.
• This results in significant cost to the institution. We
cannot charge patients for supplies given at
discharge, therefore we are incurring costs without a
methods to control the loss.
• Secondly, only 33% RNs are satisfied with the current
discharge supply method.
• In scope: 7 West Dressing supplies at discharge
• Out of scope: Night shift, reusable linens, personal
care supplies, ostomy supplies, Foley supplies

4. Current State
0
1
15
6
2
0
2
4
6
8
10
12
14
16
Very unsatisfied Dissatisfied Neutral Satisfied Very Satisfied
NursesSurveyed
Initial Nurse Satisfaction
67% of nurses dissatisfied or neutral
4.2% 63% 25.2% 8.4%

5. Current State
2
7
5
4
1
5
0
1
2
3
4
5
6
7
8
1-2min 3-4min 5-6min 7-8min 9-10min >10min
Initial Supply Collection Time
Avg: 6.1 minutes/patient

6. Current State
0
4
7
3
2
0
4
0 0
2
0 0 0
2
0
0
1
2
3
4
5
6
7
8
1 2 3 4 5 6 7 8 9 10 11 12 13 14 >14
# of Days of Dressing Supplies Sent Home for JP Drain
Avg: 5 days of dressing supplies per discharge

7. Current State
0
5
4
2
4
0
3
1
0
3
0 0 0
2
0
0
1
2
3
4
5
6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 >14
# of Days of Dressing Supplies Sent Home for Abdominal Wound
Avg: 6 days of dressing supplies per discharge

8. Current State
0
3 3
4 4
0
3
2
0
3
0 0 0
2
0
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 >14
# of Days of Dressing Supplies Sent Home for Wet to Dry Dressing
Avg: 6 days of dressing supplies per discharge

9. Current State
Based on initial survey, known supply cost, and average number
of discharged patients per week:
Per Patient:
$4.27
Per Week:
$284.67
Per Year:
$14,802.84

10. Target State
Reduce average RN time spent collecting supplies for
patient discharge
6.1min → 2 min
Reduce wasted supply in discharge dressing supplies
$4.27/pt → $2/pt
Improve staff satisfaction with discharge supply collection
process
33% → 66%

11. Gap Analysis
GAP ROOT CAUSE
Excessive distribution of supplies at
discharge
Lack of standardization of supplies given
at discharge
Excessive RN time spent through multiple
trips to gather supplies, multiple supply
locations
Lack of standardization of discharge
dressing supplies, Supplies scattered
around the JIT room
Concern patient’s will not have adequate
number of dressing supplies at home
No method/service in place for getting
supplies after discharge, other than
outpatient pharmacy

12. Solution Approach
CAUSE COUNTERMEASURE
Lack of standardization If we create a standard pre-made dressing kit for
discharge, then we reduce the amount of time spent
on collecting supplies for discharge and improve RN
satisfaction with the process.
Lack of post-discharge dressing
supply source, excluding
expensive outpatient
pharmacy
If we provide patients with medical supply company
information so that supplies can be delivered to
their home one day post-discharge and billable
through their insurance then we reduce supply loss
at discharge (ie: 14 days worth of dressing supplies)

13. Experiments
• Staff Communication Plan – promoting staff
buy-in
• Email blasts
• Flyers
• Shift huddles
• Management and Leadership support
• Pre-made Dressing Kits
• Medical Supply Sources
• 3 supply company order
forms, in dressing kits
• Order assistance provided
by discharging RN

14. Actions Taken
Staff Communication Plan:
After two attempted Go-Lives with poor staff participation, a revised Go-Live launched
with the outlined communication plan on 7/25/2016 and ran for two weeks
Pre-Made Dressing Kits:
Took the place of the old “shopping” method used for discharge supply process. Kits
were distributed by discharge RN as needed to meet patient need for 24 hours.
Medical Supply Sources:
To meet the supply need 24 hours after discharge, supply company information and
ordering assistance is provided by discharging RN. When ordered at discharge, supplies
will arrive at patient’s home within 24 hours of orders; this process eliminates the need
for multiple days of dressing supplies previously given out of unit supply.

15. Results
0
2
4
6
8
10
12
Very Dissatisfied Dissatisfied Neurtal Satisfied Very Satisfied
NursesSurveryed
Post-LEAN Nurse Satisfaction
Adv: 73% of nurses satisfied or very satisfied with new
process

16. Results
0
1
2
3
4
5
6
7
8
9
1-2 min 3-4 min 5-6 min 7-8 min 9-10 min > 10 min
NursesSurveyed
Post-LEAN Supply Collection Time
Adv: Time gathering supplies 2.6 minutes, a 3.5 minute
improvement

17. Results
Based on post-LEAN survey, known supply cost, and average
number of discharged patients per week:
Per Patient:
$2.47
• Saved $1.80 per patient discharged
Per Week:
$164.67
• Saved $120.00 per week
Per Year:
$8,562.77
• Saved $6,240.07 annually

18. Results
• Increased nurse satisfaction with dressing discharge process 40%
• Exceeded Target State goal of total nurse satisfaction
• Decreased time spent collecting supplies by 3.5 minutes per patient
• Saved $6,240.07 from 7 West annual supply budget

19. Insights
Positives
• Understanding of LEAN process
• Leadership and Process development experience
• Standardization makes data more accurate to project
• Coworkers like the written instructions provided with the dressing kits. Made
dressing teaching easier for patients to understand.
• We already were using premade kits, coworkers liked that we included more
frequently used kits. Especially the wet-to-dry and non-mastectomy JP kits.
• Staff satisfaction is related to how much perceived work is added
• Less work = higher satisfaction

20. Insights
Difficulties & Changes Needed
• Staff buy-in early in the process by involving the nay-sayers
• Post-LEAN survey participant pool smaller due to trial time limitations
• Medical supply company order process streamlined to speed discharge
• Coworkers expressed they wanted to send patients home with more than 1 days
worth of supplies.
• To give patients adequate time to purchase needed supplies.
• In case of increased drainage, they would have supplies on hand.
• Revisions of this project should include alterations in kit contents:
• More JP cups for drain dressing kits
• No Xeroform needed in dry dressing kits
• Dry dressing kits were too variable for our patient population.