• MARCH 2008 FEATURE ARTICLES •
Supply Chain/Materials Management
Forged In Fire
A San Diego hospital benefits from automated inventory management during the 2007 wildfires.
By Kristoffer L. Stewart, Associate Editor
Southern California is renowned for the
semi-arid climate that brings it abundant sunshine and average
annual precipitation of less than 12 inches; but the long
stretches of fair skies, warm temperatures and low humidity
often come at a price. In 2007, the National Climatic Data
Center of the U.S. Department of Commerce reported that
long-term moisture deficits were subjecting much of the area to
conditions of "severe to exceptional drought." Often, the months
of late summer and early fall bring with them strong winds
called "Santa Ana" that characteristically gust through the
inland mountains and coastal valleys at near hurricane force.
This combination of wind, dryness and heat
turns the region's dense-growing evergreens and other
drought-resistant shrubs, or chaparral, into explosive fuel for
wildfires. On Oct. 19, the National Weather Service issued a Red
Flag Warning for the mountains and coastal valleys of San Diego
County, citing strong Santa Ana winds, gusting to 80 mph in some
places, very low relative humidity and warm, dry conditions. The
only ingredient missing from this recipe for disaster was an
ignition source; a vehicle fire, a carelessly tossed cigarette,
a match. The next day, the powder keg was lit.
Five separate wildfires were raging through
San Diego County (site of the two largest wildfires) by Oct. 22.
Two hospitals in the northern portion of the county were forced
to evacuate, or face the possibility that escape routes might
later be cut off. Pomerado Hospital, in Poway, began evacuating
just before 9 a.m., using school buses and ambulances to
transfer patients to several area hospitals. At 3 p.m., in the
nearby community of Fallbrook, emergency management officials
ordered the evacuation of the city's entire population,
including that of Fallbrook Hospital. Sixteen patients found
their way to Tri-City Medical Center (TCMC) in Oceanside as
thick smoke from the fires choked freeways, forcing some
Pomerado transfer patients elsewhere.
Because of a robust supply chain delivery and
materials management system, TCMC was prepared to respond to a
significant patient influx and remained operational throughout
the disaster.
Prepared, Just-In-Time
As TCMC discovered during the four days of
wildfires, having an efficient combination of inventory
tracking, disaster planning and supply chain logistics was key
to a successful response. Alan Coates, director of Supply Chain
Management at TCMC, says that previously inventory was
hand-counted. This slow, often inaccurate process would have
created a nightmare scenario during the wildfires. "With our
automated system, we receive realtime information. This supports
our "just-in-time" (JIT) approach to materials management, and
it's a better method of controlling cart levels and re-order
points," says Coates.
TCMC selected the Pyxis SupplyStation system
from Cardinal Health in 2000, as part of an overall effort to
automate materials-management processes, including medication
administration. For that particular process, TCMC uses another
Pyxis product, the MedStation. To Coates, it made sense to
standardize the automation of their materials management
processes by using the same vendor.
A key link in their supply chain, the
SupplyStation system is a secured supply storage cabinet that
uses touch-to-take technology. By touching a "take" button on
the cabinet when removing an item, usage, inventory and
replenishment information is automatically recorded and
transmitted to the hospital's materials management inventory
system (MMIS). The Pyxis system manages a network of these
secure storage stations, which are located throughout the
hospital, with a SupplyStation console that is, essentially, a
Microsoft Windows 2000 server linked to the MMIS.
Wireless technology integrates approximately 70 of the
SupplyStation units, located in 12 OR suites and on patient
floors throughout the hospital, with ValueLink, the vendor's stockless inventory-management
service. ValueLink interfaces with the MMIS and provides
automated order entry, par level replenishment, electronic
invoicing, guaranteed fill rates and 24-hour-a-day availability.
The hospital has bulk orders delivered daily and needed supplies
can be delivered several times a day from the vendor's
distribution center located 90 miles away. This channels all of
TCMC's supplies through a single integrated system that breaks
bulk quantities into immediately required units, enabling low
unit-of-measure orders to be delivered directly to individual
hospital units or other points of care.
Therefore, TCMC is constantly aware of what
materials are inbound to the hospital from the vendor's JIT
warehouse – a crucial factor of their success during the
wildfires. "The realtime reporting of the SupplyStations helped
us to monitor, analyze and maintain the supply chain," says
Coates. "Not only did we know what was being consumed every day,
but also what was coming in the next day."
By operating as a stockless
inventory-management system with their supply chain partners at
Cardinal Health, TCMC mitigates the cost of storing, maintaining
and distributing supplies. The vendor owns the inventory
contained within the SupplyStations until it is taken out (at
which point it is simultaneously recorded) and utilized at the
point of consumption. "This is a benefit to our organization
because those supplies then become an expense related to patient
care, so it becomes more of a proportional dollar expense of
consumption for that activity," says Coates.
Leave Nothing to Chance
This realtime inventory tracking was
invaluable to Coates and other TCMC staff who were tasked with
keeping the hospital supplied while eight wildfires devoured
countryside, homes and other structures throughout San Diego
County.
Craig Lawyer, TCMC's Environment of Care
officer and incident commander during the wildfire event,
ensures the hospital is prepared to respond to a mass-casualty
event even before one occurs. "What I look for when developing
disaster response plans are ways we can mitigate its impact to
our facility," says Lawyer. "Since we are a JIT
warehouse-supplied healthcare facility, I consider the Pyxis
Supply system a valuable resource to our clinicians. If they
need supplies, those materials are readily available to them and
they aren't forced to wait for the distribution process to take
effect."
"The primary objective is to develop a plan
with the vendor and identify supply chain needs," he says.
Lawyer and TCMC use what they call a "memo of understanding,"
making the vendor aware in advance, what to have on standby. In
addition, he adds, it's important to identify supplies that are
routinely consumed during mass-casualty events. These supplies
are prepurchased and staged at the vendor's JIT distribution
facility, ready to go, when hospital inventories begin to be
consumed more rapidly than normal.
Some of the supply chain routes frequently
used by the vendor had been shut down due to the nearby
wildfires. "The logistics of getting the vendor's supplies to us
needs to be preplanned as well," says Lawyer. "Including
alternate routes and airlifting, if needed." To do this, TCMC
met with all 24 San Diego County hospitals as part of their
regional disaster preparedness program, identifying core
supplies that would be utilized and shared in such an event.
During the four days of wildfires, the vendor
supported TCMC with six materials services technicians (MST)
along with a ValueLink program supervisor, to oversee every link
in the supply chain. "They played an integral role during our
planning process," says Lawyer. "They ensured that I was
provided with actionable information regarding what was being
consumed. We knew that we were running low on albuterols for the
respiratory illnesses, as well as the N95 masks," he says,
referring to the particulate respirator/surgical mask commonly
worn by clinicians. "Having that kind of robust information
flow, and knowing what's going to be available in our inventory
tomorrow, helped me to plan for the injection of a supply and
identify needs for the next day's response."
Responding to Disaster
Had the automated materials management system
not been in place during the wildfires, TCMC staff would have
had to cycle count everything by hand. Instead, materials
management personnel generated a constant stream of supply
inventory reports to identify supplies that were rapidly being
consumed. "During the wildfires, it was the N95 mask that we
needed, because we were providing those to the public as well as
to our staff," says Lawyer.
Many of the TCMC staff themselves were forced
to evacuate from their homes during the disaster. "We were
wrestling not only with the patient volume increases, but also
with our own staff's difficulties getting to the hospital
because they lived in the evacuation zones," says Coates. "One
member of our staff, who was evacuated from her home, took her
family to the QualComm Stadium evacuation shelter and then drove
another two hours back to Tri-City so she could support our
activities and response to the disaster," says Lawyer. "It
really demonstrated the caring, compassionate side that Tri-City
medical staff have towards each other, as well as towards our
community."
In addition to continuing to provide
high-quality patient care at their own facility during the
fires, TCMC sent nursing staff out to several evacuation
shelters to perform patient respiratory illness assessments. A
child day care site was set up at the hospital, at one point
caring for 72 children, as well as a pet shelter. Meals were
supplied around the clock to staff members and their families
and sleeping arrangements were also provided. Additionally, TCMC
set up surge capacity tents next to its ED, providing it with 60
additional beds to accommodate the 9 percent influx of patients
during the event. "We were able to deploy all of our assets
within about an hour of our first notification of patient
transfers," says Lawyer.
A Positive Outcome
On Nov. 6, nearly three weeks after the fires
first ignited, California declared the wildfires finally under
control. More than 6,000 firefighters had battled alongside U.S.
Armed Forces, the National Guard and firefighters from Mexico to
extinguish the rampaging blaze. Left behind in its sooty,
smoldering path was half a million-acres of destruction
stretching from Santa Barbara County to the U.S./Mexico border.
The fires had consumed more than 1,500 homes in seven counties,
killing 14 people and injuring 85 others, 61 of them
firefighters.
Although they were powerless to stop the raging wildfires,
Coates and Lawyer, along with the entire staff of TCMC, had been
prepared to respond. Being aware of the materials they needed
and having those ready at a moment's notice, enabled them to
make the crucial difference.