University of Michigan Health SystemProgram and Operations Analysis

Northville Health Center Exam Room Supply Standardization

Final Report

To: Ms. Nicole Kirkman, Facilities Coordinator, Ambulatory Care ServicesMs. Amy Christenson, Senior Project Manager, Ambulatory Care ServicesMs. Sheri Chisholm, Industrial Engineer Lead, Program and Operations AnalysisMr. Andrew Sweeney, Management Engineering Fellow, Materiel ServicesDr. Mark Van Oyen, Professor, Industrial & Operations Engineering

From: IOE 481 Team 3–ExamRm

Patrick HooperTroy SnellerZhao Wang

Date: December 10, 2013

Table of Contents

Executive Summary.........................................................................................................................1Background..................................................................................................................................1Methodology................................................................................................................................2Findings.......................................................................................................................................2Conclusions..................................................................................................................................3Recommendations........................................................................................................................3

Introduction......................................................................................................................................4Background......................................................................................................................................4

Key Issues....................................................................................................................................5Goals and Objectives...................................................................................................................5Project Scope...............................................................................................................................5

Methodology....................................................................................................................................6Data Collection............................................................................................................................6

Literature Search......................................................................................................................6Historical Data.........................................................................................................................7Observation..............................................................................................................................7Informal Interviews.................................................................................................................7

Data Refining and Analysis.........................................................................................................7Historical Data.........................................................................................................................8Observation..............................................................................................................................8Informal Interviews.................................................................................................................8

Findings...........................................................................................................................................8Supplies........................................................................................................................................8

Adult: 78% of Supplies in Three or Less Clinics....................................................................9Children’s and Women’s: 73% of Supplies in Three or Less Clinics...................................10MPU: 95% Of Supplies in Two or Less Clinics....................................................................11MSK: 89% of Supplies in Two or Less Clinics.....................................................................12

Restocking.................................................................................................................................13Adult: Patterns Vary, Daily is Most Common.......................................................................13Children’s and Women’s: Patterns Vary, Twice a Week is Most Common.........................14MPU: Patterns Vary, Daily is Most Common.......................................................................15MSK: Patterns Vary, As Needed is Most Common..............................................................16

Linens........................................................................................................................................17Adult: 100% of Clinics Use Patient Gowns..........................................................................17Children’s and Women’s: At Least 90% of Clinics Use Patient Gowns...............................18MPU: 100% of Clinics Use Patient Gowns and Pillowcases................................................19MSK: At Least 67% of Clinics Use Patient Gowns and Large Sheets..................................20

Papers.........................................................................................................................................21Adult: Little Commonality and Much Variation...................................................................21Children’s and Women’s: Little Commonality and Much Variation....................................22MPU: Little Commonality and Much Variation....................................................................22MSK: Little Commonality and Much Variation....................................................................23

Future Work: Applying Usage Data..........................................................................................23Follow-Up Forms...................................................................................................................23

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Microsoft Access Tool...........................................................................................................24Conclusions....................................................................................................................................24

Observation: Supplies................................................................................................................24Informal Interviews: Restocking Patterns, Linens, Papers........................................................25Future Work: Applying Usage Data..........................................................................................25

Recommendations..........................................................................................................................25Minimum Threshold for Including Supplies in Standard Exam Rooms...................................25

Adult: 32 Supplies for Standard Exam Rooms......................................................................26Children’s and Women’s: 31 Supplies for Standard Exam Rooms.......................................27MPU: 12 Supplies for Standard Exam Rooms......................................................................28MSK: 16 Supplies for Standard Exam Rooms......................................................................28

Informal Interviews: Restock Daily, Linens, and Further Paper Analysis................................29Future Work: Apply Usage Data...............................................................................................29

Expected Impact............................................................................................................................29References......................................................................................................................................30Appendix A : Table of All Clinics..............................................................................................A-1Appendix B : Table of Clinics Needing Follow-Up Forms.........................................................B-1Appendix C : Sample Follow-Up Form.......................................................................................C-1Appendix D : Sample Microsoft Access Tool Output.................................................................D-1Appendix E : Sample Key Item Information In Supply Spreadsheets.........................................E-1Appendix F : Complete Supply List for Adult.............................................................................F-1Appendix G : Complete Supply List for Children’s and Women’s............................................G-1Appendix H : Complete Supply List for MPU............................................................................H-1Appendix I : Complete Supply List for MSK...............................................................................I-1Appendix J : Complete Restocking List of Adult.........................................................................J-1Appendix K : Complete Restocking List of Children’s and Women’s.......................................K-1Appendix L : Complete Restocking List of MPU.......................................................................L-1Appendix M : Complete Restocking List of MSK.....................................................................M-1Appendix N : Complete Linens List for Adult............................................................................N-1Appendix O : Complete Linens List for Children’s and Women’s.............................................O-1Appendix P : Complete Linens List for MPU..............................................................................P-1Appendix Q : Complete Linens List for MSK............................................................................Q-1

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List of Figures and Tables

Figure 1. Low Number of Adult Clinics (3 or Less) Have the Most Supplies................................9Figure 2. Low Number of Children's & Women's Clinics (3 or Less) Have the Most Supplies...10Figure 3. Low Number of MPU Clinics (2 or Less) Have the Most Supplies..............................11Figure 4. Low Number (2 or Less) of MSK Clinics (2 or Less) Have the Most Supplies............12Figure 5. Variation in the Number of Adult Clinics per Restocking Pattern................................13Figure 6. Variation in the Number of Children's and Women's Clinics per Restocking Pattern...14Figure 7. Variation in the Number of MPU Clinics per Restocking Pattern.................................15Figure 8. Variation in the Number of MSK Clinics per Restocking Pattern.................................16Figure 9. Linens Most Used by Number of Adult Clinics.............................................................17Figure 10. Linens Most Used by Number of Children's and Women's Clinics.............................18Figure 11. Linens Most Used by Number of MPU Clinics...........................................................19Figure 12. Linens Most Used by Number of MSK Clinics...........................................................20

Table 1. Variation and Specialization of Papers in Adult Clinics.................................................21Table 2. Variation and Specialization of Papers in Children's and Women's Clinics...................22Table 3. Variation and Specialization of Papers in MPU Clinics..................................................22Table 4. Variation and Specialization of Papers in MSK Clinics..................................................23Table 5. 32 Supplies Recommended for Standardized Adult Exam Rooms.................................26Table 6. 31 Supplies Recommended for Standardized Children's and Women's Exam Rooms.. .27Table 7. 12 Supplies Recommended for Standardized MPU Exam Rooms..................................28Table 8. 16 Supplies Recommended for Standardized MSK Exam Rooms..................................28

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Executive Summary

A health center is currently being built in Northville, Michigan. The University of Michigan will rent the building and use it to house a variety of clinics. The University of Michigan will establish residence within the building starting in April 2014 and will start healthcare operations in July 2014. This Northville building will have units to provide various types of patient care (“departments”) that are currently spread across southeast Michigan, located across multiple buildings. A goal of the Northville Health Center is to implement a culture of resource sharing; one facet of that would be standardizing supplies across multiple clinics within a department.

Ambulatory Care Services has asked a student team from the University of Michigan Industrial & Operations Engineering (IOE) 481 class to standardize the supplies and provide baseline information about restocking patterns of supplies, linens used, and papers present across all of the exam rooms in each department of the new facility. Each room will be health system space, available to any clinic within that department, rather than a room used and designed to fit only one or two patient care specialists. This will help introduce and support a new culture of resource sharing and 5S principles that are not prominent at all the current locations.

After gathering data and analyzing the current state of supplies, restocking patterns, linens, and papers in the exam rooms for 33 clinic locations, the student team developed tentative recommendations about how to standardize these aspects of the exam rooms for each department at the new health center. These recommendations need to be verified by future work with item usage data; the student team has created and recommended methods for how to do this.

Background

There are many goals for this new health center. The first goal is to offer a more convenient location for patients, rather than traveling to Ann Arbor. Another goal of the project is to change the current culture of exam room use within a clinic and across a department. The current culture supports specialized exam rooms tailored to the needs of one or two patient care specialists. The new Northville Health Center will support a culture of resource sharing. The building will be divided into departments such that every clinic within that department can use any of the available exam rooms at any time due to standardization of exam rooms for each department. Standardization should help with patient flow as each room could be used for any patient at any time. Patient caregivers will also know where each supply is stored in every room, thus lowering the learning curve to only one room. Standard rooms will help with the implementation of a 5S system, which is not widely used at clinic locations. This project will help with the first “S”: sort.

The specific goals and objectives of this project were to document what supplies are stored in each exam room for every clinic from the four in-scope departments, then compare which supplies are common for all clinics within a department. Lastly the student team documented what types of linens and papers are kept in each exam room. The student team also noted the restocking patterns of each clinic. The last two project goals served as benchmarks for future planning in the Northville Health Center. Not all departments were included in this project due to high specialization. Therefore, only four departments were included in the scope of this project: Adult, Children’s and Women’s, Medical Procedure (MPU), and Musculoskeletal (MSK).

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Methodology

The student team’s data collection was achieved through four methods: a literature search, historical data, observation, and informal interviews. The literature search provided information from online articles about 5S principles that were applied to this project, specifically in the first “S”: Sort. The historical data was a master list of every item (8,376 in total) that the University of Michigan Health System distributes from its warehouse, and complete supply room inventory lists for each clinic that were obtained via the shortcode for that clinic (provided by clinic managers). Observation involved 33 site visits, 11 sites by each member of the team. A team member took the inventory list for that clinic to a site visit, and then went into an exam room and checked off every item that was present in the exam room. Informal interviews were conducted by the team member on a site visit. Informal interviews consisted of simple questions asked to the clinic employee leading the visit about restocking patterns, linens, and papers in exam rooms.

The student team performed analysis on the historical data, observation data, and informal interview information. The student team only refined the historical data by removing unnecessary columns. The data was provided raw to the student team, so a lot of information was not relevant. Analysis of the observation data was done using a database built by the student team in Google Spreadsheets and Microsoft Excel. This database started as all 8,376 items in the warehouse with a column for each of the 33 clinics included in the project definition. If an item had been present in the exam room for a given clinic, a “1” was placed in the cell for that item row in that clinic column. The number of clinics each item appeared in was counted, and any items that were not used by any clinic were deleted. The remaining items were then stratified by department and sorted by number of common clinics to see which items were used by the most clinics at the departmental level. Analysis of the restocking, linens, and papers data involved identifying common trends from each category of information.

Findings

The student team had findings about supplies, restocking patterns, types of linens, and types of papers. For the Adult department, the team found 148 supplies were used by all clinics, and only 32 supplies were in 4 or more clinics (out of 13). For Children’s and Women’s, 115 supplies were used, and only 31 supplies were in 4 or more clinics (out of 10). For MPU, 233 supplies were used, and only 12 supplies were in 3 or more clinics (out of 4). For MSK, 146 supplies were used, and only 16 supplies were in 3 or more clinics (out of 6). Restocking analysis showed the most common pattern for each department to be daily for Adult, twice a week for Children’s and Women’s, daily for MPU, and as needed for MSK. Linen analysis showed patient gowns, 3x gowns, and 5x gowns to be the most used type of linen in every department. In addition to this, Adult used bath towels in 8 of 13 clinics, Children’s and Women’s used large sheets, diapers, and crib blankets in 5 or more of 10 clinics, MPU used pillowcases, large sheets, bath blankets, and bath towels in 2 or more of 4 clinics, and MSK used large sheets and bath towels in 3 or more of 6 clinics. Paper analysis displayed very little commonality and a lot of variation and specialization for types of papers within a department.

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The student team also found usage data would be needed to make accurate and complete decisions regarding what items to place in standardized exam rooms. In order to aid in the collection and analysis of this usage data in the future, the team created follow-up forms to be sent to 15 clinics that either shared a supply room or did not have any historical usage data in the main health system database. These forms would gather information about an item’s utilization rate and quantity. The remaining clinics all had shortcodes that led to historical usage data, so the student team created a tool in Microsoft Access to analyze this usage data and output a 1-day on hand recommended quantity for each supply in the exam room for a clinic.

Conclusions

The student team set a tentative minimum threshold for the number of common supplies within each department. This threshold was set based on the frequency of supplies showing up in multiple clinics within a department. Thus the student team tentatively recommended each supply that is located in enough clinics to be above the minimum threshold be placed in the exam room. However, final decisions about which supplies to include in standardized exam rooms should be made based on analysis of usage data in future work. Each department was assigned a different minimum threshold cutoff based on the amount of supplies that are shared. For the Adult department this was 4 out of 13 clinics. For the Children’s and Women’s department this was set at 4 out of 10 clinics. The MPU department had a minimum threshold set at 3 out of 4 clinics. Finally, the MSK department had a minimum threshold of 3 out of 6 clinics.

The student team used the informal interviews to record baseline data regarding the use of paper, linens, and restocking patterns within each clinic. The restocking methods used would vary from both between and within departments varying from restocking as needed, to daily, or weekly. For linens there was also variation, although not as much, both between and within departments. All sizes of patient gowns were the most common linen with each department having certain various lines such as large sheets, bath towels, or crib blankets. Information gathered about papers showed a common theme of using informative materials (pamphlets and posters) frequently, and forms for patients or doctors are prevalent, too.

Recommendations

The student team tentatively recommends including any items above the minimum threshold for a department in the standardized exam rooms. For Adult, this is 32 items. For Children’s and Women’s this is 31 items. For MPU, this is 12 items. For MSK, this is 16 items. Again, usage data should be analyzed to see how often and how much of an item is used, which will further indicate how important it is that an item be included in a standardized exam room. The team recommends that any items not included in the standardized exam room should be considered specialty supplies and kept in the clean supply room and brought in to the exam room when necessary.

The team recommends restocking all exam rooms daily. The team also recommends including patient gowns, 3X gowns, and 5X gowns in all standardized exam rooms. Large sheets and bath towels should be included if there is space. Diapers and crib blankets should be included in

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Children’s and Women’s exam rooms, and pillowcases should be included in MPU exam rooms. For papers, further analysis in a separate future project should be done.

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Introduction A health center is currently being built in Northville, Michigan. A non-University of Michigan third party will own the Northville Health Center. The University of Michigan will rent the building and use it to house a variety of clinics. The University of Michigan will establish residence within the building starting in April 2014 and will start healthcare and patient operations in July 2014. This building will have departments to provide different types of patient care (“departments”) that are currently spread across southeast Michigan in multiple buildings. A goal within the Northville Health Center is to implement a culture of resource sharing; one facet of that would be standardizing supplies across multiple clinics within a department. Ambulatory Care Services has asked a student team from the University of Michigan Industrial & Operations Engineering (IOE) 481 class to standardize all of the supplies across all of the exam rooms within each department at the new facility. Each room will be health system space rather than a room used and designed to fit only one or two patient care specialists. This will help introduce and support a new culture of resource sharing and 5S principles that are not prominent at the current locations. The student team has determined:

● Which supplies each clinic uses within their exam rooms.● Which supplies are common across each department.● A tentative threshold for deciding which supplies to include in the exam rooms● Baselines for restocking supplies and types of linens and papers used in the exam rooms.

This report outlines the methods used to analyze the activities of 33 existing Ambulatory Care Services locations and form recommendations about how to stock and standardize the exam rooms within a department to create and support a new culture of resource sharing.

Background The University of Michigan has addressed a need for a new health center in the Northville / Livonia area to combine a variety of clinics, which are currently located across southeast Michigan, into one facility. The Northville Health Center will offer a more convenient geographical option for patients in that area instead of having to commute to Ann Arbor. This new facility will be two floors and a total of 100,000 square feet. Eight departments will be mixed into this building: Adult, Medical Procedure, Musculoskeletal, Infusion, Ophthalmology, Pathology, Radiology, and Children’s and Women’s. Each floor will also only have one check-in and one checkout location. This facility will be turned over to the University of Michigan in April 2014 and will open in July 2014. The goal of this building will be to ensure a culture of resource sharing. Currently the culture within different departments supports individualized rooms that are tailored to only a few different patient care specialists (“caregivers”). This new Northville Health Center will be arranged so that caregivers within a department can use any exam room in that same department without issue at any given time. This resource sharing will help with patient flow as any room will be available to meet a patient’s needs. Each caregiver will also know exactly what is in each room and where to find a specific piece of equipment as supplies will be standardized

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across all rooms in a department. These changes will allow the exam rooms to be set up according to 5S principles that will create workplace organization and standard work. When implemented, the results will be a clean, organized visual workplace [1]. 5S is a discipline for creating and maintaining a clutter-free, clean, organized, safe and high performance workplace in five steps [2]. 5S consists of sorting items and supplies, setting them in order or finding their proper place, shining / cleaning the area, standardizing the process, and finally sustaining the process [1]. The departments that were included in this standardization project included: Adult, Medical Procedure, Musculoskeletal, and Children’s and Women’s departments. Once the Northville building is operational, each room will be able to meet the needs of all doctors within a department. The goal of this project was to standardize the exam room supply configuration before operations begin in the building. This will help promote a culture of resource sharing rather than individualization.

The IOE 481 student team helped form a new culture of resource sharing by examining the supply inventory in selected departments of Ambulatory Care Services for the Northville Health Center, opening July 2014. The primary parties involved in this project included Ambulatory Care Service managers, medical assistants, physicians, registered nurses, clerks, and patients.

Key Issues The following key issues within Ambulatory Care Services were the motivation for this project:

● Caregivers have the habit of individualizing exam rooms, making them unusable to other caregivers who are unfamiliar with the exam room due to the degree of specialization.

● Limited overarching culture of resource sharing among caregivers.● Need for information on a standardized system to fill and restock exam room supplies.● Opportunity to further apply 5S principals within a hospital environment.

Goals and Objectives To help implement a culture of resource sharing and further apply 5S principles to medical supply organization, the student team achieved the following tasks:

● Determined which supplies each clinic used in their exam room.● Determined which supplies are common across each department.● Determined a tentative threshold for deciding which supplies to store in the exam rooms

for each department● Found current state of restocking patterns and types of linens and paper forms being used

in the exam rooms.

Project Scope The four Ambulatory Care Services departments included in this project were: Adult, Medical Procedure, Musculoskeletal, and Children’s and Women’s departments. This project included

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only the supplies stored in the exam rooms. Supplies used by more than a certain number of clinics within a department were those likely to be stored in the exam rooms. Baseline information on supply restocking patterns and the types of linens and papers that are used in the exam rooms was also included. All in-scope clinics can be found in Appendix A. Departments excluded from this project were Infusion, Ophthalmology, Pathology, and Radiology. The layout of the entire exam room was also excluded from the scope of this project, which includes the exam room table, chairs, walls, and any other furniture in the room. Information about restocking, linens, and papers in the exam rooms that was not relevant to forming a baseline was not included in this project. Visiting the Northville Health Center was also not an option because it is under construction.

Methodology

The student team collected data using four methods: a literature search, historical data, observation, and informal interviews. The student team performed data refining and analysis in three areas: historical data, observation, and informal interviews. The student team also found usage data was necessary to make complete recommendations about all the supplies that need to be stored in the exam rooms and their locations within the exam rooms. Usage data was also necessary to set accurate PAR levels for supplies. The student team did not collect this information during observations because many clinics had one supply room that was shared by multiple clinics, which would have skewed the usage data. Time was also a constraint.

The data collection phase for this project was completed during the week of November 3, 2013. The data analysis phase was completed during the week of November 17, 2013.

Data Collection

The data collection phase of the project began the week of September 1, 2013 and concluded the week of November 3, 2013. The data was collected using four methods: literature search, historical data, observation, and informal interviews. These methods of data collection complemented each other and served to provide redundancy and better accuracy for the process. The historical data showed all the items that a clinic uses or keeps in its clean supply room. The observation process built on this by determining which of these supplies were used specifically in the exam rooms. Observation also offered the chance to ask informal questions to an employee and obtain in-depth information about exam room supplies and restocking. This iterative process ensured higher accuracy of the results.

Literature Search The team carried out a literature search during the first month of the project. The purpose of this search was to find information about 5S methodology so the student team could apply concepts from this methodology to the project. The literature search yielded information from two online articles about the first S, “Sort”, which was applied to the observation data to help sort and standardize which supplies need to be kept in the exam rooms for each of the four departments.

Historical Data

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Historical data included one master list of every item (8,376 in total) that the supply warehouse at the University of Michigan Hospital provides for the clean supply rooms. Historical data also included the inventory list of every item a specific clinic stocks in its clean supply room. In total, the team obtained 33 separate inventory lists. A shortcode was obtained from the manager of each clinic, and the Management Engineering Fellow used these shortcodes to search for and download the inventory lists from a database.

Observation The student team visited and observed the current exam rooms for each clinic and recorded data such as supplies, linens, and papers used in the exam rooms and the frequency with which the exam rooms are being restocked.

The Facilities Coordinator for Ambulatory Care Services provided the manager contact information for each clinic to the student team. There were 33 clinics. The student team visited the first site as a team and then split the remaining 32 to make sure all locations were visited in the time allotted for the project. The student visiting a site obtained the inventory list from the Management Engineering Fellow for that specific clinic at least one day in advance. On the day of the visit, the student brought the inventory list for that clinic into an exam room. The inventory list contained every item stocked in the clean supply room, so the student (or in some cases an employee) indicated on the inventory list which of those supplies from the supply room were also stored in the exam room. The team member also recorded any supplies not on the list.

Informal Interviews

A student conducted an informal interview while visiting each clinic. These were done concurrently with observations. Informal questions were asked to the employee (manager, nurse, medical assistant) who was working with the student at the site. The questions asked for information about the types and quantities of linens and papers being used and how often the rooms are restocked. These questions were:• How often would you say you restock the exam room?• How often do you stock out of supplies?• How much of each supply do you restock? Do you ever overstock or meet PAR-levels?• What types of linens do you use in the exam room?  • What types of papers do you use in the exam room?

Data Refining and Analysis

The data analysis phase of the project began the week of October 6, 2013 and concluded the week of November 17, 2013. Analysis was done in three areas: historical data, observation, and informal interviews. Analysis in these three areas led to conclusions and recommendations about how to standardize the exam rooms for each of the four departments. After being manipulated, the historical data provided a point from which to create the database and record observations in the exam rooms. Once analyzed, the observation data showed which items were used by enough clinics in the department to warrant being included in the standardized exam rooms. The

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informal interviews provided the baseline information requested by the Facilities Coordinator about linens, papers, and restocking.

Historical Data

Historical data was provided to the student team in raw form just as it is stored in the database. The files contained a lot of extraneous information and columns of data that were not relevant to the project. The student team manipulated these lists of data in Microsoft Excel to remove unnecessary columns. The columns kept were related to item information (ID, description, lead time), manufacturer information (name and ID), and model information (packaging style).

Observation

The student team uploaded the observation results (the supplies stored in the exam room for a clinic) into a database that was stored and manipulated using both Google Drive and Microsoft Excel. The initial database was a master list of every item in the supply warehouse for the University of Michigan Hospital and was created by the student team based on the list provided by the Management Engineering Fellow. The database had a column for each clinic. If a supply was used by a clinic, a “1” was entered in the row for that supply in the column for that clinic. Any items not used by any clinic were deleted from the database. From there, the student team stratified the results by department (Adult, C&W, MPU, MSK). Within a department, the results were analyzed to identify the items that are common across all clinics and items that were specific to a certain clinic. This process helped standardize the items in departmental exam rooms because any items that were used by all clinics in that department will likely need to be in the exam rooms at the new health center. Items that are only used by one or two clinics may not be included in the standardized exam rooms but were indicated as something that specific clinic will need.

Informal Interviews

Baseline information obtained from informal interviews about linens, paper, and restocking information was recorded in three separate Microsoft Word documents, one for each category. The Facilities Coordinator was only looking for information in these categories and nothing more, so the Word documents provided sufficient information. Findings

The results of the data analysis were stratified first by type of information (supplies, restocking, papers, linens) and then by department (Adult, Children’s and Women’s, MPU, MSK). Each department will have its own standardized exam room, so seeing information stratified by department helps determine the specific standardization process for a given department.

Supplies

The student team broke down observed data about which supplies are currently kept in the exam rooms for each clinic by department to find common supplies. Within a department, the student

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team sorted the results by the number and percentage of clinics that used each supply in that department.

Adult: 78% of Supplies in Three or Less Clinics

Appendix F lists all the supplies that are currently used in exam rooms in the Adult department. Figure 1 displays a bar-line graph of the number of supplies that are in a certain number of common clinics (the bar graph and left y-axis) and the percentile that corresponds to the minimum number of common clinics a certain percentage of supplies are found in (the line and right y-axis). The bars in Figure 1 show a big increase in the number of supplies found in four common clinics (13) to the number of supplies found in three common clinics (60). The line shows a steep increase from four to three common clinics, indicating 78.37% (116/148) of all supplies are in three or less clinics, which is a very low number of clinics.

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Figure 1. Low Number of Adult Clinics (3 or Less) Have the Most SuppliesSample Size: 13 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

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Children’s and Women’s: 73% of Supplies in Three or Less Clinics

Appendix G lists all the supplies that are currently used in exam rooms in the Children’s and Women’s department. Figure 2 displays a bar-line graph of the number of supplies that are in a certain number of common clinics (the bar graph and left y-axis) and the percentile that corresponds to the minimum number of common clinics a certain percentage of supplies are found in (the line and right y-axis). The bars in Figure 2 show a big increase in the number of supplies found in four common clinics (7) to the number of supplies found in three common clinics (36). The line shows a steep increase from four to three common clinics, indicating 73.03% (84/115) of all supplies are in three or less clinics, which is a very low number of clinics.

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eFigure 2. Low Number of Children's & Women's Clinics (3 or Less) Have the Most Supplies

Sample Size: 10 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

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MPU: 95% Of Supplies in Two or Less Clinics

Appendix H lists all the supplies that are currently used in exam rooms in the MPU department. Figure 3 displays a bar-line graph of the number of supplies that are in a certain number of common clinics (the bar graph and left y-axis) and the percentile that corresponds to the minimum number of common clinics a certain percentage of supplies are found in (the line and right y-axis). The bars in Figure 3 show a big increase in the number of supplies found in three common clinics (6) to the number of supplies found in two common clinics (33). The line shows a steep increase from three to two common clinics, indicating 94.85% (221/233) of all supplies are in two or less clinics, which is a very low number of clinics.

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eFigure 3. Low Number of MPU Clinics (2 or Less) Have the Most SuppliesSample Size: 4 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

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MSK: 89% of Supplies in Two or Less Clinics

Appendix I lists all the supplies that are currently used in exam rooms in the MSK department. Figure 4 displays a bar-line graph of the number of supplies that are in a certain number of common clinics (the bar graph and left y-axis) and the percentile that corresponds to the minimum number of common clinics a certain percentage of supplies are found in (the line and right y-axis). The bars in Figure 4 show an increase in the number of supplies found in three common clinics (12) to the number of supplies found in two common clinics (20). The line shows an increase from three to two common clinics, indicating 89.04% (130/146) of all supplies are in two or less clinics, which is a very low number of clinics.

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entil

eFigure 4. Low Number (2 or Less) of MSK Clinics (2 or Less) Have the Most Supplies

Sample Size: 6 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

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Restocking

The student team sorted baseline information about restocking patterns by department to find common restocking patterns. Within a department, the student team grouped the results by types of restocking patterns seen within that department.

Adult: Patterns Vary, Daily is Most Common

Appendix J lists the complete restocking information for each of the 13 clinics in the Adult department. Figure 5 shows a bar graph of the number of clinics that practiced a certain restocking pattern. The statistically most common restocking pattern is daily at 46.15% (6/13) clinics, but there is a lot of variation.

Daily Once a Week Twice a Week As Needed0

1

2

3

4

5

6

7

Restocking Pattern

Num

ber

of C

linic

s (ou

t of 1

3)

Figure 5. Variation in the Number of Adult Clinics per Restocking PatternSample Size: 13 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

14

Children’s and Women’s: Patterns Vary, Twice a Week is Most Common

Appendix K lists the complete restocking information for each of the 10 clinics in the Children’s and Women’s department. Figure 6 shows a bar graph of the number of clinics that practiced a certain restocking pattern. The statistically most common restocking pattern is twice a week at 50% (5/10) clinics, but there is a lot of variation.

Twice a Week Once a Week As Needed0

1

2

3

4

5

6

Restocking Pattern

Num

ber

of C

linic

s (ou

t of 1

0)

Figure 6. Variation in the Number of Children's and Women's Clinics per Restocking PatternSample Size: 10 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

15

MPU: Patterns Vary, Daily is Most Common

Appendix L lists the complete restocking information for each of the 4 clinics in the MPU department. Figure 7 shows a bar graph of the number of clinics that practiced a certain restocking pattern. The statistically most common restocking pattern is daily at 50% (2/4) clinics, but there is a lot of variation.

Daily As Needed Once a Week0

1

2

3

Restocking Pattern

Num

ber

of C

linic

s (ou

t of 4

)

Figure 7. Variation in the Number of MPU Clinics per Restocking PatternSample Size: 4 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

16

MSK: Patterns Vary, As Needed is Most Common

Appendix M lists the complete restocking information for each of the 6 clinics in the MSK department. Figure 8 shows a bar graph of the number of clinics that practiced a certain restocking pattern. The statistically most common restocking pattern is as needed at 50% (3/6) clinics, but there is a lot of variation.

As Needed Once a Week Daily0

1

2

3

4

Restocking Pattern

Num

ber

of C

linic

s (ou

t of 6

)

Figure 8. Variation in the Number of MSK Clinics per Restocking PatternSample Size: 6 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

17

Linens

The student team sorted baseline information about linens by department to find the linens used the most within a department. Within a department, the student team grouped the results by types of linens seen within that department.

Adult: 100% of Clinics Use Patient Gowns

Appendix N lists the complete linens information for each of the 13 clinics in the Adult department. Figure 9 shows a bar graph of the number of clinics that use each type of linen. The most significant findings are that patient gowns, 3x gowns, and 5x gowns are used by 100% (13/13) of clinics and bath towels are used by 61.54% (8/13) of clinics.

Patien

t Gow

n

3X go

wn

5X G

own

Bath Tow

el

Lg. She

et

Pillowcas

e

Draw She

et

Bath B

lanke

t0

2

4

6

8

10

12

14

Linen Type

Num

ber

of C

linic

s (ou

t of 1

3)

Figure 9. Linens Most Used by Number of Adult ClinicsSample Size: 13 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

18

Children’s and Women’s: At Least 90% of Clinics Use Patient Gowns

Appendix O lists the complete linens information for each of the 10 clinics in the Children’s and Women’s department. Figure 10 shows a bar graph of the number of clinics that use each type of linen. The most significant findings are that patient gowns are used by 100% (10/10) of clinics, 3x gowns and 5x gowns are used by 90% (9/10) of clinics, large sheet and diapers are used by 60% (6/10) of clinics, and crib blankets are used by 50% (5/10) of clinics.

Patient Gown

3X gown

5X Gown

Lg. Sheet

Diaper Crib Blanket

Bath Blanket

Bath Towel

Draw Sheet

0

2

4

6

8

10

Linen Type

Num

ber

of C

linic

s (ou

t of 1

0)

Figure 10. Linens Most Used by Number of Children's and Women's ClinicsSample Size: 10 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

19

MPU: 100% of Clinics Use Patient Gowns and Pillowcases

Appendix P lists the complete linens information for each of the 4 clinics in the MPU department. Figure 11 shows a bar graph of the number of clinics that use each type of linen. The most significant findings are that patient gowns, 3x gowns, 5x gowns, and pillowcases are used by 100% (4/4) of clinics, large sheets and bath blankets are used by 75% (3/4) of clinics, and bath towels are used by 50% (2/4) of clinics.

Patien

t Gow

n

3X go

wn

5X G

own

Pillowcas

e

Lg. She

et

Bath B

lanke

t

Bath Tow

el

Draw She

et

Contou

r She

et

Crib B

lanke

t

IV G

own

0

1

2

3

4

5

Linen Type

Num

ber

of C

linic

s (ou

t of 4

)

Figure 11. Linens Most Used by Number of MPU ClinicsSample Size: 4 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

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MSK: At Least 67% of Clinics Use Patient Gowns and Large Sheets

Appendix Q lists the complete linens information for each of the 6 clinics in the MSK department. Figure 12 shows a bar graph of the number of clinics that use each type of linen. The most significant findings are that patient gowns, 3x gowns, 5x gowns, and large sheets are used by 66.67% (4/6) of clinics, and bath towels are used by 50% (3/6) of clinics.

Patien

t Gow

n

3X go

wn

5X G

own

Lg. She

et

Bath Tow

el

Pillowcas

e

Draw She

et

Bath B

lanke

t

Contou

r She

et0

1

2

3

4

5

Linen Type

Num

ber

of C

linic

s (ou

t of 6

)

Figure 12. Linens Most Used by Number of MSK ClinicsSample Size: 6 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

Papers

21

The student team recorded baseline information about types of papers used in the exam rooms for each of the 33 clinics. The student team stratified this data by department. Within a department, the student team looked for common forms used across the clinics in that department.

Adult: Little Commonality and Much Variation

Table 1 lists the baseline information about papers for the 13 clinics in the Adult department. The most commonality occurs between only 23.07% (3/13) of clinics. There is a lot of variation, and the more specialized a department, the more specialized the papers.

Table 1. Variation and Specialization of Papers in Adult ClinicsSample Size: 13 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

Clinics InformationCardiology All in a 5 slot paper holder - each slot about 5 inches;

Forms; VIS sheet; Medicare annual visit form; Pharm D information; HIM; Release Info; Diabetes Booklet

General Medicine All in a 5 slot paper holder - each slot about 5 inches; Forms; VIS sheet; Medicare annual visit form; Pharm D information; HIM; Release Info; Diabetes Booklet

Hepatology All in a 5 slot paper holder - each slot about 5 inches; Forms; VIS sheet; Medicare annual visit form; Pharm D information; HIM; Release Info; Diabetes Booklet

OB/GYN Reproductive Endo NonePulmonary A few inches of Medical Records papersHem/Onc Chemotherapy scheduling request sheet; Chemotherapy

information handoutNeurology Patient Papers; MiChart backupAllergy Informative posters; Few magazines; 2’x2’ full of black box

of forms for the doctorGI Informative posters; Few magazines; 2’x2’ full of black box

of forms for the doctorMaternal Fetal Medicine NoneOB/GYN Minimally Invasive Surg NoneOB/GYN Uro/Gyn NonePre-Operative 5” advanced directives pamphlets; 5” maps; 2-3 magazines;

5 tobacco pamphlets

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Children’s and Women’s: Little Commonality and Much Variation

Table 2 lists the baseline information about papers for the 10 clinics in the Children’s and Women’s department. The most commonality occurs between only 30% (3/10) of clinics. There is a lot of variation, and the more specialized a department, the more specialized the papers.

Table 2. Variation and Specialization of Papers in Children's and Women's ClinicsSample Size: 10 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

Clinics InformationGeneral Pediatrics Vaccine info sheets by age - 15 groups, a few per group; Cover Your Cough

posters; Random other postersOB/GYN All in a 5 slot paper holder - each slot about 5 inches; Forms; VIS sheet;

Medicare annual visit form; Pharm D information; HIM; Release Info; Diabetes Booklet

Rheumatology All in a 5 slot paper holder - each slot about 5 inches; Forms; VIS sheet; Medicare annual visit form; Pharm D information; HIM; Release Info; Diabetes Booklet

Urology All in a 5 slot paper holder - each slot about 5 inches; Forms; VIS sheet; Medicare annual visit form; Pharm D information; HIM; Release Info; Diabetes Booklet

Hem Onc 2 BMT focus group ; 1 refill reminderNephrology NoneNeurology NonePeds Surgery General consent forms; Photography consent formsPulmonary NoneCardiology How the heart works; Six types of pamphlets; Important ones - patient rights

and responsibilities and innocent heart murmurs; Few inches for each

MPU: Little Commonality and Much Variation

Table 3 lists the baseline information about papers for the 4 clinics in the MPU department. The most commonality occurs between only 50% (2/4) of clinics. There is a lot of variation, and the more specialized a department, the more specialized the papers.

Table 3. Variation and Specialization of Papers in MPU ClinicsSample Size: 4 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

Clinics InformationCardiology NoneNephrology Patient Discharge Form; Billing info; Conscious sedation formPM&R NoneGI 10-15 posters for specific procedures; 2-3” of forms

23

MSK: Little Commonality and Much Variation

Table 4 lists the baseline information about papers for the 6 clinics in the MSK department. The most commonality occurs between only 50% (3/6) of clinics. There is a lot of variation, and the more specialized a department, the more specialized the papers.

Table 4. Variation and Specialization of Papers in MSK ClinicsSample Size: 6 clinics; Collection Period: 9/1/2013-11/3/2013; Source: Team 3–ExamRm

Clinics InformationNeurosurgery No papers; Models and posters on the bodyPT/OT MedSport 2 magazines; Pain score poster; 1” MedSport prescription forms; 1”

requisition form; ¼” informative arts; Random posterRheumatology Magazine Rack; 5 inches of extra papers (various space)Orthopaedics Adult Handicap placards; Patient information forms; Individual foot/hand

information handoutsPain/Anesthesia Magazine Rack - few magazines; 48” by 48” grey rack for hanging

things; Tack Board - CorkPM&R Adult & Peds None

Future Work: Applying Usage Data

After completing the data collection and during data analysis, the student team found that standard exam room supplies could not be determined based on commonality among clinics alone. Usage data was needed to find how frequently an item was used. This data would help further refine which supplies need to be permanently stored in the exam rooms. Supplies that are used very often would have priority over those that are only used in special cases. However, the student team did not collect this information during the data collection phase because many clinics shared one supply room, so utilization was not attainable at that time for one clinic since resources were pooled. Time was also a constraint. Therefore, the student team created two methods for obtaining and analyzing the usage data for each of the 33 clinics in future work. Those clinics that shared a supply room or did not have usage data stored in a database will fill out a follow-up form created by the student team (15 clinics). The remaining clinics had historical usage data in a database, and this data will be analyzed using a tool created by the student team in Microsoft Access.

Follow-Up Forms

The student team first identified which clinics shared a supply room or did not have usage data in a database (see Appendix B). The clinics that shared a supply room had a common shortcode. Clinics that did not have usage data in a database either did not have a shortcode or their shortcode returned no results when searched in the database. After these clinics were determined, the student team created a follow-up form for each clinic. This follow-up form consisted of the department and clinic name, a brief description of what the form is for, and a list of each item that clinic currently keeps in its exam room. Next to each item was a space to indicate the quantity of that item stored in the exam room when fully stocked and a space to indicate how

24

frequently an item is used (A = used for 80% or more of patients, B = used for between 20% and 80% of patients, C = used for 20% or less of patients). Appendix C shows a sample follow-up form. These forms were given to the Facilities Coordinator to distribute in the future.

Microsoft Access Tool

Any clinics that did not require a follow-up form were found to have usage data stored in a database. This historical usage data indicates how frequently over the past four months a clinic ordered a specific item from its supply room. The student team created a tool in Microsoft Access that combines historical usage data with the items a clinic stores in its exam rooms to output a recommended 1-day on hand quantity for each exam room item. The utilization rate for each item can also be calculated based on this data. Sample output from this tool is shown in Appendix D.

These two methods for collecting and analyzing usage data will aid future efforts to standardize the items in the exam rooms because they will show how often an item is used, which will indicate how important it is that an item be stored permanently in the exam room. These methods will also give information about the current quantity of each item stored in an exam room, which will help set PAR levels (quantities) of items in the exam rooms at the new health center.

Conclusions

After the student team completed the analysis and findings, the team came to conclusions about observations (supplies) and informal interviews (restocking patterns, linens, papers) in the exam rooms. The team also concluded more work with usage data was needed in the future to make firm decisions about how to standardize the exam rooms. The conclusions helped form recommendations.

Observation: Supplies

Based on the clinic observation findings, the student team set a tentative minimum threshold for the number of common clinics within each department. This minimum threshold is a benchmarking tool that will help form recommendations about which supplies should permanently be stored in the exam room (those above the threshold) and those that should not (those below the threshold). The minimum threshold was set where the number of supplies for a certain number of common exam rooms exceeded 15. Each department was assigned a different minimum threshold cutoff based on the number of common clinics. For the Adult department, the minimum threshold was 4 out of 13 clinics; which consisted of 32 supplies. For the Children’s and Women’s department, the minimum threshold was set at 4 out of 10 clinics with a total of 31 different supplies. Next the MPU department had a minimum threshold set at 3 out of 4 clinics with a total of 12 different supplies. Lastly the MSK department had a minimum threshold set at 3 out of 6 clinics for a total of 16 different supplies to be tentatively stored in the exam room.

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Informal Interviews: Restocking Patterns, Linens, Papers

The student team used the informal interviews to record data regarding the use of paper, linens, and restocking patterns within each clinic. This information was collected to show what the current baseline conditions are within a specific clinic. This information, provided above in the findings, will help for the planning and setup of the new Northville health center exam rooms. Restocking methods varied both within and between departments. Nearly half of the Adult clinics (6/13) restocked on a daily basis. Half of the MPU clinics (2/4) restocked daily as well. However, for Children’s and Women’s clinics, half (5/10) restocked once a week, while half of the MSK clinics (3/6) restocked as needed. For linens, patient gowns, 3X gowns, and 5X gowns were the most used linens (30 or more clinics). Large sheets and bath towels were used by more than 50% of all clinics. Diapers and crib blankets were used by more than 50% of all Children’s and Women’s clinics. Pillowcases were used by all MPU clinics. Papers information shows a common theme of using informative materials (pamphlets and posters) frequently, and forms for patients or doctors are prevalent, too.

Future Work: Applying Usage Data

Definitive and accurate choices to put certain supplies into the exam rooms can only be made with the future work of usage data. Usage data will reveal not only how much is used of a potential exam room item, but how frequently it is used. Usage data information is important because when trying to decide between large amounts of items (greater than 15 in this case), knowing that one is used more frequently than another indicates if a spot should be made for it in the exam room before the other, less used item. Because of the small amount of shared supplies within each department, a very low usage item would probably not be stored in an exam room regardless of how many clinics use it, whereas a high usage item would.

Recommendations

The following recommendations will identify items to be stored permanently in the exam rooms based on the number of common clinics, identify specialty items to be stored outside the exam rooms, and discuss how to approach the trends and themes from baseline information about linens, papers, and restocking. All of these recommendations will aid in the formation of a standardized exam room for each department and an overarching culture of resource sharing at the Northville Health Center.

Minimum Threshold for Including Supplies in Standard Exam Rooms

Partial recommendations can be provided about which supplies should be included in each of the 4 standardized departmental exam rooms. For each of the 4 departments, a minimum threshold was established as described in the conclusions. Any item that is present in enough clinics of that department to meet the threshold should be tentatively be included in the Northville Health Center exam rooms, pending the results of future usage data collection and analysis. Supplies that a clinic uses but that fall below the minimum threshold and will likely not be stored in an exam room should to be placed on a cart or in storage in the clean supply room.

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Adult: 32 Supplies for Standard Exam Rooms

Table 5 lists all the supplies that are above the recommended minimum threshold for number of common clinics for the Adult department. As shown in Table 5, the student group is recommending that any item that is present in at least 4 of 13 (30.8%) clinics should be included in the Northville Health Center exam room.

Table 5. 32 Supplies Recommended for Standardized Adult Exam Rooms

Item ID Description Clinics1149 DEPRESSOR, TONGUE INDIVIDUALLY WRAPPED ADULT 121126 BASIN, EMESIS 700CC NONSTERILE 10IN 101738 PAD, PREP ALCOHOL ISOPROPYL 70% 102579 LUBRICANT, JELLY WATER SOLUBLE 4OZ W/FLIP-TOP CAP 81016 TAPE, MEASURING PAPER 36IN 7603 CUP, PLASTIC CLEAR 7OZ 72751 OTOSCOPE, SPECULUM ADULT 4MM 62961 GLOVE, EXAM VINYL TRILON SMALL 6R44375 SANITIZER, HAND PURELL W/ALOE 12OZ FOR UH, CVC, MOTT & TC 61040 PAPER, EXAM TABLE SMOOTH 18IN X 225FT 51060 TOWELETTE, PREMOISTENED 51172 CUFF, BLOOD PRESSURE ADULT 23CM - 33CM 51173 CUFF, BLOOD PRESSURE ADULT LARGE 31CM- 40CM 51290 TISSUE, FACIAL 2 PLY 51640 BANDAGE, FABRIC FLEXIBLE STERILE 1IN X 3IN 51667 BALLS, PREPPING COTTON NONSTERILE MEDIUM 52021 ANOSCOPE, PLASTIC 52526 DEVELOPER, HEMOCCULT SENSA 52750 OTOSCOPE, SPECULUM PEDIATRIC 2.75MM 51013 PINS, SAFETY NONSTERILE 1 7/8IN 41054 REMOVER, ADHESIVE 1/2OZ 41107 APPLICATOR, COTTON TIP 6IN STERILE 41109 SWAB, 10% POVIDONE IODINE 1.7ML 41171 CUFF, BLOOD PRESSURE ADULT SMALL 17CM - 25CM 41237 CUFF, BLOOD PRESSURE ADULT THIGH 38CM - 50CM 41295 GLOVE, EXAM VINYL TRILON X-LARGE 41971 BASIN, WASH FACE DISPOSABLE NONSTERILE 7 QT 420021 CURETTE, EAR DISPOSABLE LOOP END NONSTERILE 42009 BEDPAN, PONTOON STYLE MEDIUM 42523 MASK, PROCEDURE EAR LOOPS 42524 MASK, SURGICAL TIE ON 45266 SUB/ BOTTLE, IRRIGATION SODIUM CHLORIDE 0.9% 1000ML STERILE 4

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Children’s and Women’s: 31 Supplies for Standard Exam Rooms

Table 6 lists the all the supplies that are above the recommended minimum threshold for number of common clinics for the Children’s and Women’s department. The minimum threshold in Children’s and Women’s has been set at 4 out of 10 clinics, or 40%.

Table 6. 31 Supplies Recommended for Standardized Children's and Women's Exam Rooms

Item ID Description Clinics1738 PAD, PREP ALCOHOL ISOPROPYL 70% 10R44375 SANITIZER, HAND PURELL W/ALOE 12OZ FOR UH, CVC, MOTT & TC 101160 CUFF, BLOOD PRESSURE INFANT 8CM - 13CM 91170 CUFF, BLOOD PRESSURE CHILD 12CM - 19CM 91171 CUFF, BLOOD PRESSURE ADULT SMALL 17CM - 25CM 91290 TISSUE, FACIAL 2 PLY 91119 COLLECTOR, URINE SINGLE SPECIMEN PEDIATRIC 82750 OTOSCOPE, SPECULUM PEDIATRIC 2.75MM 82751 OTOSCOPE, SPECULUM ADULT 4MM 81149 DEPRESSOR, TONGUE INDIVIDUALLY WRAPPED ADULT 720020 CURETTE, EAR DISPOSABLE PEDIATRIC MICROLOOP 71126 BASIN, EMESIS 700CC NONSTERILE 10IN 61172 CUFF, BLOOD PRESSURE ADULT 23CM - 33CM 61173 CUFF, BLOOD PRESSURE ADULT LARGE 31CM- 40CM 61307 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE XLARGE 61433 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE SMALL 62965 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE MEDIUM 62966 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE LARGE 61040 PAPER, EXAM TABLE SMOOTH 18IN X 225FT 51237 CUFF, BLOOD PRESSURE ADULT THIGH 38CM - 50CM 51640 BANDAGE, FABRIC FLEXIBLE STERILE 1IN X 3IN 51759 UNDERPAD, DISPOSABLE 23IN X 24 51971 BASIN, WASH FACE DISPOSABLE NONSTERILE 7 QT 544217 COVER, PROBE ORAL/RECTAL THERMOMETER 51014 TAPE, MEASURING METRIC AND INCH NONSTERILE 41121 COLLECTOR, URINE SINGLE SPECIMEN NEWBORN 41295 GLOVE, EXAM VINYL TRILON X-LARGE 42540 OINTMENT, PETROLATUM WHITE 5GM 42961 GLOVE, EXAM VINYL TRILON SMALL 443019 WIPES, BABY 4603 CUP, PLASTIC CLEAR 7OZ 4

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MPU: 12 Supplies for Standard Exam Rooms

Table 7 lists the all the supplies that are above the recommended minimum threshold for number of common clinics for the MPU department. The minimum threshold in MPU has been set at 3 out of 4 clinics, or 75%.

Table 7. 12 Supplies Recommended for Standardized MPU Exam RoomsItem ID Description Clinics1640 BANDAGE, FABRIC FLEXIBLE STERILE 1IN X 3IN 41738 PAD, PREP ALCOHOL ISOPROPYL 70% 41774 NEEDLE, 18GA 1 1/2 IN SHORT BEVEL 41788 SYRINGE, W/O NEEDLE 3ML 41792 SYRINGE, W/O NEEDLE 10ML 42557 GOWN, PROTECTIVE PLASTIC DISPOSABLE 41063 ALCOHOL, RUBBING 70% ISOPROPYL 16OZ 31757 TAPE, SURGICAL PAPER MICROPORE 1IN X 10YD 31784 NEEDLE, FILTER 19 GA 1 1/2IN 34301 STRAP, TOURNIQUET 1IN X 18IN 35108 CANNULA, BLUNT IV LOCKING DEHP FREE 35338 TUBING, IV MACRODRIP PRIMARY VENT 2-Y 80IN DEHP FREE 3

MSK: 16 Supplies for Standard Exam Rooms

Table 8 lists the all the supplies that are above the recommended minimum threshold for number of common clinics for the MSK department. The minimum threshold in MSK has been set at 3 out of 6 clinics, or 50%.

Table 8. 16 Supplies Recommended for Standardized MSK Exam RoomsItem ID Description Clinics1640 BANDAGE, FABRIC FLEXIBLE STERILE 1IN X 3IN 61107 APPLICATOR, COTTON TIP 6IN STERILE 41109 SWAB, 10% POVIDONE IODINE 1.7ML 41176 GLOVE, EXAM VINYL TRILON MEDIUM 41063 ALCOHOL, RUBBING 70% ISOPROPYL 16OZ 31175 GLOVE, EXAM VINYL TRILON LARGE 31290 TISSUE, FACIAL 2 PLY 31639 BANDAGE, VINYL CARTOON 3/4IN X 3IN 31738 PAD, PREP ALCOHOL ISOPROPYL 70% 31739 SPONGE, GAUZE STERILE 8 PLY 2IN X 2IN 31741 SPONGE, GAUZE STERILE 8 PLY 4IN X 4IN 31759 UNDERPAD, DISPOSABLE 23IN X 24 32961 GLOVE, EXAM VINYL TRILON SMALL 35266 SUB/ BOTTLE, IRRIGATION SODIUM CHLORIDE 0.9% 1000ML STERILE 36090 SCISSORS, IRIS CURVED 36091 SCISSORS, OR SHARP/SHARP 3

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Informal Interviews: Restock Daily, Linens, and Further Paper Analysis

The student team recommends looking into a more standardized policy for restocking because there is a lot of variation in restocking both within and between departments, which results in more waste and less efficiency than a set restocking method. It is recommended that departments restock supplies on a daily basis. Such a system lowers the quantity per supply that needs to be stored in an exam room. In turn, it allows for more types of supplies to be stored in the exam rooms. For linens, the student team recommends including patient gowns, 3X gowns, and 5X gowns, in all the standardized exam rooms. If there is space, large sheets and bath towels should be included as well. For Children’s and Women’s standardized exam rooms, diapers and crib blankets should be included. MPU standardized exam rooms should have pillowcases. For papers, if the informative materials don’t apply to all clinics in a department, they should not be included. Clinic-specific forms should be kept elsewhere and brought to the patient if needed.

More in-depth analysis about supplies tentatively recommended for inclusion in the standardized exam rooms for each department at the Northville Health Center are detailed below. Adult has 13 clinics, Children’s and Women’s has 10, MPU has 4, and MSK has 6.

Future Work: Apply Usage Data

The student team strongly advocates the use of usage data (collected and analyzed using the methods from the Future Work section) in making final decisions about items to be stored in the exam room or in the clean supply room. For example, if an item is not present in a large number of clinics, but is still used very frequently, it could still be a candidate for inclusion in an exam room. Usage data will provide critical information as to how important each item is to individual clinics by determining how much and how often an item has been used in the past by that clinic. If it is deemed an item should not be placed in an exam room, the item will remain in a clean supply room. When needed during an examination, such items can be wheeled or carried into the exam room from the supply room.

Expected Impact At project completion, the departments in the Ambulatory Care Services at the new Northville Health Center should see standardized exam rooms, in which doctors, nurses, managers, patients, and other hospital employees or clients can use any room within their respective department at any given date or time. The extra flexibility of being able to use any room will promote and support a new culture of resource sharing. Resource sharing will have a positive effect on supplies, staff, and other important functions of the care center.

Ideally, another important outcome of the project is a care center in which exam rooms can reliably maintain supplies, reducing waste and preventing cases in which materials run out. High-level information about current restocking patterns will be provided that could lead to an improved system of restocking supplies in future phases of the health center development. Any caregivers that need specialty supply boxes will be identified, and a procedure will be recommended for maintaining and storing these boxes. The project will also help implement various 5S principles that have not been implemented at other area hospitals.

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References

[1] University of Michigan Department of Family Medicine, Practice Management Module – 5S Unit, University of Michigan, [Online]. Available: http://sitemaker.umich.edu/fm_gmeig_practice-management_s5/introduction_to_5s, [Accessed: September 20, 2013]

[2] Sigma Process Consulting, The 5S-Method, 6 Sigma, [Online]. Available: http://www.6sigma.de/english/Lean-Manufacturing-Expertise/5S%20Methode%20%20EN_091227.pdf, [Accessed: September 20, 2013]

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Appendix A: Table of All Clinics

Department

Clinic

ADULT CardiologyADULT General MedicineADULT HepatologyADULT OB/GYN Reproductive EndoADULT PulmonaryADULT Hem/OncADULT NeurologyADULT AllergyADULT GIADULT Maternal Fetal MedicineADULT OB/GYN Minimally Invasive SurgADULT OB/GYN Uro/GynADULT Pre-OperativeC&W General PediatricsC&W OB/GYNC&W RheumatologyC&W UrologyC&W Hem OncC&W NephrologyC&W NeurologyC&W Peds SurgeryC&W PulmonaryC&W CardiologyMPU CardiologyMPU NephrologyMPU PM&RMPU GIMSK NeurosurgeryMSK PT/OT MedSportMSK RheumatologyMSK Orthopaedics AdultMSK Pain/AnesthesiaMSK PM&R Adult & Peds

A-1

Appendix B: Table of Clinics Needing Follow-Up Forms

Department

Clinic

ADULT CardiologyADULT General MedicineADULT HepatologyADULT OB/GYN Reproductive EndoADULT AllergyADULT GIADULT Maternal Fetal MedicineADULT OB/GYN Minimally Invasive SurgADULT OB/GYN Uro/GynC&W General PediatricsC&W OB/GYNC&W RheumatologyC&W UrologyMPU CardiologyMSK Rheumatology

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Appendix C: Sample Follow-Up Form

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Appendix D: Sample Microsoft Access Tool Output

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Appendix E: Sample Key Item Information In Supply Spreadsheets

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Appendix F: Complete Supply List for Adult

Item ID Description Clinics1149 DEPRESSOR, TONGUE INDIVIDUALLY WRAPPED ADULT 121126 BASIN, EMESIS 700CC NONSTERILE 10IN 101738 PAD, PREP ALCOHOL ISOPROPYL 70% 102579 LUBRICANT, JELLY WATER SOLUBLE 4OZ W/FLIP-TOP CAP 81016 TAPE, MEASURING PAPER 36IN 7603 CUP, PLASTIC CLEAR 7OZ 72751 OTOSCOPE, SPECULUM ADULT 4MM 62961 GLOVE, EXAM VINYL TRILON SMALL 6R44375 SANITIZER, HAND PURELL W/ALOE 12OZ FOR UH, CVC, MOTT & TC 61040 PAPER, EXAM TABLE SMOOTH 18IN X 225FT 51060 TOWELETTE, PREMOISTENED 51172 CUFF, BLOOD PRESSURE ADULT 23CM - 33CM 51173 CUFF, BLOOD PRESSURE ADULT LARGE 31CM- 40CM 51290 TISSUE, FACIAL 2 PLY 51640 BANDAGE, FABRIC FLEXIBLE STERILE 1IN X 3IN 51667 BALLS, PREPPING COTTON NONSTERILE MEDIUM 52021 ANOSCOPE, PLASTIC 52526 DEVELOPER, HEMOCCULT SENSA 52750 OTOSCOPE, SPECULUM PEDIATRIC 2.75MM 51013 PINS, SAFETY NONSTERILE 1 7/8IN 41054 REMOVER, ADHESIVE 1/2OZ 41107 APPLICATOR, COTTON TIP 6IN STERILE 41109 SWAB, 10% POVIDONE IODINE 1.7ML 41171 CUFF, BLOOD PRESSURE ADULT SMALL 17CM - 25CM 41237 CUFF, BLOOD PRESSURE ADULT THIGH 38CM - 50CM 41295 GLOVE, EXAM VINYL TRILON X-LARGE 41971 BASIN, WASH FACE DISPOSABLE NONSTERILE 7 QT 420021 CURETTE, EAR DISPOSABLE LOOP END NONSTERILE 42009 BEDPAN, PONTOON STYLE MEDIUM 42523 MASK, PROCEDURE EAR LOOPS 42524 MASK, SURGICAL TIE ON 45266 SUB/ BOTTLE, IRRIGATION SODIUM CHLORIDE 0.9% 1000ML STERILE 41014 TAPE, MEASURING METRIC AND INCH NONSTERILE 31015 COVER, EXAM LIGHT DISPOSABLE 31055 BEVERAGE, GLUCOSE TEST 50GR ORANGE 10OZ 31119 COLLECTOR, URINE SINGLE SPECIMEN PEDIATRIC 31121 COLLECTOR, URINE SINGLE SPECIMEN NEWBORN 311401 STRIP, URINE TEST 10 31160 CUFF, BLOOD PRESSURE INFANT 8CM - 13CM 31170 CUFF, BLOOD PRESSURE CHILD 12CM - 19CM 31175 GLOVE, EXAM VINYL TRILON LARGE 31176 GLOVE, EXAM VINYL TRILON MEDIUM 31216 BUTTERFLY, BLOOD COLLECTION 23GA X .75IN SAFETY-LOK 31217 BUTTERFLY, INFUSION 25GA X .75IN W/12IN TUBING SAFETY 31260 FIXATIVE, CYTOLOGY NONAEROSOL 4OZ 31639 BANDAGE, VINYL CARTOON 3/4IN X 3IN 3

F-1

1715 GAUZE, FINE MESH PACKING STERILE 1/2IN X 5YD 31741 SPONGE, GAUZE STERILE 8 PLY 4IN X 4IN 31759 UNDERPAD, DISPOSABLE 23IN X 24 320019 CURETTE, EAR DISPOSABLE CURVED NONSTERILE 320020 CURETTE, EAR DISPOSABLE PEDIATRIC MICROLOOP 320023 NEBULIZER, T UPDRAFT W/ SUPPLY TUBING 32006 HAMMER, PERCUSSION NONSTERILE 8IN 32111 BOTTLE, PERINEAL WRAPPED NONSTERILE 8OZ 32128 GOWN, IMPERVIOUS ASTOUND LARGE LEVEL 4 STERILE DISPOSABLE 323028 SPECULUM, ENDOCERVICAL KOGEN WIDE W/ GAUGE & SCREWS NONSTERI 323031 CURETTE, ENDOCERVICAL KEVORKIAN-YOUNGE 12IN NARROW TIP NONST 325123 GAUZE, FINE MESH PACKING STERILE 1/4IN X 5YD 325185 CURETTE, EAR DISPOSABLE YELLOW 325584 SPECULUM, VAGINAL PEDERSON MEDIUM 4IN X 7/8IN NONSTERILE 32565 BRIEF, INCONTINENT ADULT LARGE 326087 CANNULA, NASAL ADULT 16FT 32655 DISINFECTANT, METRICIDE GALLON 32844 SPECULUM, VAGINAL DISPOSABLE MEDIUM 343019 WIPES, BABY 34303 CATHETER, FOLEY SILICONE 12FR 5CC 343087 KIT, TEST TUBE VIRAL (INC. FLU), CHLAMYDIA & GC M4 W/ FLOCKE 34350 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 6 34351 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 6.5 34352 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 7 34353 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 7.5 34354 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 8 34355 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 8.5 34402 CATHETER, FOLEY SILICONE 8FR 3CC 34405 CATHETER, FOLEY STERILE 14FR 5CC 34406 CATHETER, FOLEY STERILE 16FR 5CC 34407 CATHETER, FOLEY STERILE 18FR 5CC 34408 CATHETER, FOLEY STERILE 20FR 5CC 34450 TRAY, PREP FOLEY 16FR & 2L BAG 344623 KIT, TEST TUBE CHLAMYDIA & GC FOR ENDOCERVICAL 344624 KIT, TEST TUBE CHLAMYDIA & GC FOR URETHRAL 344626 KIT, TEST TUBE CHLAMYDIA & GC FOR VAGINAL 344644 BRUSHES, CYTOLOGY 344648 KIT, TEST TUBE CHLAMYDIA & GC FOR URINE 3480 FORMULA, WATER STERILE 2OZ 35269 SUB/ BOTTLE, IRRIGATION WATER 1000ML 36119 SPECULUM, NASAL 36120 SPECULUM, VAGINAL GRAVES LARGE 36121 SPECULUM, VAGINAL GRAVES MEDIUM 36122 SPECULUM, VAGINAL PEDERSON NARROW MEDIUM 36125 SPECULUM, VAGINAL PEDERSON MEDIUM 3RS0002 CONTAINER, SHARPS GATORGUARD 2GAL FOR EVS/OR 31063 ALCOHOL, RUBBING 70% ISOPROPYL 16OZ 211007 BANDAGE, PLASTIC SPOT 7/8IN 21124 SUB/ APPLICATOR, TIPPED OB/GYN NONSTERILE 8IN 21242 PACK, COLD INSTANT 6IN X 9IN 2

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1246 MARKER, SKIN STERILE SURGICAL 21739 SPONGE, GAUZE STERILE 8 PLY 2IN X 2IN 21740 SPONGE, ALL PURPOSE NONSTERILE 3PLY 4IN X 4IN 21751 TAPE, SURGICAL SILK DURAPORE 1IN X 10YD 21752 TAPE, SURGICAL SILK DURAPORE 2IN X 10YD 21786 SYRINGE, ALLERGY SKIN TESTING 1ML W/26GA X 1/2IN 220004 MOUTHPIECE, OVAL FOR PERSONAL BEST PEAK FLOW METERS HS755-0 220018 LINER, PANTY 220022 KIT, NEBULIZER MASK FILTER ADULT W/ AEROSOL 220024 KIT, NEBULIZER MASK FILTER PEDIATRIC W/ AEROSOL 220029 NEBULIZER, FILTERED 220045 MASK OPTICHAMBER SMALL USE WITH #2177 22527 ENEMA, SODIUM PHOSPHATE 4.5OZ 225318 WIPE, DISINFECTANT QUAT 15% ALCOHOL SANICLOTH PLUS 6IN 22538 LUBRICANT, JELLY WATER SOLUBLE 3GR 22552 SOLUTION, HYDROGEN PEROXIDE 3% 16OZ 22760 OTOSCOPE, SPECULUM 4MM 230154 FLOWMETER, PEAK NORMAL RANGE 230159 MASK, AEROSOL PEDIATRIC 231055 DISC/ FLOWMETER, PEAK LOW RANGE 238574 SYRINGE, ECLIPSE 1ML 27GA X 1/2IN SAFETY 243085 SWAB, FLOCKED IN AEROBIC TRANSPORT 26128 TOWEL, BIOPSY STERILE 21031 CONTAINER, SPECIMEN W/LID STERILE 4OZ 11041 TOWEL, POLY TISSUE 2PLY 13IN X 18IN 11070 SOLUTION, SCRUB CHLORHEXIDINE 4% 4OZ 11104 APPLICATOR, COTTON TIP 6IN NONSTERILE 11266 SET, SUTURE REMOVAL 11757 TAPE, SURGICAL PAPER MICROPORE 1IN X 10YD 11889 VACUTAINER, URINE YELLOW 10ML SAFETY 120009 BULB, INSUFFLATOR WITH TIP FOR DIAGNOSTIC OTOSCOPE 120054 COVER, TRANSDUCER PROBE BULK 4.6CM X 24.1CM 12014 RAZOR, PREP SHAVE 12020 STETHOSCOPE 12044 URINAL, MALE W/COVER PLASTIC DISPOSABLE 125161 DRAPE, WHITE 2 PLY 40IN X 48IN 12528 OINTMENT, TRIPLE ANTIBIOTIC .9GR 12545 UNDERPAD, DISPOSABLE 23IN X 36IN 125592 SPONGE, GAUZE NONSTERILE 12 PLY 4IN X 4IN 125749 PIECE, EAR FOR LITTMAN STETHOSCOPE 12577 TEST, FECAL HEMOCCULT SENSA 12649 PAD, OBSTETRICAL VERSALON 3IN X 11IN W/STICK BACK 12965 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE MEDIUM 12966 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE LARGE 14023 TAPE, SURGICAL SOFT CLOTH MEDIPORE H 2IN X 10YD 140706 WIPE, DISINFECTANT QUAT SANICLOTH 8IN X 14IN 65/CANISTER 144217 COVER, PROBE ORAL/RECTAL THERMOMETER 144372 BAG, SPECIMEN TRANSPORT 6IN X 9IN 144654 WIPE, DISINFECTANT 10% BLEACH CLOROX 6IN X 5IN 145989 SHORTS, EXAM DISPOSABLE LG/XL 1

F-3

46330 TAPE, CLOTH ADHESIVE 1IN X 10YD 15714 TUBE, STERILE SALINE PINK 5ML 1

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Appendix G : Complete Supply List for Children’s and Women’s

Item ID Description Clinics1738 PAD, PREP ALCOHOL ISOPROPYL 70% 10R44375 SANITIZER, HAND PURELL W/ALOE 12OZ FOR UH, CVC, MOTT & TC 101160 CUFF, BLOOD PRESSURE INFANT 8CM - 13CM 91170 CUFF, BLOOD PRESSURE CHILD 12CM - 19CM 91171 CUFF, BLOOD PRESSURE ADULT SMALL 17CM - 25CM 91290 TISSUE, FACIAL 2 PLY 91119 COLLECTOR, URINE SINGLE SPECIMEN PEDIATRIC 82750 OTOSCOPE, SPECULUM PEDIATRIC 2.75MM 82751 OTOSCOPE, SPECULUM ADULT 4MM 81149 DEPRESSOR, TONGUE INDIVIDUALLY WRAPPED ADULT 720020 CURETTE, EAR DISPOSABLE PEDIATRIC MICROLOOP 71126 BASIN, EMESIS 700CC NONSTERILE 10IN 61172 CUFF, BLOOD PRESSURE ADULT 23CM - 33CM 61173 CUFF, BLOOD PRESSURE ADULT LARGE 31CM- 40CM 61307 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE XLARGE 61433 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE SMALL 62965 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE MEDIUM 62966 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE LARGE 61040 PAPER, EXAM TABLE SMOOTH 18IN X 225FT 51237 CUFF, BLOOD PRESSURE ADULT THIGH 38CM - 50CM 51640 BANDAGE, FABRIC FLEXIBLE STERILE 1IN X 3IN 51759 UNDERPAD, DISPOSABLE 23IN X 24 51971 BASIN, WASH FACE DISPOSABLE NONSTERILE 7 QT 544217 COVER, PROBE ORAL/RECTAL THERMOMETER 51014 TAPE, MEASURING METRIC AND INCH NONSTERILE 41121 COLLECTOR, URINE SINGLE SPECIMEN NEWBORN 41295 GLOVE, EXAM VINYL TRILON X-LARGE 42540 OINTMENT, PETROLATUM WHITE 5GM 42961 GLOVE, EXAM VINYL TRILON SMALL 443019 WIPES, BABY 4603 CUP, PLASTIC CLEAR 7OZ 41013 PINS, SAFETY NONSTERILE 1 7/8IN 31015 COVER, EXAM LIGHT DISPOSABLE 31031 CONTAINER, SPECIMEN W/LID STERILE 4OZ 31060 TOWELETTE, PREMOISTENED 31715 GAUZE, FINE MESH PACKING STERILE 1/2IN X 5YD 32021 ANOSCOPE, PLASTIC 323028 SPECULUM, ENDOCERVICAL KOGEN WIDE W/ GAUGE & SCREWS NONSTERI 323031 CURETTE, ENDOCERVICAL KEVORKIAN-YOUNGE 12IN NARROW TIP NONST 325123 GAUZE, FINE MESH PACKING STERILE 1/4IN X 5YD 32524 MASK, SURGICAL TIE ON 32526 DEVELOPER, HEMOCCULT SENSA 32557 GOWN, PROTECTIVE PLASTIC DISPOSABLE 325584 SPECULUM, VAGINAL PEDERSON MEDIUM 4IN X 7/8IN NONSTERILE 32579 LUBRICANT, JELLY WATER SOLUBLE 4OZ W/FLIP-TOP CAP 325955 COVER, PROBE TYMPANIC FOR THERMOSCAN 3

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2844 SPECULUM, VAGINAL DISPOSABLE MEDIUM 343087 KIT, TEST TUBE VIRAL (INC. FLU), CHLAMYDIA & GC M4 W/ FLOCKE 34350 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 6 34351 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 6.5 34352 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 7 34353 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 7.5 34354 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 8 34355 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 8.5 344623 KIT, TEST TUBE CHLAMYDIA & GC FOR ENDOCERVICAL 344624 KIT, TEST TUBE CHLAMYDIA & GC FOR URETHRAL 344626 KIT, TEST TUBE CHLAMYDIA & GC FOR VAGINAL 344644 BRUSHES, CYTOLOGY 344648 KIT, TEST TUBE CHLAMYDIA & GC FOR URINE 3480 FORMULA, WATER STERILE 2OZ 35266 SUB/ BOTTLE, IRRIGATION SODIUM CHLORIDE 0.9% 1000ML STERILE 36119 SPECULUM, NASAL 36120 SPECULUM, VAGINAL GRAVES LARGE 36121 SPECULUM, VAGINAL GRAVES MEDIUM 36122 SPECULUM, VAGINAL PEDERSON NARROW MEDIUM 36125 SPECULUM, VAGINAL PEDERSON MEDIUM 3RS0002 CONTAINER, SHARPS GATORGUARD 2GAL FOR EVS/OR 31107 APPLICATOR, COTTON TIP 6IN STERILE 21741 SPONGE, GAUZE STERILE 8 PLY 4IN X 4IN 21757 TAPE, SURGICAL PAPER MICROPORE 1IN X 10YD 220019 CURETTE, EAR DISPOSABLE CURVED NONSTERILE 220021 CURETTE, EAR DISPOSABLE LOOP END NONSTERILE 22006 HAMMER, PERCUSSION NONSTERILE 8IN 225185 CURETTE, EAR DISPOSABLE YELLOW 22538 LUBRICANT, JELLY WATER SOLUBLE 3GR 22543 DIAPER, SIZE 1 8LB - 14LB 22556 DIAPER, SIZE 3 16LB - 28LB 22568 DIAPER, SIZE 4 22LB - 37LB 243085 SWAB, FLOCKED IN AEROBIC TRANSPORT 21016 TAPE, MEASURING PAPER 36IN 11050 SWAB, ORAL DISPOSABLE 11054 REMOVER, ADHESIVE 1/2OZ 11063 ALCOHOL, RUBBING 70% ISOPROPYL 16OZ 11109 SWAB, 10% POVIDONE IODINE 1.7ML 11123 BAG, URINARY LEG W/18IN TUBING 500ML 11175 GLOVE, EXAM VINYL TRILON LARGE 11176 GLOVE, EXAM VINYL TRILON MEDIUM 11289 TRAY, CATHETER FOLEY 16FR & 200ML URIMETER 11639 BANDAGE, VINYL CARTOON 3/4IN X 3IN 11667 BALLS, PREPPING COTTON NONSTERILE MEDIUM 11707 SPONGE, DRAIN TRACHEOTOMY 6 PLY STERILE 4IN X 4IN 11714 STRIPS, PACKING IODOFORM STERILE 1/2IN X 5YD 11719 STRIP, STERI SKIN CLOSURE 1/2 X 4IN 11720 STRIP, STERI SKIN CLOSURE 1/4 X 2IN 11739 SPONGE, GAUZE STERILE 8 PLY 2IN X 2IN 11791 SYRINGE, W/O NEEDLE 5ML 1

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1792 SYRINGE, W/O NEEDLE 10ML 11796 SYRINGE, W/O NEEDLE 60ML 11812 SPONGE, GAUZE TRACH STERILE 6 PLY 2IN X 2IN 12298 BLANKET, WARMING FULL ACCESS PEDIATRIC 36IN X 33IN 12511 ADHESIVE, LIQUID MASTISOL 2/3 CC AMPULE 12523 MASK, PROCEDURE EAR LOOPS 12528 OINTMENT, TRIPLE ANTIBIOTIC .9GR 125318 WIPE, DISINFECTANT QUAT 15% ALCOHOL SANICLOTH PLUS 6IN 125592 SPONGE, GAUZE NONSTERILE 12 PLY 4IN X 4IN 12641 MASK, SURGICAL TIE ON ANTI-FOG 136584 SCRUB, SURGICAL HAND ALCOHOL AVAGARD W/ MOISTURIZER 500ML 140706 WIPE, DISINFECTANT QUAT SANICLOTH 8IN X 14IN 65/CANISTER 143691 PAPER, EXAM TABLE BUGS-N-THINGS 18IN X 225FT 144372 BAG, SPECIMEN TRANSPORT 6IN X 9IN 14602 TRAY, STAPLE REMOVER TWEEZER STERILE 156348 GEL, ULTRASOUND AQUASONIC 20G STERILE 16052 FORCEP, IRIS 16090 SCISSORS, IRIS CURVED 16092 SCISSORS, OR SHARP/BLUNT 1

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Appendix H: Complete Supply List for MPU

Item ID Description Clinics1640 BANDAGE, FABRIC FLEXIBLE STERILE 1IN X 3IN 41738 PAD, PREP ALCOHOL ISOPROPYL 70% 41774 NEEDLE, 18GA 1 1/2 IN SHORT BEVEL 41788 SYRINGE, W/O NEEDLE 3ML 41792 SYRINGE, W/O NEEDLE 10ML 42557 GOWN, PROTECTIVE PLASTIC DISPOSABLE 41063 ALCOHOL, RUBBING 70% ISOPROPYL 16OZ 31757 TAPE, SURGICAL PAPER MICROPORE 1IN X 10YD 31784 NEEDLE, FILTER 19 GA 1 1/2IN 34301 STRAP, TOURNIQUET 1IN X 18IN 35108 CANNULA, BLUNT IV LOCKING DEHP FREE 35338 TUBING, IV MACRODRIP PRIMARY VENT 2-Y 80IN DEHP FREE 31146 GEL, ULTRASOUND LIQUASONIC 8OZ 211545 NEEDLE, 25GA X 1IN SAFETY 21178 GLOVE, LATEX TRIUMPH 6.5 21180 GLOVE, LATEX TRIUMPH 7.5 21181 GLOVE, LATEX TRIUMPH 8 21246 MARKER, SKIN STERILE SURGICAL 21433 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE SMALL 21739 SPONGE, GAUZE STERILE 8 PLY 2IN X 2IN 21754 TAPE, SURGICAL TRANSPARENT TRANSPORE 1IN X 10YD 21759 UNDERPAD, DISPOSABLE 23IN X 24 21791 SYRINGE, W/O NEEDLE 5ML 21794 SYRINGE, W/O NEEDLE 20ML 21911 TUBING, SUCTION 5MM X 10FT STERILE 21992 CATHETER, IV BLUE 22GA X 1.00IN SAFETY 22513 REMOVER, POLISH NAIL 22523 MASK, PROCEDURE EAR LOOPS 225318 WIPE, DISINFECTANT QUAT 15% ALCOHOL SANICLOTH PLUS 6IN 22545 UNDERPAD, DISPOSABLE 23IN X 36IN 226303 ATOMIZER, MUCOSAL WITHOUT SYRINGE 22689 STOPCOCK, 4 WAY SMALL BORE W/ROTATING ADAPTER DEHP FREE 22965 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE MEDIUM 22966 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE LARGE 24351 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 6.5 24352 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 7 244372 BAG, SPECIMEN TRANSPORT 6IN X 9IN 246520 TOWEL, BLUE 17IN X 27IN STERILE 1/PK 25102 TUBING, IV 2 Y-SITE W/ CHECK VALVE & CLAMP 100IN DEHP FREE 25264 BAG, IV SODIUM CHLORIDE 0.9% 500ML 25266 SUB/ BOTTLE, IRRIGATION SODIUM CHLORIDE 0.9% 1000ML STERILE 25270 BAG, IV SODIUM CHLORIDE 0.9% 1000ML 25334 TUBING, EXTENSION IV W/ 2 PREPIERCED Y-SITES 40IN DEHP FREE 25335 PLUG, MALE LUER PREPIERCED 25337 CANNULA, SYRINGE BLUNT 18GA X 1IN 21031 CONTAINER, SPECIMEN W/LID STERILE 4OZ 1

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1035 CUP, MEDICINE CLEAR PLASTIC 1OZ 11036 CUP, DENTURE PLASTIC NEON GREEN W/LID 11041 TOWEL, POLY TISSUE 2PLY 13IN X 18IN 11054 REMOVER, ADHESIVE 1/2OZ 11070 SOLUTION, SCRUB CHLORHEXIDINE 4% 4OZ 11073 SOLUTION, PREP 10% POVIDONE IODINE 2OZ 11075 WRISTBAND, IDENTIFICATION ADULT 11107 APPLICATOR, COTTON TIP 6IN STERILE 111070 PAD, GROUND ADULT W/O CORD EAA/KEC/LSC 11109 SWAB, 10% POVIDONE IODINE 1.7ML 11126 BASIN, EMESIS 700CC NONSTERILE 10IN 11149 DEPRESSOR, TONGUE INDIVIDUALLY WRAPPED ADULT 11153 TRANSDUCER, TRANSPAC IV DISPOSABLE 111540 NEEDLE, VACUTAINER MULTI-SAMPLE STERILE 21GA SAFETY 111544 CATHETER, IV WINGED 24GA X 5/8IN SAFETY 111547 NEEDLE, 21GA X 1 1/2IN SAFETY 111556 SYRINGE, W/O NEEDLE 1ML 111557 NEEDLE, 23GA X 1IN SAFETY 11164 ELECTRODE, ECG NEONATAL/PEDIATRIC 11165 ELECTRODE, ECG POSITRACE ADULT (3 PACK) 11171 CUFF, BLOOD PRESSURE ADULT SMALL 17CM - 25CM 11172 CUFF, BLOOD PRESSURE ADULT 23CM - 33CM 11173 CUFF, BLOOD PRESSURE ADULT LARGE 31CM- 40CM 11175 GLOVE, EXAM VINYL TRILON LARGE 11176 GLOVE, EXAM VINYL TRILON MEDIUM 111781 SPHYGMOMANOMETER, ANEROID ADULT 11179 GLOVE, LATEX TRIUMPH 7 11183 GLOVE, LATEX BIOGEL SENSOR 6 11184 GLOVE, LATEX BIOGEL SENSOR 6.5 11185 GLOVE, LATEX BIOGEL SENSOR 7 11186 GLOVE, LATEX BIOGEL SENSOR 7.5 11187 GLOVE, LATEX BIOGEL SENSOR 8 11188 GLOVE, LATEX BIOGEL SENSOR 8.5 11201 CANNULA, NASAL OVER THE EAR FLARED 11215 BUTTERFLY, INFUSION 21GA X .75IN W/12IN TUBING SAFETY 11216 BUTTERFLY, BLOOD COLLECTION 23GA X .75IN SAFETY-LOK 11234 TUBING, ARTERIAL PRESSURE 36IN 11237 CUFF, BLOOD PRESSURE ADULT THIGH 38CM - 50CM 11242 PACK, COLD INSTANT 6IN X 9IN 11253 DONUT, RING NONSTERILE 7IN 11266 SET, SUTURE REMOVAL 11267 HANDLE, SUCTION YANKAUER W/O CONTROL VENT 11268 HANDLE, SUCTION YANKAUER W/CONTROL VENT 11278 TRAY, DRY PREP 11286 TRAY, PREP PREOP SKIN GEL 11290 TISSUE, FACIAL 2 PLY 11298 CUFF, BLOOD PRESSURE DISPOSABLE ADULT THIGH 38CM - 50CM 11299 CUFF, BLOOD PRESSURE DISPOSABLE ADULT 23CM - 33CM 11307 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE XLARGE 11352 CUFF, BLOOD PRESSURE DISPOSABLE CHILD 12CM - 19CM 1

H-2

1409 APPLICATOR, CHLORAPREP W/ ORANGE TINT 26ML 11411 APPLICATOR, CHLORAPREP W/ ORANGE TINT 10.5ML 11415 APPLICATOR, CHLORAPREP W/ ORANGE TINT 3ML 11478 NEEDLE, HUBER MINILOC WINGED W/ Y SITE 22GA X .75IN SAFETY 11529 TAPE, SURGICAL SOFT CLOTH MEDIPORE H 1IN X 10YD 11592 CAP, PERITONEAL DIALYSIS DISCONNECT W/ POVIDONE IODINE MINI 11639 BANDAGE, VINYL CARTOON 3/4IN X 3IN 11695 PAD, ABDOMINAL STERILE 8IN X 10IN 11699 DRESSING, TRANSPARENT TEGADERM HP W/ FRAME 2 3/8 X 2 3/4IN 11700 DRESSING, TRANSPARENT TEGADERM HP W/ FRAME 4 X 4 3/4IN 11718 STRIP, STERI SKIN CLOSURE 1/4 X 4IN 11740 SPONGE, ALL PURPOSE NONSTERILE 3PLY 4IN X 4IN 11741 SPONGE, GAUZE STERILE 8 PLY 4IN X 4IN 11742 SPONGE, GENERAL USE STERILE 4IN X 4IN 11751 TAPE, SURGICAL SILK DURAPORE 1IN X 10YD 11752 TAPE, SURGICAL SILK DURAPORE 2IN X 10YD 11753 TAPE, SURGICAL ELASTIC MICROFOAM 4IN X 5 1/2YD 11768 NEEDLE, 25GA X 1 1/2IN 11776 NEEDLE, HUBER MINILOC W/ Y SITE 20GA X 1IN SAFETY 11779 NEEDLE, SPINAL QUINCKE BLACK 22GA X 3.5IN 11781 NEEDLE, SPINAL QUINCKE PINK 18GA X 3.5IN 11782 NEEDLE, SPINAL QUINCKE BLUE 25GA X 3.5 IN 11783 NEEDLE, SPINAL QUINCKE TAN 26GA X 3.5IN 11787 SYRINGE, CATHETER TIP 2OZ 11795 SYRINGE, W/O NEEDLE 30ML 11796 SYRINGE, W/O NEEDLE 60ML 11814 VACUTAINER, BLOOD SST YELLOW 5ML W/ CLOT ACTIVATOR SAFETY 11818 VACUTAINER, BLOOD LAVENDER 3ML W/ K2DETA SAFETY 11849 TRAP, SPECIMEN MUCUS W/O CATHETER 40CC 11910 TUBING, SUCTION 5MM X 6FT STERILE 11971 BASIN, WASH FACE DISPOSABLE NONSTERILE 7 QT 11979 BOWL, SOLUTION PLASTIC STERILE 1QT 11996 CATHETER, IV YELLOW 24GA X .75IN SAFETY 12001 SET, CAPD SOLUTION TRANSFER 48IN 12009 BEDPAN, PONTOON STYLE MEDIUM 12010 BEDPAN, FRACTURE DISPOSABLE 12018 INSTRUMENT, SIGMOIDOSCOPIC SUCTION 18FR 12036 REMOVER, ADHESIVE 12044 URINAL, MALE W/COVER PLASTIC DISPOSABLE 12110 JAR, FORMALIN PLASTIC 2OZ/30ML 10% 12122 DRAPE, SHEET 3/4 TIBURON 57IN X 76IN 12129 GOWN, IMPERVIOUS ASTOUND X-LARGE LEVEL 4 STERILE DISPOSABLE 12143 DRAPE, THYROID TIBURON 77IN X 122.5IN 12153 DRAPE, EXTREMITY TIBURON 87IN X 128.5IN 12154 DRAPE, LAPAROTOMY TRANSVERSE TIBURON 106IN X 122IN X 77IN 122029 NEEDLE, HUBER MINILOC WINGED W/ Y SITE 20GA X .75IN SAFETY 12244 SENSOR, PULSE OX ADULT REUSABLE 124082 GAUZE, PACKING IODOFORM STERILE 1/4IN 124502 BUTTERFLY, BLOOD COLLECTION 23GA X .75IN PUSH BUTTON 12511 ADHESIVE, LIQUID MASTISOL 2/3 CC AMPULE 1

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2522 CAP, BOUFFANT LARGE 24IN 12531 COVER, PILLOW WATERPROOF 21IN X 30IN 12535 STRIP, BLOOD TEST GLUCOSE 125438 TAPE, SURGICAL PAPER MICROPORE 2IN X 10YD 12547 SLIPPER, SLIP RESISTANT DOUBLE TREAD LARGE ADULT 12548 SLIPPER, SLIP RESISTANT DOUBLE TREAD XX-LARGE ADULT 12550 COVER, SHOE NONCONDUCTIVE DISPOSABLE 125501 ALCOHOL, ISOPROPYL 70% 1GAL 125592 SPONGE, GAUZE NONSTERILE 12 PLY 4IN X 4IN 12567 GOGGLES, EYESHIELDZ 12573 CLAMP, DIALYSIS OUTLET PORT 12579 LUBRICANT, JELLY WATER SOLUBLE 4OZ W/FLIP-TOP CAP 125952 PAPER, SONY ULTRASOUND 126087 CANNULA, NASAL ADULT 16FT 126253 CAP, SURGEON TIE BACK 126501 GUARD, EASY MOUTH 12654 VACUTAINER, BLOOD BLUE 2.7ML SODIUM CITRATE SAFETY 12769 DRESSING, SOFT CLOTH ADHESIVE MEDIPORE +PAD 2 3/8 X 4IN 128009 COVER, STERILE 36IN X 20IN 12829 PAD, DEFIBRILLATOR PACING ADULT RADIOTRANSPARENT 12830 PAD, DEFIBRILLATOR PACING PEDIATRIC RADIOTRANSLUCENT 128533 COVER, PROBE SITE RITE WITH GEL 6IN X 48IN 128620 SCALE, SPRING 128644 CAP, INJECTION SEALING 128654 TUNNELING DEVICE 12868 DRESSING, TRANSPARENT TEGADERM +PAD 2 X 2 3/4IN 12885 WRAP, SELF ADHERING TAN 2IN X 5YD NONSTERILE 12898 SET, TRANSFER MINICAP EXTENDED LIFE 6IN W/TWIST CLAMP 12961 GLOVE, EXAM VINYL TRILON SMALL 12986 SYRINGE, SALINE POSIFLUSH 10ML IN 10ML 130005 MASK, TRACHEOSTOMY 13013 CONTRAST, IV OMNIPAQUE 240MG/ML IN 50ML PLASTIC 13026 CONTRAST, IV VISIPAQUE 270MG/50ML 13103 SEALANT, SURGICEL 2IN X 14IN 131035 BLOCK, BITE OMNIBLOC FOR ENDOSCOPY 131985 CLIP, ENDOSCOPIC RESOLUTION 11CM X 235CM 133999 DEVICE, BALLOON INFLATION BASIX 135736 SUB/ SET, EXTENSION MACROBORE W/PREPIERCED T-SITE 5IN DEHP-F 136584 SCRUB, SURGICAL HAND ALCOHOL AVAGARD W/ MOISTURIZER 500ML 137495 DRESSING, ANTIMICROBIAL BIOPATCH DISK 3/4IN WITH 1.5MM 137496 DRESSING, ANTIMICROBIAL BIOPATCH DISK 1IN X 4.0MM HOLE FOR 138454 DRESSING, TRANSPARENT TEGADERM IV W/ BORDER 3 1/2 X 4 1/2IN 138456 DRESSING, TRANSPARENT TEGADERM IV W/ BORDER 2 3/4 X 3 1/4IN 138458 CATHETER, IV JELCO 24GA X 3/4IN 140534 CONTRAST, IV ISOVUE 250MG/ML IN 50ML 140706 WIPE, DISINFECTANT QUAT SANICLOTH 8IN X 14IN 65/CANISTER 142046 SNARE, POLYPECTOMY 7FR X 3CM X 4.5CM 142048 BRUSH, CYTOLOGY FOR GI 142051 SNARE, POLYPECTOMY 7FR X 1.5CM X 3CM 142052 NEEDLE, INJECTION FOR ENDOSCOPY 25GA X 5MM 1

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42877 NET, RETRIEVER STANDARD ROTH 2.5MM X 230CM 142930 BLADE, CLIPPER SURGICAL FIXED HEAD 143290 NEEDLE, SPINAL QUINCKE 22GA X 6IN 143291 NEEDLE, SPINAL QUINCKE 25GA X 6IN 143308 TRAY, SPINAL ACCESS 18GA X 1.5IN 25GA X 1.5IN 2GA X 1.25IN 143405 CONTRAST, MRI PROHANCE 20ML 14350 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 6 143518 SYRINGE, W/O NEEDLE 60ML SLIP TIP 14353 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 7.5 14354 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 8 14355 GLOVE, POLYCHLOROPRENE BIOGEL SKINSENSE 8.5 143677 FORCEP, RADIAL JAW 4 COLD BIOPSY 2.4MM X 240CM SINGLE USE 144217 COVER, PROBE ORAL/RECTAL THERMOMETER 14441 LINER, SUCTION 1500CC W/O TUBE 145131 KIT, IRRIGATION PUMP TUBING W/ SMART CAP 102IN 14609 SUTURE, ETHIBOND 3-0 KS GREEN 30IN 14611 SUTURE, CHROMIC GUT 2-0 CT-1 27IN 14620 SUTURE, SILK 2-0 FSL BLACK 18IN 14631 SUTURE, SILK 3-0 BB BLACK 30IN 14640 SUTURE, SILK 4-0 TIES BLACK 18IN 12/PK 14686 SUTURE, SILK 3-0 SH CR BLACK 18IN 8/PK 147191 GLOVE, POLYISOPRENE BIOGEL INDICATOR 6 15103 TUBING, IV BLOOD UNVENTED W/ 180 MICRON FILTER 15250 BAG, IV SODIUM CHLORIDE 0.9% 250ML 15260 BAG, IV DEXTROSE 5% SODIUM CHLORIDE 0.9% 1000ML 15269 SUB/ BOTTLE, IRRIGATION WATER 1000ML 15308 ANTICOAGULANT, CITRATE DEXTROSE 1000ML 15341 CANNULA, BLUNT IV LOCKING FOR HOSPIRA 15412 TUBING, EXTENSION IV MICROBORE T-CONNECTOR 5IN W/ SPIN COLLA 15416 SUB/ TUBING, BLOOD Y-TYPE NONVENTED 100IN DEHP FREE 156348 GEL, ULTRASOUND AQUASONIC 20G STERILE 15703 BAG, DIALYSIS DEXTROSE 1.5% 1L LUER 15742 BAG, DIALYSIS ULTRABAG LOW CALCIUM DEXTROSE 1.5% 2L 1602 CUP, STYROFOAM 10OZ 16071 HANDLE, KNIFE 3 1R44375 SANITIZER, HAND PURELL W/ALOE 12OZ FOR UH, CVC, MOTT & TC 1R85011 WIPE, CLOTH CHG 2% 2/PK "FOR ICU/L&D/OR/PACU/7E&W/8A&B/SPINE 1

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Appendix I: Complete Supply List for MSK

Item ID Description Clinics1640 BANDAGE, FABRIC FLEXIBLE STERILE 1IN X 3IN 61107 APPLICATOR, COTTON TIP 6IN STERILE 41109 SWAB, 10% POVIDONE IODINE 1.7ML 41176 GLOVE, EXAM VINYL TRILON MEDIUM 41063 ALCOHOL, RUBBING 70% ISOPROPYL 16OZ 31175 GLOVE, EXAM VINYL TRILON LARGE 31290 TISSUE, FACIAL 2 PLY 31639 BANDAGE, VINYL CARTOON 3/4IN X 3IN 31738 PAD, PREP ALCOHOL ISOPROPYL 70% 31739 SPONGE, GAUZE STERILE 8 PLY 2IN X 2IN 31741 SPONGE, GAUZE STERILE 8 PLY 4IN X 4IN 31759 UNDERPAD, DISPOSABLE 23IN X 24 32961 GLOVE, EXAM VINYL TRILON SMALL 35266 SUB/ BOTTLE, IRRIGATION SODIUM CHLORIDE 0.9% 1000ML STERILE 36090 SCISSORS, IRIS CURVED 36091 SCISSORS, OR SHARP/SHARP 31126 BASIN, EMESIS 700CC NONSTERILE 10IN 21149 DEPRESSOR, TONGUE INDIVIDUALLY WRAPPED ADULT 21295 GLOVE, EXAM VINYL TRILON X-LARGE 21714 STRIPS, PACKING IODOFORM STERILE 1/2IN X 5YD 21728 GAUZE, ROLL KERLIX STERILE 4 1/2IN X 4YD 21732 GAUZE, ROLL KERLIX STERILE 2 1/4IN X 3YD 21751 TAPE, SURGICAL SILK DURAPORE 1IN X 10YD 21754 TAPE, SURGICAL TRANSPARENT TRANSPORE 1IN X 10YD 21757 TAPE, SURGICAL PAPER MICROPORE 1IN X 10YD 22009 BEDPAN, PONTOON STYLE MEDIUM 22531 COVER, PILLOW WATERPROOF 21IN X 30IN 225318 WIPE, DISINFECTANT QUAT 15% ALCOHOL SANICLOTH PLUS 6IN 22552 SOLUTION, HYDROGEN PEROXIDE 3% 16OZ 225592 SPONGE, GAUZE NONSTERILE 12 PLY 4IN X 4IN 22565 BRIEF, INCONTINENT ADULT LARGE 24023 TAPE, SURGICAL SOFT CLOTH MEDIPORE H 2IN X 10YD 25714 TUBE, STERILE SALINE PINK 5ML 26052 FORCEP, IRIS 26058 FORCEP, THUMB 2R44375 SANITIZER, HAND PURELL W/ALOE 12OZ FOR UH, CVC, MOTT & TC 21013 PINS, SAFETY NONSTERILE 1 7/8IN 11016 TAPE, MEASURING PAPER 36IN 11018 CLEANSER, SKIN BAG BATH ALOE VESTA 4L 11031 CONTAINER, SPECIMEN W/LID STERILE 4OZ 11040 PAPER, EXAM TABLE SMOOTH 18IN X 225FT 11073 SOLUTION, PREP 10% POVIDONE IODINE 2OZ 11266 SET, SUTURE REMOVAL 11296 REMOVER, LOTION 11301 DRESSING, ELTA DRY HYDROGEL W/ FOAM 4IN X 4IN 11420 HYDROGEL, WOUND DRESSING SOLOSITE 3OZ 1

I-1

1424 GLOVE, CHEMO PURPLE NITRILE LARGE 11428 GLOVE, CHEMO PURPLE NITRILE SMALL 11429 GLOVE, CHEMO PURPLE NITRILE MEDIUM 11513 WAFER, FLAT W/ FLOATING FLANGE 1 3/4IN 11570 CLEANSER, SKIN CARE FOAM 8OZ 11650 BANDAGE, ROLL STERILE 3IN X 10YD 11686 DRESSING, ADHESIVE W/ TELFA 2IN X 3IN STERILE 11690 DRESSING, NON-ADHERENT W/OIL EMULSION PAD 3IN X 3IN STERILE 11691 DRESSING, NON-ADHERENT W/ TELFA 3IN X 8IN STERILE 11692 GAUZE, PETROLATUM STERILE 3IN X 9IN 11693 DRESSING, PETROLATUM XEROFORM 1 X 8IN 11694 DRESSING, PETROLATUM XEROFORM 5 X 9IN 11699 DRESSING, TRANSPARENT TEGADERM HP W/ FRAME 2 3/8 X 2 3/4IN 11700 DRESSING, TRANSPARENT TEGADERM HP W/ FRAME 4 X 4 3/4IN 11706 UNAVAILABLE/ DRESSING, VIGILON HYDROGEL SHEET STERILE 4IN X 11708 DRESSING, FOAM COPA 4IN X 4IN STERILE 11719 STRIP, STERI SKIN CLOSURE 1/2 X 4IN 11720 STRIP, STERI SKIN CLOSURE 1/4 X 2IN 11722 DRESSING, NON-ADHERENT W/ TELFA 3IN X 6IN STERILE 11827 CATHETER, LATEX RED ROBINSON STRAIGHT TIP 8FR X 16IN 11828 CATHETER, LATEX RED ROBINSON STRAIGHT TIP 10FR X 16IN 11829 CATHETER, LATEX RED ROBINSON STRAIGHT TIP 12FR X 16IN 11831 CATHETER, LATEX RED ROBINSON STRAIGHT TIP 16FR X 16IN 11834 CATHETER, URINARY MALE EXTERNAL 32MM 11835 CATHETER, URINARY MALE EXTERNAL 25MM 11836 CATHETER, URINARY MALE EXTERNAL 36MM 11837 CATHETER, URINARY MALE EXTERNAL 29MM 11961 CATHETER, STRAIGHT TIP 14FR X 16IN 11971 BASIN, WASH FACE DISPOSABLE NONSTERILE 7 QT 11979 BOWL, SOLUTION PLASTIC STERILE 1QT 120019 CURETTE, EAR DISPOSABLE CURVED NONSTERILE 12010 BEDPAN, FRACTURE DISPOSABLE 12025 WIPE, SKIN BARRIER FILM CAVILON 12031 WAFER, STOMAHESIVE 4IN X 4IN 12036 REMOVER, ADHESIVE 125054 SCISSORS, STITCH SPENCER 3 1/2IN DELICATE NONSTERILE 12511 ADHESIVE, LIQUID MASTISOL 2/3 CC AMPULE 125117 PAPER, EXAM TABLE SMOOTH 21IN X 225FT 125126 TAPE, SURGICAL SOFT CLOTH MEDIPORE H 4IN X 10YD 125164 PAPER, EXAM TABLE CREPE 21IN X 125FT 12528 OINTMENT, TRIPLE ANTIBIOTIC .9GR 12537 LOTION, HAND CHG COMPATABLE 2OZ 125372 DRESSING, ADHESIVE TELFA MINI ISLAND 2IN X 3IN 12538 LUBRICANT, JELLY WATER SOLUBLE 3GR 125438 TAPE, SURGICAL PAPER MICROPORE 2IN X 10YD 125587 BANDAGE, ELASTIC CONFORM 1IN X 75IN STERILE 12564 BRIEF, INCONTINENT ADULT MEDIUM 30IN-44IN WAIST 125646 PADDING, UNDERCAST NONSTERILE 3IN X 4YD 12571 BANDAGE, ELASTIC CONFORM 2IN X 75IN STERILE 12579 LUBRICANT, JELLY WATER SOLUBLE 4OZ W/FLIP-TOP CAP 1

I-2

2586 BANDAGE, ELASTIC CONFORM 4IN X 75IN STERILE 12587 TAPE, ZINC OXIDE BASE WATERPROOF 1IN X 5YD 125911 DRESSING, ADHESIVE W/ TELFA 3IN X 4IN STERILE 12694 TAPE, SURGICAL SILK DURAPORE 3IN X 10YD 12769 DRESSING, SOFT CLOTH ADHESIVE MEDIPORE +PAD 2 3/8 X 4IN 12863 PILLOW, DISPOSABLE 16.5IN X 22IN 8OZ 129196 SCISSORS, CAST SERIAL FINGER 3 1/2IN 12965 SUB/ GLOVE, CHEMO SENSICARE ICE NITRILE MEDIUM 12970 GLOVE, LATEX BIOGEL ORTHO 7 12971 GLOVE, LATEX BIOGEL ORTHO 7.5 12975 GLOVE, LATEX BIOGEL ORTHO 6.5 131190 DRESSING, HYDROCOLLOID DUODERM EXTRA THIN CGF 2IN X 4IN 131191 DRESSING, HYDROCOLLOID DUODERM EXTRA THIN CGF 1IN X 1 1/4IN 131192 DRESSING, DUODERM HYDROACTIVE GEL 131379 BANDAGE, KNUCKLE 131750 BANDAGE, FLEXIBLE CO-FLEX 1IN X 5YD TAN COHESIVE 136457 DRESSING, NON-ADHERENT 2IN X 3IN STERILE 140630 GLOVE, SINGLE STERILE POWDERED SENSICARE LATEXFREE MEDIUM 143019 WIPES, BABY 143175 DRESSING, SOFT CLOTH ADHESIVE MEDIPORE +PAD 3 1/2 X 8IN 14324 CATHETER, STRAIGHT TIP 16FR X 16IN 143697 STRAP, FINGER BUDDY 14404 CATHETER, FOLEY STERILE 12FR 5CC 14405 CATHETER, FOLEY STERILE 14FR 5CC 14406 CATHETER, FOLEY STERILE 16FR 5CC 14407 CATHETER, FOLEY STERILE 18FR 5CC 144217 COVER, PROBE ORAL/RECTAL THERMOMETER 14452 TRAY, LUMBAR PUNCTURE ADULT W/ MANOMETER AND 22GA NEEDLE 14477 DRESSING, HYDROCOLLOID RESTORE 4IN X 4IN 14602 TRAY, STAPLE REMOVER TWEEZER STERILE 146329 TAPE, CLOTH ADHESIVE 1/2IN X 10YD 146330 TAPE, CLOTH ADHESIVE 1IN X 10YD 146520 TOWEL, BLUE 17IN X 27IN STERILE 1/PK 14672 CATHETER, COUDE OLIVE TIP 14FR X 16IN 14673 CATHETER, COUDE OLIVE TIP 16FR X 16IN 15269 SUB/ BOTTLE, IRRIGATION WATER 1000ML 1602 CUP, STYROFOAM 10OZ 16027 FORCEP, RIGHT ANGLE DELICATE 6 1/4IN 1603 CUP, PLASTIC CLEAR 7OZ 1604 CUP, STYROFOAM 16OZ 16046 FORCEP, ALLIS 16064 HEMOSTAT, KELLY CURVED 5 1/2IN 16065 HEMOSTAT, CURVED 6 1/4IN 16066 HEMOSTAT, MOSQUITO CURVED HALSTEAD 16067 HEMOSTAT, MOSQUITO STRAIGHT HALSTEAD 16068 HEMOSTAT, KELLY STRAIGHT 5 1/2IN 16079 HOLDER, NEEDLE MAYO-HEGAR 16096 SCISSORS, STRABISMUS STRAIGHT 16219 HOLDER, NEEDLE WEBSTER 16240 RONGEUR, BONE LEMPERT 1

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Appendix J: Complete Restocking List of Adult

Clinics InformationCardiology As needed, weekly for sureGeneral Medicine As needed, weekly for sureHepatology As needed, weekly for sureOB/GYN Reproductive Endo Restock daily to PAR; Some supplies more often whenever

lowPulmonary As needed, usually every Tuesday and ThursdayHem/Onc Refill as needed, keep at least a handful of everythingNeurology Twice a week; Fill each bin; Biggest mover is safety pinsAllergy Daily at end of dayGI Daily at end of dayMaternal Fetal Medicine Restock daily to PAROB/GYN Minimally Invasive Surg Restock daily to PAROB/GYN Uro/Gyn Restock daily to PARPre-Operative Every 1-2 weeks to PAR

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Appendix K: Complete Restocking List of Children’s and Women’s

Clinics InformationGeneral Pediatrics As needed, not routineOB/GYN As needed; Weekly orderRheumatology As needed; Weekly orderUrology As needed; Weekly orderHem Onc Every WednesdayNephrology Varies based on week, usually 1-2 times per week to PARNeurology Varies based on week, usually 1-2 times per week to PARPeds Surgery 1 time on Friday to PAR; Maybe 2 times on Wednesday and Friday to PARPulmonary Varies based on week, usually 1-2 times per week to PARCardiology Every other day; Make sure everything is there

K-1

Appendix L: Complete Restocking List of MPU

Clinics InformationCardiology Top off everyday or every other day;Never stock out; Overstock bite blocksNephrology Daily to PAR; Rarely stock out, occasionally more specialized itemsPM&R As needed; Depends on the number of procedure; Check inventory weeklyGI As needed - varies based on throughput

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Appendix M: Complete Restocking List of MSK

Clinics InformationNeurosurgery As neededPT/OT MedSport Daily to PAR; As neededRheumatology As needed, fill to ample amountOrthopaedics Adult Restock as needed to PAR; New order once a weekPain/Anesthesia As neededPM&R Adult & Peds Weekly Check; Rarely run out; Never overstock

M-1

Appendix N: Complete Linens List for Adult

Clinics InformationCardiology Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), 5X

Gown (8135)General Medicine Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), 5X

Gown (8135)Hepatology Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), 5X

Gown (8135)OB/GYN Reproductive Endo Pillowcase (8005), Draw Sheet (8010), Lg. Sheet (8011), Bath

Towel (8013), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

Pulmonary Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

Hem/Onc Draw Sheet (8010), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

Neurology Bath Blanket (8001), Lg. Sheet (8011), Bath Towel (8013), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

Allergy Bath Towel (8013), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

GI Bath Towel (8013), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

Maternal Fetal Medicine Pillowcase (8005), Bath Towel (8013), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

OB/GYN Minimally Invasive Surg

Pillowcase (8005), Bath Towel (8013), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

OB/GYN Uro/Gyn Pillowcase (8005), Bath Towel (8013), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

Pre-Operative Pillowcase (8005), Draw Sheet (8010), Bath Towel (8013), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

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Appendix O: Complete Linens List for Children’s and Women’s

Clinics InformationGeneral Pediatrics Draw Sheet (8010), Patient Gown (8063), 3X Gown (8064), 5X

Gown (8135)OB/GYN Lg. Sheet (8011), Bath Towel (8013), Patient Gown (8063), 3X

Gown (8064), 5X Gown (8135)Rheumatology Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), 5X

Gown (8135)Urology Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), 5X

Gown (8135)Hem Onc Bath Blanket (8001), Crib Blanket (8002), Bath Towel (8013),

Patient Gown (8063), 3X Gown (8064), Diaper (8122), 5X Gown (8135)

Nephrology Bath Blanket (8001), Crib Blanket (8002), Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), Diaper (8122), 5X Gown (8135)

Neurology Bath Blanket (8001), Crib Blanket (8002), Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), Diaper (8122), 5X Gown (8135)

Peds Surgery Bath Towel (8013), Patient Gown (8063), 3X Gown (8064), Diaper (8122), 5X Gown (8135)

Pulmonary Bath Blanket (8001), Crib Blanket (8002), Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), Diaper (8122), 5X Gown (8135)

Cardiology Crib Blanket (8002), Patient Gown (8063), Diaper (8122)

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Appendix P: Complete Linens List for MPU

Clinics InformationCardiology Bath Blanket (8001), Contour Sheet (8002), Pillowcase (8005),

Bath Towel (8013), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

Nephrology Bath Blanket (8001), Crib Blanket (8002), Pillowcase (8005), Draw Sheet (8010), Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

PM&R Pillowcase (8005), Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

GI Bath Blanket (8001), Pillowcase (8005), Bath Towel (8013), IV Gown (8062), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

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Appendix Q: Complete Linens List for MSK

Clinics InformationNeurosurgery NonePT/OT MedSport Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)Rheumatology Bath Blanket (8001), Pillowcase (8005), Lg. Sheet (8011), Bath

Towel (8013), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

Orthopaedics Adult Contour Sheet (8002), Draw Sheet (8010), Lg. Sheet (8011), Bath Towel (8013)

Pain/Anesthesia Pillowcase (8005), Lg. Sheet (8011), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

PM&R Adult & Peds Lg. Sheet (8011), Bath Towel (8013), Patient Gown (8063), 3X Gown (8064), 5X Gown (8135)

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