Overall design
Since 2013, the department has been exploring the effect of consumable management, including management based on Microsoft Excel tabulation and the later application of failure mode and effect analysis (FMEA) combined with root cause analysis (RCA) [12]. Additionally, an in–out storage management system for the endocrinology department was developed and used.
Management mode
Manual management mode
Consumable application forms were collected and evaluated monthly. Consumables that were not charged as per the doctor’s advice were registered in a paper book after they were used, and those that were charged were recorded in the hospital information system (HIS) by a specially assigned person. After an account was made of all the consumables used at the end of each month, the departmental collection data and the data from the HIS were compared with the manual paper registration data to obtain statistics on consumable management in the department.
Excel-based management mode
Consumables were divided into two Excel spreadsheets, chargeable and nonchargeable. Each consumable item was accounted for using the following four headings: original inventory, new stock, used inventory, and remaining inventory. On the first day of each month, the remaining inventory of the previous month was entered as the original inventory, the supplies acquired in the current month were the new stock, the supplies consumed by routine use were entered as the used inventory, and the remaining inventory was automatically calculated and displayed in real time (original inventory + new collection – used inventory). At the end of each month, the departmental collection data and the data from the HIS were compared with the data in the Excel sheets to obtain statistics on consumable management in the department.
Consumable storage inflow and outflow management system
Expert and R&D teams were established for consumable management. The expert team consisted of eight persons, comprising one medical nursing expert, one surgical nursing expert, two supervisor nurses working on the clinical frontlines, two information experts, and two consumable management experts, who were responsible for reviewing and forming the first draft of the system design. After three rounds of expert team meetings, improvements were made in the aspects of scientific rigor, practicability, safety, and convenience, and a draft was ultimately handed over to the R&D personnel for development, testing, and online use. The R&D team consisted of 10 persons, comprising 2 head nurses, 2 senior nurses, 2 clinical nurses with intermediate professional titles, 2 information engineers, and 2 consumable management engineers, who were responsible for development, testing, adjustment, and application guidance.
The storage inflow and outflow management system was connected to the supply room, equipment warehouse, administrative warehouse, and HIS. The inventory increased automatically after the consumable application form was issued, and the consumable was automatically listed as part of the storage outflow after the consumer was charged. Nonchargeable consumables were released from storage in association with the doctor’s advice or manual entry. The management system was divided into three parts: public consumables, bed consumables, and quality control management. The specific modules, an introduction to the functions, and a demonstration of the software interfaces are shown in Fig. 1.
Through the management system, the head nurses and the consumable management team made a statistical comparison of the quantities of storage inflow and outflow, the quantity charged according to the HIS, the quantity of remaining inventory as recorded in the system, and the actual inventory of the department. Key consumables were tracked every week. If these values were approximately consistent, the collection, use, and charge matching, as well as the department’s consumable management, were found to be reasonable. If the difference was significant, the department faced problems such as possible overstocking of consumables, serious loss, repeated charging, charge missing, and loss of consumables, among others. In the case of an inconsistency, FMEA, RCA, and brainstorming were applied to determine the causes, rectify the problem, and adjust the collected amount in a timely manner [13]. The inventory consumables were checked regularly to ensure that the accounts were consistent with the goods and with each other by real-time monitoring and evaluation through the consumable management system. The closed-loop consumable management system comprised application submissions, distribution and checking, storage inflow and outflow, statistics/feedback, and evaluation/adjustment of applied quantities and types. A brief flow chart is shown in Fig. 2.
Data source
The consumable management practices of the endocrinology department were taken as the research object. Data were collected from three periods during which different modes of management were used: manual record management from January 2013 to February 2015 (hereinafter referred to as the manual management group, Group 1), Excel computer software from March 2015 to February 2018 (hereinafter referred to as the Excel management group, Group 2), and the application management system from March 2018 to December 2019 (hereinafter referred to as the management system group, Group 3). The names and specifications of all low-value consumables were constant and thus comparable across these three periods.
Evaluation indicators
Daily consumable use per bed, also called daily cost per bed, was calculated as follows: daily consumables per bed = [direct cost to the department (total consumable cost for items under 1000 yuan) and indirect cost (water and electricity cost)]/[number of beds × total days (days per month)].
The quantity of monthly consumable storage outflow is the total cost of the consumables under 1000 yuan that are used by the department in one month.
A missed bookkeeping event refers to a failure to charge for an item due to a failure to register, record, or statistically analyse the transaction on time after the use of the consumable.
Expired consumables are defined as medical consumables that are beyond their expiry date due to overstocking, going unnoticed, low frequency of use, or noncompliance with the collection specifications.
Daily inventory time refers to the time required by nurses for daily registration and checking of medical consumables as part of consumable management.
Time spent by main shift nurses on discharge settlement, measured in person-time, is the time it takes the nurse to check the use of medical materials and the corresponding charges when a patient is discharged.
In the blood glucose monitoring management system, a portable blood glucose metre was connected to the hospital HIS system, and the blood glucose results were matched one to one with the patients’ information. The system automatically generated each patient’s fixed-point blood glucose recording table and trend chart and displayed the number of blood glucose measurements from the patient in real time. The number of blood glucose results was equal to the number of blood glucose test strips consumed.
The monthly consumable collection frequency is the number of times medical consumables are requested per month.
The match between the quantities of monthly collection and use was calculated as follows: match = [amount collected/amount used]*100%.
A job burnout scale [14] for nurses was used to interpret the questionnaire data from the Maslach Burnout Inventory. The inventory had 22 items spanning 3 dimensions: emotional fatigue, job indifference, and lack of a sense of achievement. Each item was scored from 0 to 6 points, and the scores were summed within each dimension. The emotional fatigue dimension included nine positively scored items that evaluated emotional reaction caused by work pressure, for a total score of 0–54 points. The dimension of job indifference included five items, which evaluated objectifying attitudes and feelings towards patients due to work pressure; these items were scored positively, and possible scores on this dimension ranged from 0 to 30. The dimension of lack of a sense of achievement included eight items. It evaluated this effect of work pressure on a reverse scale, with a possible total score of 0–48. The scale was demonstrated to have good internal consistency. For the dimensions of fatigue, job indifference, and lack of a sense of achievement, Cronbach’s alpha coefficient (a measure of reliability) was 0.837, 0.869, and 0.881, respectively. The survey was administered to all 22 nurses in the endocrinology department.
Satisfaction of warehouse keeper and collection staff
Satisfaction is most commonly assessed with a single-item instrument such as the visual analogue scale (VAS). The satisfaction VAS is a 10-cm straight line with labels on each end to anchor the scale from ‘not satisfied at all’ to ‘completely satisfied’ [15, 16]. A satisfaction questionnaire (Additional file 1) that included the time of collection, the duration of collection, and the accuracy of nurses’ filling in the form, planning of receiving, times of replacement, dedicated management, reasonable process, time consumption, response speed in case of abnormality, and overall evaluation. There were 10 items worth 10 points each, for a total of 100 points. Staff were asked to place a moving marker on the line to represent their satisfaction, and the position of the marker was measured in millimetres. The distance marked along the line corresponded to a satisfaction score from 0 to 10. The survey questionnaire, with a maximum score of 100 points, was graded in terms of satisfaction: very low (under or equal to 30 points), low (31 to 50 points), moderate (51 to 80 points), high (81 to 92 points), and very high (93 to 100 points). The data were analysed using the R software, version 4.1.0 All data were presented as the mean and SD. For internal reliability, Cronbach’s α was 0.859 (values ≥ 0.7 for the overall score and for each section were considered adequate) [17]; for external reliability, a paired t-test was performed, and an intra-class correlation coefficient of 0.844 was calculated (intra-class correlation coefficient values ≥ 0.7 were considered adequate). Excluding temporary personnel, a total of 5 warehouse keepers and 4 collection staff members participated in the investigation. The questionnaire was self-administered to safeguard the anonymity of the study participants.
Statistical analysis
Statistical analyses were performed using the R software, version 4.1.0. Graphs were drawn using Adobe lllustrator version 2010. Excel was using WPS Office,version 11.0. Normally distributed measurement data are expressed as the mean ± standard deviation (SD), and abnormally distributed measurement data are expressed as the median (upper and lower quartiles). The significance of differences among groups was determined by a paired t-test and McNemar's test. Comparisons between the job burnout scores of nurses within each group were performed by repeated-measures analysis of variance. A P value < 0.05 was considered statistically significant.