Creating an Inventory Culture

A nurse from one of our infusion centers called me and said she was missing 10 Xolair vials from a recent delivery. With a value of about $2,500 per vial, 10 of these amounted to around $25,000 of missing inventory. 

Upon further investigation and a review of the surveillance video from the mixing room, we found the issue. A distributor delivery had arrived early that morning, and the box and cooler were placed on the med room floor. One of our nurses opened the box, removed the packing slip, and started to look through the packing bubbles and ice blocks to unpack the meds. At that point, an infusion pump started alarming, and she quickly dashed off to attend to the patient’s pump. Another nurse came into view and, in a hurry to get some other meds prepared for her next patient, gently nudged the open box to the side with her foot. She nudged the box into a pile of already-opened cardboard boxes, styrofoam coolers, and packing materials from other shipments from that morning’s activities (the trash pile). 

We fast-forwarded through the footage as the day dragged on and saw that no one noticed or remembered the still-unpacked cooler. We all watched with horror as the day ended, the night cleaning crew came in, picked up the day’s unpacked mess, along with our $25,000 of Xolair, and loaded it all into the trash bin. 

This is a true story, and sadly, it was not an isolated incident. We unfortunately had several similar mistakes made by our teams at multiple locations that same year. 

Something needed to change. 

If you work for an infusion center, specialty pharmacy, or home infusion pharmacy, you may already know that inventory management is a big deal. It is common in these environments that you will be holding anywhere from thousands to hundreds of thousands of dollars’ worth of medication at any given time. With those kinds of dollars under management, it is imperative that everyone on the team has what we came to call an “inventory culture”. 

What is an “Inventory Culture”?

An inventory culture is where everyone in the organization is educated on and understands their role in the provisioning, handling, and accounting for medication inventory. 

I know what you are thinking: “Our medications are worth many thousands of dollars—shouldn’t everyone already care about inventory?” You would think so, but as the earlier story and many more like it show, awareness of the high cost of medication is not enough to keep everyone focused on the importance of inventory management. 

A few reasons why:

Some in the organization really may not know the medications $ value

Provide your team with a quick quiz. Pick a medication like Rituxan (rituximab) and ask, “How much do you think a single vial of Rituxan 500mg costs?” Your supply chain team members might know, however, you might find your nurses, pharmacy techs, schedulers, and even RCM team have no idea what kind of value we are talking about (at the time of this writing, it’s about $2,500-$5,000 per vial for a single 1000mg dose).

It’s not their money

This is not a new idea; it has always been harder for individuals to care about something of value when it’s not something they own or something they will have to repay if it gets lost or destroyed.

It’s someone else’s job

A typical nurse working at an infusion center likely trusts that the inventory supply chain team is handling all the inventory issues. Most nurses and techs understandably just want to take care of patients and get home on time to be with their families.

Medication inventory does not look like money

There were many days when I worked alongside our teams in the infusion center or pharmacy to receive medication shipments. It was never lost on me that while unpacking and stocking these medications, we were all very casually moving around $100,000-$500,000 worth of product. 

Now, imagine that every box or cooler opened contained stacks of $100 bills. Do you think everyone’s posture and movements with those dollars would change? Of course they would. When someone is holding or moving anything of obvious high value, they focus much more on what they are doing.

Ok, great, now you know the problem. So, what can you do about it?

I found over the years in my own infusion company and recently with so many of our clients’ infusion centers / pharmacies that most inventory issues occur at the operating level (remote pharmacy, infusion center, etc.). These are the locations furthest from the corporate office and likely to lack an “inventory culture” baked in by default. To build an “inventory culture”, I provided some pointers below. 

Start with education

It seems obvious at first, but think about it – does your current training/onboarding program for your infusion center nursing, front-desk, and pharmacy tech team members include any inventory education? Probably not. 

Step 1 is to make sure that part of your new team member training at all levels includes information about the importance of inventory controls and accounting, and how each team member has a specific role to play. 

Make sure they are aware of the overall costs in dollars of the medications they are handling. Give them the “guess the value” quiz and show some examples. Hand the team member a single vial of Krystexxa and tell them, “You are holding $30,000 in your hand.” Watch as they suddenly grab that vial with two hands and get very focused! 

Make sure the team member understands how their role and inventory responsibilities ensure that patient care is not interrupted. Most nurses care a great deal about their patients, so they are careful with the ordering, receiving, stocking, counting, and documenting of inventory to ensure medications are in stock when patients show up for their appointments.

When inventory counts are off at the infusion center or pharmacy, supply chain teams can’t accurately order the meds patients need for their appointments or dispenses, and those shortages interrupt patient care. Nurses hate it when patients show up for their appointments and the meds they need aren’t available in the infusion center to administer, so help your new team member understand that they have an important role in preventing these kinds of issues. 

Create a solid counting system

Teams with an  “inventory culture” are great at inventory counts. If your team is only counting med inventory once a month or once a quarter, that may not be often enough. When everyone on the team is locked in on keeping an accurate inventory count, then the daily and weekly cycle counts become the norm. 

I am not saying to count every vial in the infusion center or pharmacy every day, but checking the high-dollar med counts against the system should be a quick start- or end-of-day process that anyone can do. 

At a minimum, start with end-of-week counts to make sure the total quantity of meds in the system of record matches the physical counts, and do your full counts monthly. 

Make non-compliance sting a little

At my last company, there was a counting policy that I really thought worked well. The policy for all new locations was to do full weekly counts. After a month or so, if the local team at the infusion center or pharmacy was consistently keeping inventory within 1% variance from the system count to the physical count, they could move to a weekly cycle count of only the high-dollar items and a monthly full count. Over a few months, if those counts were also within a 1% variance, the team could move to monthly cycle counts of only high-dollar items and only do full-counts quarterly. 

Here is why this works: full counts suck. They include lots of small items like diphenhydramine vials, diluents, fluid bags, etc. that take a lot of time to inventory. Most teams hate doing these. By adding a reward system to the counting process, everyone on the local team will get with the program in time. New team members who get sloppy with inventory will get reined back in by the other local team members, as they don’t want to get stuck after-hours doing full counts just because the new member isn’t paying attention. 

Make unpacking and stocking a ritual

Most inventory issues come from errors in inventory check-in and treatment documentation. Remember our Xolair story from before? Mixing new deliveries with the trash is one of many ways to mess up. 

You must have a very rigid, almost religious process for local teams when it comes to unpacking, stocking, and checking in medications. 

The process we developed is as follows:

Don’t touch the package unless you plan to see it all the way through.

There is some urgency that motivates team members to open a package as soon as it arrives and put the meds away as fast as possible. For some, they get super worried about refrigerated meds, even though the cooler and ice packs in those deliveries will likely allow that box to sit on the floor all day long. 

I see many team members who open the box, shove all the meds into the refrigerator, and then put the packing slip on the counter, only to come back hours later to process the check-in into the inventory system. This creates all kinds of opportunities for problems. 

(Typical morning delivery stack at a location ^^)

Our policy was simple: if you were not in a spot where you could unpack, check in, stock the meds, and break down the packaging per our policy, don’t touch it until you have time. 

If this box, shown below, with meds inside….

…gets pushed into this pile of mess, who is going to know?

(Some of you just cringed because this is what your med room looks like right now! ^^)

Recalling our Xolair story, the nurse got sidetracked in the middle of the unpacking and forgot to complete the process. For busy infusion centers or pharmacies, sometimes it’s better to train a non-clinical team member to do inventory check-ins, as they are less likely to get pulled away for urgent patient issues. 

Packaging must be fully processed and broken down all the way

Unfortunately, most medications come grossly overpacked. A single vial of medication can show up in a huge box inside a large cooler full of packing peanuts and ice packs. Sometimes it’s a scavenger hunt just to locate the vial(s) in the box. 

Our process was that any delivery had to be completely broken down. 

What does this mean?

• All packing materials must be removed and placed in the trash – bubble wrap, brown paper, packing peanuts, etc.
• All ice packs also need to be removed – we kept a separate bin just for these so they had their own place and went out daily with the trash. 
• Coolers must be out of their box with nothing inside, and cooler lids stacked in a separate pile – if I walked into any location and I couldn’t see the bottom of the cooler, someone was in trouble. 
• Cardboard boxes must be broken down and flattened – this also helped free up clutter and space in the med room.

Want an easy tip to help local teams remember all of this? In most locations, there is a designated area where deliveries are received and processed. We made a poster that emphasized all of the items above and even showed a photo of how everything had to be broken down so it was obvious. If a picture is worth a thousand words, this poster is worth tens of thousands of dollars saved!

This is how your deliveries should look at ALL locations:

It’s not rocket science, but a little practical education, updates to process, and maybe even a simple inventory poster can go a long way to getting your entire team to embrace an inventory culture.

Use a technology inventory management solution

In today’s medication environment, spreadsheets and DIY solutions really are not suitable for any organization managing complex biological therapies, IVIG, etc. There are too many moving parts, and the cost of these medications doesn’t leave your team with any room for error. Modern inventory management solutions need to be as connected as possible to reduce or eliminate the possibility of human error from manual entries. 

Solutions should be able to order medications directly from distributors, track shipments to your locations, and use barcoded check-in processes to ensure the right medications are ordered, tracked, and accounted for. In addition, solutions should be connected so that as medications are administered to patients and/or prepared in the pharmacy, they are scanned and consumed out of inventory so that the entire team is aware of the current counts of inventory levels at all times. 

I am, of course, biased; however, I can make a very strong argument that any inventory technology solution can also be one where the solution is made specifically for the line of business your team is operating in (infusion center, home infusion pharmacy, etc.).

Conclusion

By and large, I rarely meet my clients’ teams and find people who just don’t care about inventory at all. Most of them just don’t understand the true value of the medications they are handling or their role to play, they don’t have a solid inventory management system, and they may not fully understand how their actions can impact patient care and their company’s finances down the line. 

If you are looking for a best-in-class system to manage your infusion center or pharmacy inventory, please take a moment to connect with a member of our WeInfuse Sales team.