Use of a cloud-based search engine of a centralized donor database to identify historical antigen-negative units in hospital inventories.

BACKGROUND: The provision of units with antigen-negative attributes is required for alloimmunized transfusion recipients and to avoid alloimmunization among patients on chronic transfusion support. Recent evidence confirms that the demand for antigen-typed units is increasing. STUDY DESIGN AND METHODS: A cloud-based search engine was designed by the blood center to find antigen-negative units. The service provided access to historical antigen information for units in hospital inventories. The hospital transfusion service was required to confirm the antigen phenotype. The results of 16 hospitals' use over 5 years were analyzed to determine trends and value of the service. The time commitment of the cloud-based query was compared to the hospital performing manual phenotyping with an outcome of at least one unit found with the desired antigen-negative attribute(s). RESULTS: Hospitals were located between 4 miles and 200 miles away from the blood center. A total of 6,081 queries were submitted over the 5 years, with an overall 50% success rate of finding at least one unit. Single antigen queries accounted for 67% of total searches, with two antigen queries and three or more antigen queries accounting for 24% and 9% of the units found, respectively. The cloud-based antigen query was most efficient for combined antigen frequencies <0.5 for two or more antigen-negative attributes. CONCLUSION: A cloud-based search engine provides hospitals with access to historical antigen information housed at the blood center. Future refinements may consider regulatory submission of a process to provide confirmed historical information through this cloud-based program.

Tracking health commodity inventory and notifying stock levels via mobile devices: a mixed methods systematic review.

BACKGROUND: Health systems need timely and reliable access to essential medicines and health commodities, but problems with access are common in many settings. Mobile technologies offer potential low-cost solutions to the challenge of drug distribution and commodity availability in primary healthcare settings. However, the evidence on the use of mobile devices to address commodity shortages is sparse, and offers no clear way forward. OBJECTIVES: Primary objective To assess the effects of strategies for notifying stock levels and digital tracking of healthcare-related commodities and inventory via mobile devices across the primary healthcare system Secondary objectives To describe what mobile device strategies are currently being used to improve reporting and digital tracking of health commodities To identify factors influencing the implementation of mobile device interventions targeted at reducing stockouts of health commodities SEARCH METHODS: We searched CENTRAL, MEDLINE Ovid, Embase Ovid, Global Index Medicus WHO, POPLINE K4Health, and two trials registries in August 2019. We also searched Epistemonikos for related systematic reviews and potentially eligible primary studies. We conducted a grey literature search using mHealthevidence.org, and issued a call for papers through popular digital health communities of practice. Finally, we conducted citation searches of included studies. We searched for studies published after 2000, in any language. SELECTION CRITERIA: For the primary objective, we included individual and cluster-randomised trials, controlled before-after studies, and interrupted time series studies. For the secondary objectives, we included any study design, which could be quantitative, qualitative, or descriptive, that aimed to describe current strategies for commodity tracking or stock notification via mobile devices; or aimed to explore factors that influenced the implementation of these strategies, including studies of acceptability or feasibility. We included studies of all cadres of healthcare providers, including lay health workers, and others involved in the distribution of health commodities (administrative staff, managerial and supervisory staff, dispensary staff); and all other individuals involved in stock notification, who may be based in a facility or a community setting, and involved with the delivery of primary healthcare services. We included interventions aimed at improving the availability of health commodities using mobile devices in primary healthcare settings. For the primary objective, we included studies that compared health commodity tracking or stock notification via mobile devices with standard practice. For the secondary objectives, we included studies of health commodity tracking and stock notification via mobile device, if we could extract data relevant to our secondary objectives. DATA COLLECTION AND ANALYSIS: For the primary objective, two authors independently screened all records, extracted data from the included studies, and assessed the risk of bias. For the analyses of the primary objectives, we reported means and proportions where appropriate. We used the GRADE approach to assess the certainty of the evidence, and prepared a 'Summary of findings' table. For the secondary objective, two authors independently screened all records, extracted data from the included studies, and applied a thematic synthesis approach to synthesise the data. We assessed methodological limitation using the Ways of Evaluating Important and Relevant Data (WEIRD) tool. We used the GRADE-CERQual approach to assess our confidence in the evidence, and prepared a 'Summary of qualitative findings' table. MAIN RESULTS: Primary objective For the primary objective, we included one controlled before-after study conducted in Malawi. We are uncertain of the effect of cStock plus enhanced management, or cStock plus effective product transport on the availability of commodities, quality and timeliness of stock management, and satisfaction and acceptability, because we assessed the evidence as very low-certainty. The study did not report on resource use or unintended consequences. Secondary objective For the secondary objectives, we included 16 studies, using a range of study designs, which described a total of eleven interventions. All studies were conducted in African (Tanzania, Kenya, Malawi, Ghana, Ethiopia, Cameroon, Zambia, Liberia, Uganda, South Africa, and Rwanda) and Asian (Pakistan and India) countries. Most of the interventions aimed to make data about stock levels and potential stockouts visible to managers, who could then take corrective action to address them. We identified several factors that may influence the implementation of stock notification and tracking via mobile device. These include challenges tied to infrastructural issues, such as poor access to electricity or internet, and broader health systems issues, such as drug shortages at the national level which cannot be mitigated by interventions at the primary healthcare level (low confidence). Several factors were identified as important, including strong partnerships with local authorities, telecommunication companies, technical system providers, and non-governmental organizations (very low confidence); availability of stock-level data at all levels of the health system (low confidence); the role of supportive supervision and responsive management (moderate confidence); familiarity and training of health workers in the use of the digital devices (moderate confidence); availability of technical programming expertise for the initial development and ongoing maintenance of the digital systems (low confidence); incentives, such as phone credit for personal use, to support regular use of the system (low confidence); easy-to-use systems built with user participation (moderate confidence); use of basic or personal mobile phones to support easier adoption (low confidence); consideration for software features, such as two-way communication (low confidence); and data availability in an easy-to-use format, such as an interactive dashboard (moderate confidence). AUTHORS' CONCLUSIONS: We need more, well-designed, controlled studies comparing stock notification and commodity management via mobile devices with paper-based commodity management systems. Further studies are needed to understand the factors that may influence the implementation of such interventions, and how implementation considerations differ by variations in the intervention.

Protocol for a systematic review of the effects of interventions for vaccine stock management.

BACKGROUND: Inadequate vaccine stock management in health facilities leads to vaccine stock-outs. The latter threatens the success of immunisation programmes. Countries have used various approaches to reduce stock-outs and improve vaccine availability, but we are not aware of a systematic review of these interventions. This protocol describes the methods we will use to assess the effects of existing approaches for improving vaccine stock management. METHODS: We include randomised and non-randomised studies identified through a compehensive search of peer-reviewed and grey literature databases. We will search PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, PDQ-Evidence and Scopus. We will also search websites of the World Health Organisation (WHO), Global Alliance for Vaccine and Immunisation, PATH Vaccine Resources Library and United Nations Children's Fund. In addition, we will search the WHO International Clinical Trials Registry Platform and reference lists of included studies and relevant reviews. Finally, we plan to do a citation search for included studies. We will use Cochrane recommended methods to screen search outputs, assess study eligibility and risk of bias, extract and analyse study results. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool to assess the certainty of the evidence on the effects of the interventions. DISCUSSION: We believe that the findings of this review will serve as valuable information for policy makers on ways to improve vaccine stock management and vaccine availability. When vaccine availability is improved, those who need them, especially children, will be adequately protected from vaccine-preventable diseases. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018092215.

An Inventory Model for Deteriorating Drugs with Stochastic Lead Time.

Inventory management of deteriorating drugs has attracted considerable attention recently in hospitals. Drugs are a kind of special product. Two characteristics of some drugs are the shorter shelf life and high service level. This causes hospitals a great deal of difficulty in inventory management of perishable drugs. On one hand, hospitals should increase the drug inventory to achieve a higher service level. On the other hand, hospitals should decrease the drug inventory because of the short shelf life of drugs. An effective management of pharmaceuticals is required to ensure 100% product availability at the right time, at the right cost, in good conditions to the right customers. This requires a trade-off between shelf-life and service level. In addition, many uncontrollable factors can lead to random lead time of drugs. This paper focuses on deteriorating drugs with stochastic lead time. We have established a stochastic lead time inventory model for deteriorating drugs with fixed demand. The lead time obeyed a certain distribution function and shortages were allowed. This model also considered constraints on service level, stock space and drug shelf life. Through the analysis of the model, the shelf life of drugs and service level were weighted in different lead time distributions. Empirical analysis and sensitivity analysis were given to get reach important conclusions and enlightenment.

Streamlining a blood center and hospital transfusion service supply chain with an informatics vendor-managed inventory solution: development, implementation, and 3-month follow-up.

BACKGROUND: The ordering process at Stanford Health Care involved twice-daily shipments predicated upon current stock levels from the blood center to the hospital transfusion service. Manual census determination is time consuming and error prone. We aimed to enhance inventory management by developing an informatics platform to streamline the ordering process and reallocate staff productivity. STUDY DESIGN AND METHODS: The general inventory accounts for more than 50 product categories based on characteristics including component, blood type, irradiation status, and cytomegalovirus serology status. Over a 5-month calibration period, inventory levels were determined algorithmically and electronically. An in-house software program was created to determine inventory levels, optimize the electronic ordering process, and reduce labor time. A 3-month pilot period was implemented using this program. RESULTS: This system showed noninferiority while saving labor time. The average weekly transfused:stocked ratios for cryoprecipitate, plasma, and red blood cells, respectively, were 1.03, 1.21, and 1.48 before the pilot period, compared with 0.88, 1.17, and 1.40 during (p = 0.28). There were 27 (before) and 31 (during) average STAT units ordered per week (p = 0.86). The number of monthly wasted products due to expiration was 226 (before) and 196 (during) units, respectively (p = 0.28). An estimated 7 hours per week of technologist time was reallocated to other tasks. CONCLUSION: An in-house electronic ordering system can enhance information fidelity, reallocate and optimize valuable staff productivity, and further standardize ordering. This system showed noninferiority to the labor-intensive manual system while freeing up over 360 hours of staff time per year.

The anti-hepatitis drug use effect and inventory management optimization from the perspective of hospital drug supply chain.

By analyzing the current hospital anti hepatitis drug use, dosage, indications and drug resistance, this article studied the drug inventory management and cost optimization. The author used drug utilization evaluation method, analyzed the amount and kind distribution of anti hepatitis drugs and made dynamic monitoring of inventory. At the same time, the author puts forward an effective scheme of drug classification management, uses the ABC classification method to classify the drugs according to the average daily dose of drugs, and implements the automatic replenishment plan. The design of pharmaceutical services supply chain includes drug procurement platform, warehouse management system and connect to the hospital system through data exchange. Through the statistical analysis of drug inventory, we put forward the countermeasures of drug logistics optimization. The results showed that drug replenishment plan can effectively improve drugs inventory efficiency.

Zeroing in on red blood cell unit expiry.

BACKGROUND: Expiry of red blood cell (RBC) units is a significant contributor to wastage of precious voluntary donations. Effective strategies aimed at optimal resource utilization are required to minimize wastage. STUDY DESIGN AND METHODS: This retrospective study analyzed the strategic measures implemented to reduce expiry of RBC units in an Australian tertiary regional hospital. The measures, which included inventory rearrangement, effective stock rotation, and the number of emergency courier services required during a 24-month period, were evaluated. RESULTS: There was no wastage of RBC units due to expiry over the 12 months after policy changes. Before these changes, approximately half of RBC wastage (261/511) was due to expiry. The total number of transfusions remained constant in this period and there was no increase in the use of emergency couriers. Policy changes implemented were decreasing the RBC inventory level by one-third and effective stock rotation and using a computerized system to link the transfusion services across the area. Effective stock rotation resulted in a reduction in older blood (>28 days) received in the main laboratory rotated from peripheral hospitals, down from 6%-41% to 0%-2.5%. CONCLUSION: Age-related expiry of blood products is preventable and can be significantly reduced by improving practices in the pathology service. This study provides proof of principle for "zero tolerance for RBC unit expiry" across a large networked blood banking service.

Implementation of a new method to track propofol in an endoscopy unit.

AIM: Propofol is a widely used anesthesia induction agent and is easily accessible in most healthcare facilities. Unlike regulated or schedule drugs, propofol is inconsistently tracked, leading to inaccurate inventories, incorrect billing, and unrecognized diversion. The goal of this project was to implement a new method of tracking propofol in a single setting, with the aim of accounting for 100% of the drug. METHODS: For two, 2-week observation periods, data were extracted from an automated medication management system or pharmacy inventory system, anesthesia records, and pharmacy billing sheets for cases in a Gastrointestinal (GI) Endoscopy Unit, and compared pre-implementation and post-implementation of a new tracking and accounting protocol. Variables included amount of propofol inventoried, dispensed, administered, returned, billed, wasted, and missing. RESULTS: Pre-implementation (n = 300), 10% cases had no record of propofol removal from the automated medication system. Of the 90% that did, 25% had an amount signed out that did not match the amount administered. Thirty-one percent of all propofol was unaccounted for during this 2-week period. Furthermore, 19.7% of cases did not have a billing form located. Post-implementation of the process change, unaccounted for propofol decreased to 26% of all cases (P = ns). The percentage of missing billing forms decreased from 19.7 to 5.8% (P = 0.00). CONCLUSION: Data suggest notable amounts of propofol were unaccounted for and not billed for in the GI Endoscopy Unit prior to the protocol change. Post-protocol change data reveal modest improved accounting of the medication and significant cost-capture. Improvements may enhance inventory reconciliation, availability of drug stock, and potentially result in a decreased risk of unrecognized diversion.

[Software and hardware system for medical equipment recording in a military field hospital].

Software and hardware system for medical equipment recording in a military field hospital. The article provides characteristics on the modern software and hardware system for recording of medical equipment in a military field during military time. This system is included into the assembly of medical equipment , included in the norms of medical equipment supply for military field hospitals. Authors give an algorithm of development and use of specialized software for recording of-medical equipment in a military field hospital.

Prediction of inventory sustainability during a drug shortage.

PURPOSE: A methodology for predicting how long the on-hand inventory of a given medication will last during a supply shortage is described; a practical example of application of the methodology is provided. METHODS: Single-site data on consumption of i.v. tobramycin over an eight-month evaluation period were collected using commercial software that tabulates barcode-assisted medication administration (BCMA) events; administered doses were standardized as 1200-mg "vial-equivalents" and summed over the review period. The total number of vial-equivalents consumed was divided by the number of "non-zero weeks of consumption" (i.e., weeks during which any tobramycin use occurred) to obtain a mean ± S.D. weekly consumption rate; this rate was multiplied by the total i.v. tobramycin on-hand supply (in vial-equivalents) to determine the mean number of potentially sustainable weeks of therapy in the event a shortage were to restrict the future supply of the drug. RESULTS: Overall, 99.6 vial-equivalents of i.v. tobramycin were used during the evaluation period. The mean ± S.D. number of vial-equivalents used per non-zero week of consumption was 3.11 ± 1.26. A manual count of pharmacy inventory revealed that 102.9 vial-equivalents were available at the time of analysis. The mean predicted duration of supply was 33 weeks (95% confidence interval, -126 to 192 weeks). CONCLUSION: Available BCMA data on tobramycin consumption over eight months were used to calculate the mean number of weeks the on-hand supply of the drug could be expected to last during a persistent drug shortage.

Implementation of a novel real-time platelet inventory management system at a multi-site transfusion service.

BACKGROUND: Blood platelets (PLTs) are a valuable commodity. Management of their inventory has implications both for patient care and for the cost of health care delivery. There are a variety of different methods of managing PLT inventory currently in practice and multiple theoretical models aimed at improving PLT inventory metrics. In this study we evaluate the ability of a novel electronic dashboard system that monitors and displays both PLT inventory and patient data to improve transfusion metrics at a quaternary health care center. STUDY DESIGN AND METHODS: The Capital District Health Authority is a quaternary health care center that transfuses approximately 2500 PLT units annually. To improve PLT discard rates a novel, low-overhead system that interfaces with the laboratory information system and displays real-time data between transfusion sites on PLT inventory and orders was implemented in November 2011. This study examines the transfusion quality metrics data from the 24 months before and after implementation. RESULTS: A significant reduction in mean monthly PLT outdate rate was observed after the implementation of the PLT dashboard suite from 24.5% (n = 24, SD ± 6.4%) to 15.1% (n = 24, SD ± 6.4%; p < 0.001). PLT age at time of transfusion was also reduced from 3.60 days (n = 4796, SD ± 0.97 days) to 3.46 days (n = 4881, SD ± 1.00 days; p < 0.001). CONCLUSIONS: This study describes the implementation of a novel PLT dashboard suite. This suite significantly reduced PLT outdate rates at our institution over the 48-month study period.

[Development and use of modern hardware-software complex for medical equipment accounting in military unit of the medical service in wartime].

Development and use of modem hardware-software complex for medical equipment accounting in military unit of the medical service in wartime. The authors presented characteristics of a modern hardware-software complex for medical equipment assessment in medical troops of the medical service, included into the complete set of medical equipment <, which is accepted by the Armed Forces of the Russian Federation. An algorithm of development and routine of special- purpose software for accounting of medical equipment in medical branches of formations and military units in wartime.

Chance-constrained model predictive control applied to inventory management in hospitalary pharmacy.

This extended abstract addresses the preliminary results of applying uncertainty handling strategies and advanced control techniques to the inventary management of hospitality pharmacy. Inventory management is one of the main tasks that a pharmacy department has to carry out in a hospital. It is a complex problem because it requires to establish a tradeoff between contradictory optimization criteria. The final goal of the proposed research is to update the inventory management system of hospitals such that it is possible to reduce the average inventory while maintaining preestablished clinical guarantees.

Diferenças no desenvolvimento de meninos e meninas em condições de risco / Boys and girls in risk conditions development differences

Esse estudo teve como objetivo avaliar o desenvolvimento de bebês que possuíam alguma condição de risco. Participaram do projeto 82 crianças, 42 meninos e 40 meninas. Como critérios de inclusão definiu-se: baixo-peso ao nascer, parto pré-termo ou filhos de mães adolescentes Para avaliar o desenvolvimento foi utilizado o protocolo de "Estimulação Infantil" do Inventário Portage Operacionalizado, que foi aplicado entre 30 e 59 dias de vida do bebê. Em todas as condições as meninas tiveram melhor desempenho, porém na condição de filhos de mães adolescentes não foi observada diferença significativa entre os grupos. Os dados parecem indicar que as condições de risco possuem maior probabilidade de causar danos ao desenvolvimento à população masculina que à feminina, coerentes à literatura analisada. Análises e elaboração de programas de estimulação precoce constituem-se fundamentais para minimizar os riscos de problemas de desenvolvimento nessa população (AU)

This study aimed to evaluate the development of infants aged between 30 and 59 days, who presented some kind of risk factor threatening their development. Participated in the project 82 children, being 42 boys and 40 girls, presenting the following risk conditions: low birth weight, preterm birth or children of adolescent mothers. The protocol "Stimulation for kids" from "The Operationalized Portage Inventory" was administered. The girls presented a better performance in all conditions, however, no significant differences between genders were observed among the adolescent mothers' children. These results are consistent with those described in the literature and they indicate that the male population is more vulnerable to developmental damage. Public policies regarding early intervention to minimize the likelihood of future cognitive difficulties and consequently its impact in such population are essential. (AU)

Diferenças no desenvolvimento de meninos e meninas em condições de risco / Boys and girls in risk conditions development differences

Esse estudo teve como objetivo avaliar o desenvolvimento de bebês que possuíam alguma condição de risco. Participaram do projeto 82 crianças, 42 meninos e 40 meninas. Como critérios de inclusão definiu-se: baixo-peso ao nascer, parto pré-termo ou filhos de mães adolescentes Para avaliar o desenvolvimento foi utilizado o protocolo de "Estimulação Infantil" do Inventário Portage Operacionalizado, que foi aplicado entre 30 e 59 dias de vida do bebê. Em todas as condições as meninas tiveram melhor desempenho, porém na condição de filhos de mães adolescentes não foi observada diferença significativa entre os grupos. Os dados parecem indicar que as condições de risco possuem maior probabilidade de causar danos ao desenvolvimento à população masculina que à feminina, coerentes à literatura analisada. Análises e elaboração de programas de estimulação precoce constituem-se fundamentais para minimizar os riscos de problemas de desenvolvimento nessa população.

This study aimed to evaluate the development of infants aged between 30 and 59 days, who presented some kind of risk factor threatening their development. Participated in the project 82 children, being 42 boys and 40 girls, presenting the following risk conditions: low birth weight, preterm birth or children of adolescent mothers. The protocol "Stimulation for kids" from "The Operationalized Portage Inventory" was administered. The girls presented a better performance in all conditions, however, no significant differences between genders were observed among the adolescent mothers' children. These results are consistent with those described in the literature and they indicate that the male population is more vulnerable to developmental damage. Public policies regarding early intervention to minimize the likelihood of future cognitive difficulties and consequently its impact in such population are essential.

Applying value stream mapping techniques to eliminate non-value-added waste for the procurement of endovascular stents.

UNLABELLED: OJECTIVES: To eliminate non-value-adding (NVA) waste for the procurement of endovascular stents in interventional radiology services by applying value stream mapping (VSM). MATERIALS AND METHODS: The Lean manufacturing technique was used to analyze the process of material and information flow currently required to direct endovascular stents from external suppliers to patients. Based on a decision point analysis for the procurement of stents in the hospital, a present state VSM was drawn. After assessment of the current status VSM and progressive elimination of unnecessary NVA waste, a future state VSM was drawn. RESULTS: The current state VSM demonstrated that out of 13 processes for the procurement of stents only 2 processes were value-adding. Out of the NVA processes 5 processes were unnecessary NVA activities, which could be eliminated. The decision point analysis demonstrated that the procurement of stents was mainly a forecast driven push system. The future state VSM applies a pull inventory control system to trigger the movement of a unit after withdrawal by using a consignment stock. CONCLUSION: VSM is a visualization tool for the supply chain and value stream, based on the Toyota Production System and greatly assists in successfully implementing a Lean system.