Logistics of an advanced therapy medicinal product during COVID-19 pandemic in Italy: successful delivery of mesenchymal stromal cells in dry ice.

BACKGROUND: During the coronavirus disease-2019 (COVID-19) pandemic, Italian hospitals faced the most daunting challenges of their recent history, and only essential therapeutic interventions were feasible. From March to April 2020, the Laboratory of Advanced Cellular Therapies (Vicenza, Italy) received requests to treat a patient with severe COVID-19 and a patient with acute graft-versus-host disease with umbilical cord-derived mesenchymal stromal cells (UC-MSCs). Access to clinics was restricted due to the risk of contagion. Transport of UC-MSCs in liquid nitrogen was unmanageable, leaving shipment in dry ice as the only option. METHODS: We assessed effects of the transition from liquid nitrogen to dry ice on cell viability; apoptosis; phenotype; proliferation; immunomodulation; and clonogenesis; and validated dry ice-based transport of UC-MSCs to clinics. RESULTS: Our results showed no differences in cell functionality related to the two storage conditions, and demonstrated the preservation of immunomodulatory and clonogenic potentials in dry ice. UC-MSCs were successfully delivered to points-of-care, enabling favourable clinical outcomes. CONCLUSIONS: This experience underscores the flexibility of a public cell factory in its adaptation of the logistics of an advanced therapy medicinal product during a public health crisis. Alternative supply chains should be evaluated for other cell products to guarantee delivery during catastrophes.

Case Study: Supply Chain Transformation in the UK National Health Service.

This case study provides evidence of the impact of the Scan4Safety program demonstrated in six National Health Service (NHS) Trusts, funded to achieve supply chain transformation to improve safety, quality and performance in the NHS in England. All 154 Trusts were mandated to adopt GS1 global standards for supply chain processes and Pan-European Public Procurement On-Line standards in 2014 to enable digital transactions across the NHS. The outcomes of this case reflect the early implementation of the program infrastructure in surgical theatre and cardiac programs. Outcomes include a 4:1 return on investment and projected savings of £1 billion pounds when scaled across the NHS.

Implantação de comissão de pré-qualificação de materiais hospitalares no pregão eletrônico de hospital universitário: pré-requisito para controle de qualidade / Implementation of hospital materials prequalification commission on university hospital electronic trading: quality control prerequisite

O presente estudo tem por objetivo analisar as possibilidades da implantação de comissão de pré-qualificação de materiais hospitalares adquiridos por pregão eletrônico em hospital universitário. Trata-se de estudo observacional, descritivo, misto, com abordagem quanti-qualitativa, realizado no segundo semestre de 2015, cujos elementos de caráter quantitativo foram submetidos à análise documental, extraídos de 136 processos de compras, de materiais hospitalares realizadas no período de 2010 a 2015, devidamente organizados em planilha Excel e pelo software R. Posteriormente analisados com base na estatística descritiva e resultados apresentados em gráficos, tabelas e quadros. Os elementos qualitativos foram produzidos a partir de entrevistas realizadas com 11 médicos e 18 enfermeiros atuantes na gestão de diversos setores de internação hospitalar, no decorrer dos meses de julho a dezembro de 2015. As entrevistas foram norteadas por roteiro semiestruturado e analisadas a luz da análise de conteúdo temática. Da análise dos dados emergiram três categorias temáticas: Materiais com mais problemas: intercorrências por falta de critérios de qualidade; Credibilidade sobre solicitação de amostras para o pregão; e Conhecimento sobre o trabalho e propósitos da comissão de padronização de materiais hospitalares. Concluiu-se que as aquisições pelos pregões, adotando-se o critério menor preço, não asseguram padrões de qualidade dos materiais hospitalares, expondo pacientes e profissionais de saúde à riscos injustificáveis do ponto de vista de segurança dos pacientes e do trabalho. Razões suficientes para apontar a necessidade da implantação de comissão de pré-qualificação dos produtos para analisá-los antes dos procedimentos licitatórios. Ademais, o cenário atual de crise do financiamento público não oferece margens para desperdícios, considerando o inevitável descarte dos materiais adquiridos que não apresentem padrão de qualidade e confiabilidade para que seu uso não cause problemas adversos. Acredita-se que para solucionar os problemas ou minimizá-los, faz-se necessária a constituição da referida comissão, bem como implantar um sistema eletrônico para armazenar e compartilhar informações claras sobre a qualidade dos materiais já analisados a fim de possibilitar maior segurança aos profissionais que os utilizam e para os pacientes que são submetidos aos procedimentos terapêuticos nos hospitais de ensino

The present study aims to analyze the possibilities of the implementation of pre-qualification commission of hospital materials purchased by electronic trading in a university hospital. This is an observational, descriptive, mixed study, with a quantitative-qualitative approach, carried out in the second half of 2015, whose quantitative elements were submitted to a documentary analysis, extracted from 136 procurement processes, of hospital materials carried out in the period of 2010 To 2015, duly organized into Excel spreadsheet and software R. Subsequently analyzed based on descriptive statistics and results presented in graphs, tables and tables. The qualitative elements were produced from interviews with 11 physicians and 18 nurses working in the management of several hospital admission sectors, from July to December 2015. The interviews were guided by a semi-structured script and analyzed in light of the analysis Thematic content. From the analysis of the data emerged three thematic categories: Materials with more problems: intercurrences due to lack of quality criteria; Credibility for requesting samples for the trading session; And Knowledge about the work and purposes of the standardization committee for hospital materials. It was concluded that the acquisitions by the market, adopting the criterion lower price, do not ensure quality standards of hospital materials, exposing patients and health professionals to unjustifiable risks from the point of view of patient safety and work. Reasons sufficient to indicate the need for the implementation of pre-qualification commission of the products to analyze them before the bidding procedures. In addition, the current scenario of public financing crisis does not offer margins for waste, considering the unavoidable disposal of acquired materials that do not present quality and reliability standards so that their use does not cause adverse problems. It is believed that in order to solve the problems or minimize them, it is necessary to set up such a commission, as well as to establish an electronic system to store and share clear information about the quality of the materials already analyzed in order to provide greater security for professionals Who use them and for patients who are submitted to therapeutic procedures in teaching hospitals

The Impact of Inventory Management on Stock-Outs of Essential Drugs in Sub-Saharan Africa: Secondary Analysis of a Field Experiment in Zambia.

OBJECTIVE: To characterize the impact of widespread inventory management policies on stock-outs of essential drugs in Zambia's health clinics and develop related recommendations. METHODS: Daily clinic storeroom stock levels of artemether-lumefantrine (AL) products in 2009-2010 were captured in 145 facilities through photography and manual transcription of paper forms, then used to determine historical stock-out levels and estimate demand patterns. Delivery lead-times and estimates of monthly facility accessibility were obtained through worker surveys. A simulation model was constructed and validated for predictive accuracy against historical stock-outs, then used to evaluate various changes potentially affecting product availability. FINDINGS: While almost no stock-outs of AL products were observed during Q4 2009 consistent with primary analysis, up to 30% of surveyed facilities stocked out of some AL product during Q1 2010 despite ample inventory being simultaneously available at the national warehouse. Simulation experiments closely reproduced these results and linked them to the use of average past monthly issues and failure to capture lead-time variability in current inventory control policies. Several inventory policy enhancements currently recommended by USAID | DELIVER were found to have limited impact on product availability. CONCLUSIONS: Inventory control policies widely recommended and used for distributing medicines in sub-Saharan Africa directly account for a substantial fraction of stock-outs observed in common situations involving demand seasonality and facility access interruptions. Developing central capabilities in peripheral demand forecasting and inventory control is critical. More rigorous independent peer-reviewed research on pharmaceutical supply chain management in low-income countries is needed.

Inventory management strategies that reduce the age of red blood cell components at the time of transfusion.

BACKGROUND: There has been interest concerning patient outcomes when older red blood cell (RBC) components are utilized. Inventory management is key to maintaining a stock of fresher RBCs for general transfusion needs. We have altered our practice for RBC management to reduce RBC age at the time of transfusion. STUDY DESIGN AND METHODS: Retrospective review of RBC age at time of transfusion at a tertiary care hospital with active trauma service was performed. The baseline nonirradiated RBC inventory was decreased from 12 to 15 days of stock to 7 to 10 days of stock, with request made to the blood supplier for fresher RBCs, specified at 75% of RBCs less than 14 days old. The age of RBCs at time of receipt and at time of transfusion was tracked on a monthly basis for the next 12 months. RESULTS: The mean age of RBCs at transfusion was decreased by 9 days on average for the year. Significant decreases in the mean age of RBCs at transfusion were seen in the second half of the year, with 4 of 6 months seeing a mean age of less than 20 days. There were no documented incidences of hospital blood shortages after the reduction in inventory; no surgery was canceled or delayed because of inventory. CONCLUSION: Inventory age depends on active management, combined with vendor cooperation to receive fresher components. Reducing the age of RBC components transfused is possible without experiencing blood component shortages. Longer periods of observation may allow for further adjustment of stocking levels on a seasonal basis.

Saving Time Under Pressure: Effectiveness of Standardizing Pediatric Resuscitation Carts.

BACKGROUND: Resuscitation situations are high risk and high stress, and delays in care can have significant influences on outcomes. Standardization of care protocols and equipment is postulated to decrease some of the stress and risk. The objective of this study was to document increased efficiency in finding resuscitation equipment in a standardized resuscitation cart. METHODS: A new standardized resuscitation cart design was created, and a multimedia education program addressing the new design was launched. A goal was set to find required equipment in <15 seconds. Five cohorts of 10 nurses were timed at finding randomly chosen items 1, 12, 49, 152, and 351 days after new cart launch. t tests were used to compare estimated acquisition times of requested items using the new cart system to the old cart system (baseline), and a separate regression analysis was used to model skill degradation. RESULTS: All pairwise comparisons showed significant decreases in mean acquisition time compared with baseline. One day after launch, the mean time to find items was reduced by 46%. Mean time to find requested items was below the goal of 15 seconds 12, 49, and 152 days after launch. This effect was lost by 351 days from launch. Regression analysis predicted the time to find items would exceed 15 seconds 287 days after launch. CONCLUSIONS: Standardizing the resuscitation cart design greatly reduced time to find items and was accomplished with reduced financial cost. Skill degradation did occur over time, and refresher training was required.

High profile backing for GS1 drive.

At the 2016 GS1 UK Healthcare Conference in London, delegates heard from speakers including Pat Mills, the Department of Health's commercial director, on the ongoing work to embed GS1 standards throughout the NHS in England in line with the DH's eProcurement Strategy, published in April 2014. This mandated that any service or product procured by an English NHS acute Trust comply with the standards--one of the most obvious representations of which is on barcodes--'to enable Trusts to manage their non-pay spending by adopting master procurement data, automating the exchange of such data, and benchmarking their procurement against other Trusts and healthcare providers'. One of six 'demonstrator site' Trusts to provide a speaker at the 2016 GS1 UK national conference to report on their progress to date was Leeds Teaching Hospitals NHS Trust. Shortly after, HEJ editor, Jonathan Baillie, spoke to the Trust's associate director, Commercial and Procurement, Chris Slater, and to head of Healthcare at GS1 UK, Glen Hodgson.

ISO 55000: Creating an asset management system.

In the October 2014 issue of HEJ, Keith Hamer, group vice-president, Asset Management & Engineering at Sodexo, and marketing director at Asset Wisdom, Kevin Main, argued that the new ISO 55000 standards present facilities managers with an opportunity to create 'a joined-up, whole lifecycle approach' to managing and delivering value from assets. In this article, Kevin Main and Chris Bradley, who runs various asset management projects, examine the process of creating an asset management system.

If I were a band-aid, where would I be? Researching the use and location of supplies on two patient units.

OBJECTIVE: The purpose of this study was to gain insight into the use and storage of supplies in the neonatal intensive care and women's health units of Parkland Hospital in Dallas, Texas. BACKGROUND: Construction of a new Parkland Hospital is underway, with completion of the 862-bed, 2.5-million square feet hospital in 2014. Leaders from the hospital and representatives from one of its major vendors collaborated on a research study to evaluate the hospital's current supply management system and develop criteria to create an improved system to be implemented at the new hospital. METHOD: Approach includes qualitative and quantitative methods, that is, written survey, researcher observations, focus groups, and evaluation of hospital supply reports. RESULTS: Approaching the ideal location of supplies can be best approached by defining a nurse's activity at the point of care. Determining an optimal supply management system must be approached by understanding the "what" of caregivers' activities and then determining the "where" of the supplies that support those activities. CONCLUSIONS: An ideal supply management system locates supplies as close as possible to the point of use, is organized by activity, and is standardized within and across units.

Towards IHE profiles for e-supply in the healthcare domain.

Procurement and supply belong to the crucial supporting processes in hospitals. By providing the right products at the right time in the right quantity in the right place, these processes are of major importance for patient safety and the success of the primary hospital process cure and care. Though of such an importance, the hospital's internal and external procurement and supply processes are still not performed seamlessly by information systems, due to a variety of electronic standards for procurement and supply. These different standards and missing guidelines for electronic procurement and supply in the healthcare domain lead to little or no interoperability between the participating procurement and supply systems. Consequences can be delayed or wrong supply, and increased costs. To overcome this deficiency this work describes the derivation of a common guideline for the implementation of electronically enabled supply processes in the healthcare domain based upon the identification of commonly used electronic standards and detailed specifications of procurement processes in hospital facilities.

Squaring the circle of healthcare supplies.

PURPOSE: The purpose of this paper is to use a systems lens to assess the comparative performance of healthcare supply chains and provide guidance for their improvement. DESIGN/METHODOLOGY/APPROACH: A well-established and rigorous multi-method audit methodology, based on the uncertainty circle model, yields an objective assessment of value stream performance in eight Australasian public sector hospitals. Cause-effect analysis identifies the major barriers to achieving smooth, seamless flows. Potentially high-leverage remedial actions identified using systems thinking are examined with the aid of an exemplar case. FINDINGS: The majority of the healthcare value streams studied are underperforming compared with those in the European automotive industry. Every public hospital appears to be caught in the grip of vicious circles of system uncertainty, in large part being caused by problems of their own making. The single exception is making good progress towards seamless functional integration, which has been achieved by elevating supply chain management to a core competence; having a clearly articulated supply chain vision; adopting a systems approach; and, managing supplies with accurate information. RESEARCH LIMITATIONS/IMPLICATIONS: The small number of cases limits the generalisability of the findings at this time. PRACTICAL IMPLICATIONS: Hospital supply chain managers endeavouring to achieve smooth and seamless supply flows should attempt to elevate the status of supplies management within their organisation to that of a core competence, and should use accurate information to manage their value streams holistically as a set of interwoven processes. A four-level prism model is proposed as a useful framework for thus improving healthcare supply delivery systems. ORIGINALITY/VALUE: Material flow concepts originally developed to provide objective assessments of value stream performance in commercial settings are adapted for use in a healthcare setting. The ability to identify exemplar organisations via a context-free uncertainty measure, and to use systems thinking to identify high-leverage solutions, supports the transfer of appropriate best practices even between organisations in dissimilar business and economic settings.