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Product Selection in the OR
Product Selection in the OR A DECISION-MAKING MODEL
M. V. Ginny Baird, RN
W
ith the continuous introduction of new products, changes in existing ones, and the emphasis on reducing costs, product evaluations are inherent in the OR. Most institutions have a mechanism to evaluate and select products, either on a formal basis with product selection or standardization committees or on an informal basis on a specific unit. Regardless of the mechanism, it is important that staff from several departments offer input and receive feedback about clinical problems experienced with products.
Product Selection Process
P
erioperative nurses who have a thorough understanding of prcduct selection can help decide what is purchased for the OK. An optimum way to coordinate the product selection process is to relate it to the nursing processassessment, planning, implementation, and evaluation. The primary area for nurse involvement is in the evaluation or assessment stage. Assessment. The tirst step in the nursing process also is the first step in the product selection prtxess identification or assessment of a problem or need. Examples include inadequate clinical performance of a product, introduction of new techniques or technology requiring new products, introduction of new or improved products that will improve patient care, lack of standardization within a facility, or cost reduction. Quality assurance tools can be used to identify problems; however, improper use of a product should not be mistaken for a problem with the item itself.
Planning. After the issue or problem has been identified. the next step is to investigate available products that may solve it. In the planning stage. OR personnel should review literature, professional journals and catalogs; contact materiel management personnel; talk to manufacturers' representatives; and establish a network with other health care professionals who may have cxperienced similar problems o r needs. The next step is to review data from the manufacturer and examine the product. This is also the time to consult with other departments that have an interest in the product. For example. the biomedical o r the electrical department should check any product or equipment with electrical components, and the infection control department and/or committee should be consulted about solutions to be used for scrubbing or skin preparation. These initial consultations can prevent the clinical evaluation of iin obviously inadequate product . Implementation o j u clinicul evuluation.
Products that receive initial approval in the planning stage are subject to a clinical evaluation. Before implementing a clinical evaluation, an evaluation tool should be designed that is specific for that product (Table I ) . If two o r morc of the same type o f product are being evaluated, the
Table I
Product Evaluation Form Type of product: Disposable wrappers Manufacturer: Size of wrapper: -18x18 -24x24 -36x36 other:
At the time of this evaluation you were: -wrapping the set for sterilization or -unwrapping the set to be placed on a sterile field. Please comment on the following: Durability: Ease of handling: Does material retain specific shape: Linting: Packaging or storage: Other: In your opinion, is this product acceptable for clinical use: -yes -no
Please explain:
Name of person completing the form: Date:
same tool should be used to ensure consistency of the criteria and validity of the results. If different tools are used, the results of the evaluation are difficult to compare. When planning a clinical evaluation, it is necessary to consider the length of time to devote to the evaluation, the number of clinical units involved, and the number of products evaluated. The time limit should allow enough time to realistically judge clinical performance and detect
Service:
problems. but not so long as to reduce enthusiasm and input.' Before a clinical evaluation, all personnel who may use the product should attend an in-service meeting to learn about handling and using the product and any special precautions.? By introducing the staff to the product, the personnel are more familiar with it and can use it properly to ensure safe patient care. Being informed about the product also reduces negative product
A O R N JO I I R N-A I.
By attitude and presentation, the nurse can influence the acceptance or rejection of a product. evaluations based on mishandling or misuse. Departments related to the OR should be given an opportunity to consider the product if it is necessary. These include the central service, postanesthesia care unit, intensive care unit, and emergency room. While not all departments need to actively participate in the clinical evaluation, they should be aware of the evaluation and be informed of the results. For example, two or more surgical services may decide to evaluate some of the products being considered. After the evaluation, the results would be compared and a decision made based on the input from each surgical service. The number of products evaluated may vary according to the types of products (eg, four different brands of shoe covers) and the number of each product (eg, 50 pair of each brand). How frequently a product is used should be considered when setting limits on number of each product and length of time for the evaluation. Infrequently used products may need to have an extended period of time for evaluation, while commonly used items may need only a short period of time in which to detect problems and assess function. Evaluation: Analysis of results and decision making. After completing a clinical evaluation, data needs to be carefully analyzed, preferences and dislikes need to be compared, and packaging and ease of storage need to be considered. The most important question to ask in a product evaluation should be, “Is this product acceptable for clinical use?’ This should be answered yes or no, and reasons must be given to support the answer. While factors that indicate preference for one product over another are important, baseline clinical acceptability must be determined.’ A list of products that are clinically acceptable can be submitted to the appropriate If substitution of a routine people for f~llow-up.~ item becomes necessary, this list can be used to select alternate products that are clinically acceptable and meet the needs of the clinical 516
service. Other factors to consider include cost, competitive bids, and the ability of the equipment manufacturer to supply the product efficiently and in sufficient quantities.
Involving the Saj’j- Nurse
W
’here does the staff nurse fit in the product selection process? As a primary provider ofdirect patient care, the nurse is frequently the first person to be aware that a clinical problem exists with a product. The nurse can identify when a product does not achieve its purpose, problems in packaging or storing, or malfunctions. Because of their close working relationship with surgeons and anesthesiologists, staff nurses hear the physicians’ concerns or interest in particular items. The nurse is either directly involved in the use of the product or present when the product is used. Responsibilities may include coordinating the evaluation, making the product available to potential users, preparing and demonstrating the product, opening presterilized items, processing/ sterilizing reusable items, and receiving feedback from other personnel. The nurse can identify related problems with other products or on other care units that might not be readily apparent to someone less familiar with the entire practice setting. The nurse also is responsible for completing the evaluation tool or ensuring that the person using the product completes it. The nurse can offer objective judgment about the clinical performance of the product and note comments from the patients, physicians, and other health care team m em ber s. A well-informed nurse is often the best person to introduce new or different products to the surgical staff. By attitude and presentation. the nurse can influence the acceptance or rejection of a product. Without the assistance and support
\ I P I 1 M H I K I 9 X X V O I 1 X NL)?
of nurses, it is not possible to conduct credible clinical evaluations of products.
Conclusion
Q
uality and clinical performance should always be considered before cost.5 Cost considerations during a clinical evaluation ca influence the evaluation of the product itself. Sometimes when a poor quality, lessexpensive item is selected, more items may be used because of waste or lack of durability than if a more expensive, high-quality product had been selected. Only when two items are equal in clinical performance should cost be the deciding factor. Critical clinical performance for certain items may justify purchasing a more expensive item? Overall cost of a product needs to be determined when trying to reduce expenses. Cost containment cannot compromise the quality of patient care, though. Both can be achieved by involving the staff nurse in the clinical evaluation. Input from staff can help identify clinical problems, determine actual clinical functioning of products, judge whether products are equal in quality, and justify the purchase of more expensive, clinically superior products. The staff nurse is. and should continue to be, a strategic person in the selection and evaluation process for products to be used in the clinical setting. If nurses do not make the effort to participate in product evaluations, there are others waiting to fill the void, but this may result in clinically unacceptable products being purchased for use in the practice setting. In addition to involving nurses in the product selection process, the following guidelines should be considered. Only products that appear to meet the clinical need should be clinically evaluated. Products currently being used may be compared to products being considered. Unlimited product evaluations tend to increase frustration and decrease the quality of the input provided. Sharing results o f the clinical evaluations with the participants will also increase willingness to participate in future evaluations.
AORN JOURNAL
__
~
Notes
I . P Harone-Ameduri, “Equipment trials make wnse,“ Nursing Munugmwnt 17 (June 1986) 43. 2. M Dickerson, “Product evaluation: A key to controlling costs.” Nursing Economics 5 (MarchIApril 1987) 62. 3. E Larson, L Maciorowski, “Rational product evaluation,” Journul of Nursing Administration 16 (JulyIAugust 1986) 32. 4. T C Smith, “Materials management: A model for product review,” Nursing Management 16 (March 1985) 54. 5. B S Jackson, A Egan, M Sullivan, “Choosing products: An in-house test of three types of intravenous clamps,” Nursing Management 16 (November 1985)
40. 6. Larson, Maciorowski, “Rational product evaluation.” 33. Suggested reading
Colt, A M; Zirnmerrnan, H E. “OR nurse purchasing influence:Results ofa recent survey.” AORNJournal 42 (October 1985) 498-505. E.usebio. E et al. “Product selection in the hospital Controlling costs.” Nursing Management 16 (March 1985) 44-46. Tonges, M C. “Quality with economy: Doing the right things for less.” Nursing Economics 3 (JulyIAugust 1985) 205-2 1 1.
Volunteers Needed to Evaluate Journal The Journal staff is seeking AORN members who want to evaluate the AORN Journal. By obtaining feedback from the readers, the staff can tailor the Journal to the readers’ interests. Four times a year, the volunteers receive an evaluation form to fill out regarding Journal editorial content. All comments receive serious consideration. If you would like an opportunity to critique the Journal, now is the time to volunteer. Send your name and address to AORN Journal, I0 170 E Mississippi Ave, Denver, CO 8023 1.
517
M. V. Ginny Baird, RN
W
ith the continuous introduction of new products, changes in existing ones, and the emphasis on reducing costs, product evaluations are inherent in the OR. Most institutions have a mechanism to evaluate and select products, either on a formal basis with product selection or standardization committees or on an informal basis on a specific unit. Regardless of the mechanism, it is important that staff from several departments offer input and receive feedback about clinical problems experienced with products.
Product Selection Process
P
erioperative nurses who have a thorough understanding of prcduct selection can help decide what is purchased for the OK. An optimum way to coordinate the product selection process is to relate it to the nursing processassessment, planning, implementation, and evaluation. The primary area for nurse involvement is in the evaluation or assessment stage. Assessment. The tirst step in the nursing process also is the first step in the product selection prtxess identification or assessment of a problem or need. Examples include inadequate clinical performance of a product, introduction of new techniques or technology requiring new products, introduction of new or improved products that will improve patient care, lack of standardization within a facility, or cost reduction. Quality assurance tools can be used to identify problems; however, improper use of a product should not be mistaken for a problem with the item itself.
Planning. After the issue or problem has been identified. the next step is to investigate available products that may solve it. In the planning stage. OR personnel should review literature, professional journals and catalogs; contact materiel management personnel; talk to manufacturers' representatives; and establish a network with other health care professionals who may have cxperienced similar problems o r needs. The next step is to review data from the manufacturer and examine the product. This is also the time to consult with other departments that have an interest in the product. For example. the biomedical o r the electrical department should check any product or equipment with electrical components, and the infection control department and/or committee should be consulted about solutions to be used for scrubbing or skin preparation. These initial consultations can prevent the clinical evaluation of iin obviously inadequate product . Implementation o j u clinicul evuluation.
Products that receive initial approval in the planning stage are subject to a clinical evaluation. Before implementing a clinical evaluation, an evaluation tool should be designed that is specific for that product (Table I ) . If two o r morc of the same type o f product are being evaluated, the
Table I
Product Evaluation Form Type of product: Disposable wrappers Manufacturer: Size of wrapper: -18x18 -24x24 -36x36 other:
At the time of this evaluation you were: -wrapping the set for sterilization or -unwrapping the set to be placed on a sterile field. Please comment on the following: Durability: Ease of handling: Does material retain specific shape: Linting: Packaging or storage: Other: In your opinion, is this product acceptable for clinical use: -yes -no
Please explain:
Name of person completing the form: Date:
same tool should be used to ensure consistency of the criteria and validity of the results. If different tools are used, the results of the evaluation are difficult to compare. When planning a clinical evaluation, it is necessary to consider the length of time to devote to the evaluation, the number of clinical units involved, and the number of products evaluated. The time limit should allow enough time to realistically judge clinical performance and detect
Service:
problems. but not so long as to reduce enthusiasm and input.' Before a clinical evaluation, all personnel who may use the product should attend an in-service meeting to learn about handling and using the product and any special precautions.? By introducing the staff to the product, the personnel are more familiar with it and can use it properly to ensure safe patient care. Being informed about the product also reduces negative product
A O R N JO I I R N-A I.
By attitude and presentation, the nurse can influence the acceptance or rejection of a product. evaluations based on mishandling or misuse. Departments related to the OR should be given an opportunity to consider the product if it is necessary. These include the central service, postanesthesia care unit, intensive care unit, and emergency room. While not all departments need to actively participate in the clinical evaluation, they should be aware of the evaluation and be informed of the results. For example, two or more surgical services may decide to evaluate some of the products being considered. After the evaluation, the results would be compared and a decision made based on the input from each surgical service. The number of products evaluated may vary according to the types of products (eg, four different brands of shoe covers) and the number of each product (eg, 50 pair of each brand). How frequently a product is used should be considered when setting limits on number of each product and length of time for the evaluation. Infrequently used products may need to have an extended period of time for evaluation, while commonly used items may need only a short period of time in which to detect problems and assess function. Evaluation: Analysis of results and decision making. After completing a clinical evaluation, data needs to be carefully analyzed, preferences and dislikes need to be compared, and packaging and ease of storage need to be considered. The most important question to ask in a product evaluation should be, “Is this product acceptable for clinical use?’ This should be answered yes or no, and reasons must be given to support the answer. While factors that indicate preference for one product over another are important, baseline clinical acceptability must be determined.’ A list of products that are clinically acceptable can be submitted to the appropriate If substitution of a routine people for f~llow-up.~ item becomes necessary, this list can be used to select alternate products that are clinically acceptable and meet the needs of the clinical 516
service. Other factors to consider include cost, competitive bids, and the ability of the equipment manufacturer to supply the product efficiently and in sufficient quantities.
Involving the Saj’j- Nurse
W
’here does the staff nurse fit in the product selection process? As a primary provider ofdirect patient care, the nurse is frequently the first person to be aware that a clinical problem exists with a product. The nurse can identify when a product does not achieve its purpose, problems in packaging or storing, or malfunctions. Because of their close working relationship with surgeons and anesthesiologists, staff nurses hear the physicians’ concerns or interest in particular items. The nurse is either directly involved in the use of the product or present when the product is used. Responsibilities may include coordinating the evaluation, making the product available to potential users, preparing and demonstrating the product, opening presterilized items, processing/ sterilizing reusable items, and receiving feedback from other personnel. The nurse can identify related problems with other products or on other care units that might not be readily apparent to someone less familiar with the entire practice setting. The nurse also is responsible for completing the evaluation tool or ensuring that the person using the product completes it. The nurse can offer objective judgment about the clinical performance of the product and note comments from the patients, physicians, and other health care team m em ber s. A well-informed nurse is often the best person to introduce new or different products to the surgical staff. By attitude and presentation. the nurse can influence the acceptance or rejection of a product. Without the assistance and support
\ I P I 1 M H I K I 9 X X V O I 1 X NL)?
of nurses, it is not possible to conduct credible clinical evaluations of products.
Conclusion
Q
uality and clinical performance should always be considered before cost.5 Cost considerations during a clinical evaluation ca influence the evaluation of the product itself. Sometimes when a poor quality, lessexpensive item is selected, more items may be used because of waste or lack of durability than if a more expensive, high-quality product had been selected. Only when two items are equal in clinical performance should cost be the deciding factor. Critical clinical performance for certain items may justify purchasing a more expensive item? Overall cost of a product needs to be determined when trying to reduce expenses. Cost containment cannot compromise the quality of patient care, though. Both can be achieved by involving the staff nurse in the clinical evaluation. Input from staff can help identify clinical problems, determine actual clinical functioning of products, judge whether products are equal in quality, and justify the purchase of more expensive, clinically superior products. The staff nurse is. and should continue to be, a strategic person in the selection and evaluation process for products to be used in the clinical setting. If nurses do not make the effort to participate in product evaluations, there are others waiting to fill the void, but this may result in clinically unacceptable products being purchased for use in the practice setting. In addition to involving nurses in the product selection process, the following guidelines should be considered. Only products that appear to meet the clinical need should be clinically evaluated. Products currently being used may be compared to products being considered. Unlimited product evaluations tend to increase frustration and decrease the quality of the input provided. Sharing results o f the clinical evaluations with the participants will also increase willingness to participate in future evaluations.
AORN JOURNAL
__
~
Notes
I . P Harone-Ameduri, “Equipment trials make wnse,“ Nursing Munugmwnt 17 (June 1986) 43. 2. M Dickerson, “Product evaluation: A key to controlling costs.” Nursing Economics 5 (MarchIApril 1987) 62. 3. E Larson, L Maciorowski, “Rational product evaluation,” Journul of Nursing Administration 16 (JulyIAugust 1986) 32. 4. T C Smith, “Materials management: A model for product review,” Nursing Management 16 (March 1985) 54. 5. B S Jackson, A Egan, M Sullivan, “Choosing products: An in-house test of three types of intravenous clamps,” Nursing Management 16 (November 1985)
40. 6. Larson, Maciorowski, “Rational product evaluation.” 33. Suggested reading
Colt, A M; Zirnmerrnan, H E. “OR nurse purchasing influence:Results ofa recent survey.” AORNJournal 42 (October 1985) 498-505. E.usebio. E et al. “Product selection in the hospital Controlling costs.” Nursing Management 16 (March 1985) 44-46. Tonges, M C. “Quality with economy: Doing the right things for less.” Nursing Economics 3 (JulyIAugust 1985) 205-2 1 1.
Volunteers Needed to Evaluate Journal The Journal staff is seeking AORN members who want to evaluate the AORN Journal. By obtaining feedback from the readers, the staff can tailor the Journal to the readers’ interests. Four times a year, the volunteers receive an evaluation form to fill out regarding Journal editorial content. All comments receive serious consideration. If you would like an opportunity to critique the Journal, now is the time to volunteer. Send your name and address to AORN Journal, I0 170 E Mississippi Ave, Denver, CO 8023 1.
517