I just wanted to share a concept that we have implemented in our pharmacy. We use kan ban cards for our inventory system. The cards originated from a tool used in manufacturers. The company I work for uses the Lean concept used by Toyota. The cards are used as a pull system. Every item in our pharmacy has a kan ban card, yes it was very time consuming! Here is how the process works, each card contains the drug, form, strength,a reorder level and reorder amount. The card is placed at the reorder point for the drug and when the technician pulls product and gets to the card, they pull the card and place it in a bin. Whatever cards are pulled is what gets ordered that day. It is up to the technicians to make sure they pull the cards. The PAR levels are deteremined on data, however, some drugs have exceptions. There are some drugs where we have to have a certain amount due to emergencies. My job as a purchaser is to maintain the data on the cards. We keep a 3.5 day supply on hand. The organization has a goal of 24 turns, yes, 24!! We currently have 17.9 turns per year. I am very excited to see what our turn rate is this year. If anyone has any questions I would be happy to share more info on this subject. Just send me an email and I can answer your questions.

Name of Facility: 120 beds

Years as a Buyer: 5 years

Amanda,

24 turns, that is a significant amount of turns. Can you give more details on what data you used to establish your PARs, if you borrow from other hospitals when you run out, what is the back up plan should the Techs forget to pull the cards, do you have an Omnicell or other system throughout the hospital for the floors to pull meds, do you have a cancer center or other outside clinics, are there other tricks that you have established that we could all learn from?

Thanks so much. I may have more questions.
Keep up the good work.
Kathy

Name of Facility: 300

Years as a Buyer: 3.5 in Pharmacy, 25+ in retail hardgoods

The data comes from our Average Monthly usage. I use reports from Amerisourcbergen. We fortunately have a sister hospital across town that we can get drugs from. There is also another hospital in our town. Our biggest challenge is the technicians not pulling the cards. We keep a log for every product we run out of and the reason why. If the reason was because the card wasn't pulled, it is now the technicians job to find that product. Since the responsibility of procuring product when the card isn't pulled is now the technicians job, they are doing a much better job of pulling cards! We also have accudose machines throughout the hospital. There is a outpatient cancer center too, so we have a lot of options when we are desperate. Both of our inpatient and outpatient surgery centers place thier own pharmacy order and also all of our floors have to order their stock, we don't generaly fill any of there orders. This process was difficult for those who don't except change well. Hope this information was helpful, anything else just let me know.

Name of Facility: 120 beds

Years as a Buyer: 5 years

How do you determine what tech was resposible for not pulling the card? How many techs do you have on your staff? If and when you have to borrow from another hospital, is there a charge? If so, has that increased with this new system? Who wants (and why) your tunrs to be 24? How much time does it take you to replace all these cards? Sorry for all the questions but I'm just curious if this is something to look further into here and if it will indeed increase your turns.
Thank you for your time.
Michelle

Name of Facility: 300+

City, State: Teaching

Years as a Buyer: 8

Since we cannot pin point what technician didn't pull the card, it basically comes down to the technician who needs that product and finds that the card isn't pulled. I no longer spend my time finding products that we are out because nobody pulled the card. It is the technicians respobsibility as a team to find the product. I used to find the product when cards didn't get pulled, and wasted a lot of my time. This has taught them the importance of pulling card and the time it can save in finding a product. This process has decreased the number of cards not being pulled since they have to find the product. We usually have 9 technicians on hand during the day. Our Pharmacy manager is requesting the 24 turns. The reason is so we have less inventory hanging around. I have someone from inventory unpack my order and when I put my order away I put the cards back, some mornings it can take 1-2 hours. So far our turns have increased each year.

Name of Facility: 120 beds

Years as a Buyer: 5 years

When I was a buyer from a few decades back (maybe more than a few), I used an inventory card system coupled with a want sheet approach. When someone took something that looked like it was running low, they would write it down on the want sheet. I would check the stock and if I agreed it was close to ordering time, I would pull the inventory card from my bank of such cards that resided on a cart near my desk. This card contained all the purchasing data on the product, the wholesaler order number, the NDC number, the date and quantity of each order we had placed on this product (so you could tell the history of how fast that item moved), product size and strength, the latest contract source, etc. Once this card was pulled, meaning the product should be ordered, it was put into a To Be Ordered File, sorted by the company from which we would buy the product. Once enough cards were in a company's slot, based also upon how fast any one of the items were needed, an order was placed.

After the orders were received, the cards would then be filled out with the latest date of purchase, price paid, where purchased, etc. from the packing slip or invoice which usually came with the shipment. Then the inventory cards were put back into the bank of cards in generic order.

As a buyer, I would not trust technicians or pharmacists to place orders for me. They did not understand the supply chain as I had learned it and I was responsible for keeping expenditures within budget, so I didn't want technicians or pharmacists, whose main goal was having product in stock all the time, anywhere near my ordering function.

This type of approach may mean the buyer becomes too vital, so I do recommend training a buyer assistant who may be a pharmacy tech to learn the various facets of the purchasing function when the primary buyer is on vacation or at the networking conference. But letting regular staff do any purchasing was not in the cards for me.

Since I bought in the 1970s at a 450 bed hospital, we ordered more direct than is done now and we were not highly automated then, but I just thought I would throw in a few thoughts on this interesting chain of discussion, from a historical perspective.

Name of Facility: Pharmacy Purchasing Outlook Editor-In-Chief

Years as a Buyer: 5yrs Buyer/14yrs Pharmacy Contracts for GPO/12yrs writer

The system we use is a bit different. We don't use any want sheets. If we need a special drug or the patients dose is extremely high, the technicians fill out a form with some information so I know to order more in. With this card system nobody has to guess what may be low, since everyone's definition of low may be different. Every product has a card not just ceratin drugs. We also use the pull system for everything and the reorder amount is on the cards and it is my responsibility to monitor the PAR levels. With this sysytem I am able to trust the person who places the order on Sunday since they don't have to "think" on how much to order, that is all on the card for them!

Name of Facility: 120 beds

Years as a Buyer: 5 years

This seems like a new and exciting system. I always learn something new when I am here.

Name of Facility: 222 beds

City, State: Acute care teaching hospital Trauma II center

Years as a Buyer: 5 years

I apologize for the dumb question... I'm a newbie. What are turns?

Name of Facility: Catawba Valley Medical Center - 270 beds

City, State: Teaching

Years as a Buyer: Less than 1!!!

Coleen:

I'm surprised no one took this one. I guess it's too early in the week.

"Turns" is a short term for Inventory Turnovers. It is the number of times you've completely rotated your stock in a year. There are several ways to determine turnovers, but the simplest method is to take your total expenditures for the year and divide it by the current dollar amount of inventory in stock now. For example, if you spent $1,000,000 in drugs and materials, and you have on hand right now $100,000 in stock, your turns would be 10 (1,000,000/100,000). The higher the turns, the better it looks for you, as there is not stock just sitting on the shelves, not generating revenue.

That is what has generated the current discussion on whether or not to deplete your current stock just before inventory. By decreasing your stock, you artificially inflate your inventory turns, and you loook that much better.

Hope that answers your question

Name of Facility: Kennedy Health System / 180

City, State: http://www.pharmacypurchasing.com

Years as a Buyer: >30 but Retired (for now...)

Gotcha - thanks! No one at my hospital has mentioned turns to me as a goal to move towards, maybe its not on their radar...

Name of Facility: Catawba Valley Medical Center - 270 beds

City, State: Teaching

Years as a Buyer: Less than 1!!!

Since you're less than a year into the job, maybe it isn't an issue they want you to address - just yet. Rest assured, if you have an accounting department in your hospital, it WILL be an issue eventually.

My advice is to look at your GPO's contract compliance numbers for your facility. Unfortunately, contract compliance includes all your expendiutres, including non-contract proprietary drugs like Lunesta or Activase, as well as your IVIG and other high-dollar items. Because of these non-contract items you have to buy, getting your contract compliance numbers close to 100% to next to impossible. If it is 70% or better, you're doing as best a job as you can.

Next, look at your drugs that are in great quantity and are also expiring. Large quantities of expiring drugs should tell you that these items are slow-movers and should be downsized in quantities, with exception of course to drugs you must keep on hand despite their low use, like Dantrium.

Lastly, just before inventory, get all your out-dated drugs off the shelves and do whatever your hospital does to return them: either a reverse-distributor company or if you do it yourself, the latter I really don't recommend, because of the time and documentation it would invlove.

These easy quick-fixes help you keep your eye on the bottom line, so that when inventory time comes around, it won't be a source of major trauma if you have to return large quantites of drugs for either out-dates or just plain excessive stock.

Mike

Name of Facility: Kennedy Health System / 180

City, State: http://www.pharmacypurchasing.com

Years as a Buyer: >30 but Retired (for now...)

Here at the hospital we went threw a lean system also.
We went to the 2 bin system, in the front bin should
be a 2 wk supply in the back been also carries a 2 wk
supply. It does make it better on the ordering. Our problem is they techs or pharmacists do not seem to know how to pull the empty bins also. At first we
ran out a lot because our monthly average use was like
5 tabs on some products. Well if you fill pyxis machines you can have a few months sitting up in these
machines. I try to manage the top dollar meds, and unload them asap after the patient is discharged.

Name of Facility: 400+

City, State: Univeristy and Teaching Hospital

Years as a Buyer: 13