1. Prepare a current inventory, different kinds and ages of beds; ambulatory carts, nurse call systems, mattresses and accessories, matching appropriate furniture pieces. Compile purchasing patterns and inventory locations.
2. Review current and future needs, propose a matrix of approved standard specifications, ambulatory carts and mattress systems that would include upgrading accessories, nurse call, and other needed furniture pieces. Ensure safety equipment functions such as bedrails or entrapment potentials are addressed.
3. Propose a three- to five-year capital plan for bed, ambulatory carts, and mattress purchases and develop ongoing program for evaluation of depreciation, quality, technology, and aggregation of purchases to enhance price.
4. Review the need for rental beds and make recommendations on a rent or purchase decision.
5. Define and suggest for change, storage issues associated with beds not in use.
6. Prepare and implement an action plan for future purchases and centralization of capital resources to maintain consistency.
7. Specifically identify all dollars that can be saved by MFK from specific budgeted accounts.

1. We prepared a current inventory of all beds effective April 15, 2002, that includes ages, kinds, and current condition of all units. (Attachment I) The changes implemented were to redefine who the custodian shall be in the future which should help to locate inventory by general nursing service rather than specific floor or room number. There will be a recommendation to develop a system to update Property Management database. See Action #6.
2. Bed types that have been purchased include, Hill-Rom adult bed frames, Borg-Warner adult bed frames, Hill-Rom total care beds, Stryker beds, hard beds, labor and delivery beds, maternity, cribs and isolettes, and sleep unit beds. To complete matching appropriate furniture pieces, a new team will need to compile purchasing patterns and inventory locations, as suggested in Action #5.
3. Establish a team to do a snapshot inventory of transport carts and mattresses that would document the current inventory and state of repair. This would also include an evaluation of the manufacturer, list of repairs and condition of mattress. The ad hoc team would do a one-day inventory to note those that need replacement. See Actions #5 and #7.
4. The presentation of the plan for implementation of new nurse-call systems was presented and has team support. Attachment II
5. The need for a standard bed surface for all general adult or medical/surgical beds has been identified along with a recommendation for future replacements. New purchases related to area relocations have been very specific to patient population. The team feels this is appropriate, but offered suggestions on how we could encourage standardization and cost savings by purchasing in conjunction with total hospital interests. See Action #4. Attachment V is an example of the review criteria that we recommend for future mattress evaluations.
6. A recommendation to use existing warranties is part of the future plan. We found education of staff and movement of equipment left staff without an office to call upon for ownership and warranty issues. See Action # 1.

1. Current needs have been met by the protocol developed by Nursing Services and Patient Care, Nurse Finance area. This process which included safety concerns established in nursing has been so successful we recommend that it be applied throughout the University of Iowa Hospitals and Clinics. Attachment III
   For example:
   • Pediatric: Pediatric equipment purchases including isolettes, bed warmers, nursery beds, and other pediatric furniture that have unique needs should be purchased through a central clearing office to assure standardization.
   • In addition, question of use must be asked with acceptable answers prior to all purchases.
2. There is a need for a central repository for purchasing, budget, inventory, and repair of portable/movable equipment. The model related to standardization and purchase of capital equipment used by Nursing Finance should be adopted throughout the University of Iowa Hospitals and Clinics. See Action #1. (Historically, there has been no institutional oversight for purchase and standardization of portable/movable equipment, whether capital or portable equipment. We do not have a current tracking system or inventory. There are no standardized specification criteria in a central repository and no central oversight for annual review of needed purchases, repair expenses, or even annual repair review.)
3. Attachment II identifies the nurse call system location and the change-out priority.
4. Safety equipment functions are part of the standard list of bed specifications referenced above. The team supports the efforts of the subcommittee reviewing ergonomic issues related to equipment purchases.

Related to Charge 3: Propose a three to five-year capital plan for bed, ambulatory carts and mattress purchases and develop ongoing program for evaluation of depreciation, quality, technology and aggregation of purchases to enhance price.

The team recommends the following process for the next three to five years:

1. Standardize beds into two categories - general medical and critical care. Centralize all purchases of all beds to address function, ergonomics and price.
2. Establish a new team to evaluate patient carts and their mattress pads.
3. Establish a new team to standardize in room chairs, recliners, and over-bed tables.
4. Continuation of standardization of bed mattresses.
5. Establish an office for a house-wide re-evaluation of beds for quality, technology and ergonomics and re-establish new standard. See Action #1.

Related to Charge 4: Review the need for rental beds. The team should make recommendations on a rent or purchase decision.

1. Specialty beds need to continue to be rented on an as-needed basis for multiple reasons. Technology changes frequently, making new purchases cost prohibitive. The rental company provides support 24 hours a day, seven days a week for setup and takedown, which includes in-service or training of staff on the area. This service would need to be developed in-house and is considered cost prohibitive due to the constantly changing technology and availability of staff 24 hours a day seven days a week. In FY 2002, it is projected that we will spend about $749,860 for these beds. This is a 10% reduction in expense. This is mainly due to a new Novation contract, which reduces the cost of their products used by the University of Iowa Hospitals and Clinics.
2. Cost savings was facilitated by the use of a matrix (based on patient need) which is available in the Nursing Policy website. The team feels that additional communications would be necessary to fully implement. See Action #3.
   (Nursing Policy # 2.060) Attachment IV
3. A summary of rental bed expenses/cost savings is available.

1. A multi-departmental group identified items in storage to determine potential future storage or use for trade-in value. This group identified over 1,200 items that could be deleted from the storage area. The number of items that were taken from storage and sent to surplus was 4,809, which relates to over 4,600 square feet of storage space.
2. In addition, the group has implemented a standard format be used to identify items going into temporary storage that identifies who is responsible, and a limited timeline for storage. This will not apply to beds that are in motion on a daily basis.
3. Consistent with the charge, create standards for the purchase of beds, thus eliminating beds identified for one nursing unit that cannot be used on another unit, reducing storage problems and concerns with nurse call system incompatibility. In all future contracts, vendors will be required to remove older equipment. See Action # 1.
4. Recommend continuation of investigation to use a web site for identification of items in storage and trade-in opportunities.
5. Recommend continued investigation into a bar-code system for identifying beds and other patient room items entering and leaving storage.

1. An inventory of all beds was difficult to procure. A better way to inventory in the future would be the use of bar-code technology. Staff education was considered key on how to keep the inventory records up to date at the Property Management Office.
2. The approval for the standardization of purchase for beds is a major recommendation. The team strongly suggests the purchase of beds needs to be channeled though a central review area for standardization. See Action #1.
3. The current system for review for warranty on capital equipment is lacking. There is inconsistency when a warranty begins, lack of knowledge of its existence, no formal communication process with repair staff and the area, and parts were being replaced that were still under warranty, etc. The solution would be a central review area for this standard base of knowledge, staff education, follow-up with vendors and maintenance areas.
   See Actions #1 and 2.
4. We were unable to complete an inventory of recliners and sleeper recliners. The team suggests a separate team be established to tackle specific inventory for this type of equipment. See Action #5.
5. Coordination of purchase and validation of mattress warranty was not communicated. The vendor is now asked to date each mattress prior to delivery. If it needs to be replaced, the vendor is held to the warranty agreement for replacement.

C. Provide action plans to address implementation of recommendations by success of the team. Include the name and the department or staff responsible. Our three to five-year capital plan is related to the following actions:

Action 1: Recommend an establishment of a central repository for data related to "All about beds."

1. Approval and support for maintenance of an office for coordination of an inventory database.
2. Establish a monthly meeting with support areas to discuss questions of standardization.
   • This office will keep a current list of acceptable vendor contracts.
   • It would also monitor warranties, repair database and other related data items.
   • Patient care equipment, such as mattresses, beds, recliners, over-bed tables, etc. would be monitored for standardization.
3. Assess current and recommend future standardization of beds.
4. In all future contracts, vendors should be required to remove older equipment as part of the trade-in value.
5. Establish a Facilities Services website to identify items in storage and trade-in opportunities.
6. Department of Purchasing will ask and will incorporate warranty into each contract associated with all kinds of equipment purchase.

Nursing Services Finance

Working with:

1. Nursing Services Finance
2. Hospital Information Systems
3. Purchasing & Accounts Payable
4. Biomedical Engineering
5. Facilities Services
6. Value Analysis Program
7. Hospital Administration

October 2002

1. Establish a central database of warranty information.
2. Require departments to implement the new warranty onset date.
3. Provide ongoing staff education and communication.
4. Provide the rental bed use guidelines to department heads, medical faculty and house staff.

Nursing Services Finance Office
Bev Folkedahl to Dr. Helms

July 2002

1. Continue to utilize the rental of specialty beds utilizing the Nursing Guidelines for appropriate selection of product related to pulmonary, skin, or bariatric patient needs. (Policy 2.060)
2. Utilize Nursing Management Council, Staff Nurse Council, APN Council, Skin Care Committee and unit-based staff meetings to familiarize staff with the guidelines.

Nursing Services Finance Office
Nursing Councils
Skin Care Committee
Material Services for Data Collection

July 2002

1. Use of the specifications should be reviewed at minimum of every other year to ensure they are still valid, beginning in FY 2002-2003.

Nursing Services Finance Office
Skin Care Committee

July 2002

1. Establish a new team to assess current and recommended future standardization of inventory of patient carts, recliners, sleeper recliners, over-bed tables in room furniture and like equipment.
2. Document condition of carts and mattresses as to their repair or replacement status.
3. Review and propose standards for related ergonomic equipment.

Nursing Services Finance Office
Facilities Services

October 2002

1. Improve communication with the Property Management Office.
2. Use bar-code system for identifying beds and other patient room items.

Nursing Services Finance Office
Hospital Finance and Accounting Services

July 2002

Nursing Services Finance

October 2002

D. Quantify all operational savings for University of Iowa Hospitals and Clinics (include Master File Key identification).

1. Savings related to storage of excessive unused inventory could be liquidated to decrease the amount of space needed for storage and the utilization of unused inventory to reduce the need for additional equipment purchases.

2. Potential savings is significant when we utilize a warranty review process. Per the Nursing example from this fiscal year, the savings was $82,000.

Continued savings from extended warranties on three of the below pieces of equipment translates into approximately $ 82,000.

3. Because there is no "gate keeper" at UNIVERSITY OF IOWA HOSPITALS AND CLINICS to determine appropriate support surface for a patient, a system should be in place to ensure that patients receive therapeutic, cost beneficial support surface to meet pulmonary, skin or bariatric needs. This may be effective in reducing length of stay and the associated additional costs.

4. The operational savings from the Department of Nursing:

$ 3,600 saved with purchase of ice machines
$ 57,780 saved with purchase of beds
$ 17,500 saved by negotiating an additional 2% discount on bed purchase
$ 6,500 saved with crib purchase
$ 10,000 saved with vital monitor purchase
$ 4,000 saved with purchase of over bed tables/bedside stands
$ 22,275 saved by negotiating trade in value
$ 3,700 saved with purchase of office chairs
$ 2,500 saved with purchase of Propaq monitors
$ 162,000 saved by utilizing vendors on Novation
$ 289,855 TOTAL SAVINGS