Using PAR Levels in Inventory Management for CS

Sterile processing (SP) is a highly technical and fast paced environment that supports the care of patients through surgical operations and the delivery of sterilized items that are used during these procedures. The items provided can include surgical instruments, medical devices of all shapes and sizes, and disposable supplies. Many of the supplies needed for patient care are pre-sterilized through an industrial sterilization process and come prepared from the original manufacturer. It is extremely important that the sterile processing staff maintain the sterility during care and handling of these goods prior to and during the delivery to the procedure rooms.
Many times, the structure of SP can vary from facility to facility, where they may report to materials management or work under the central supply department. With sterile processing working either alongside, or in partnership with, the central supply department each group must have a clear understanding of the others responsibility to ensure fulfillment is at its best. This relationship is critical and can make or break the outcomes of an efficient inventory management system because many of the same responsibilities of maintaining, sorting, organizing, and storing supplies. Let’s look at how to incorporate the use of PAR levels in the inventory of a sterile processing department.

Multi-Team Approach

There are many layouts, designs, and workflows in SP when it comes to placement of inventory and supplies needed for cases. Sometimes the SP staff are responsible for picking supplies and placing them on case carts. Many times, the same SP staff are also responsible for putting the unused supplies back on shelves and maintaining sterile storage, but not managing the inventory of what is being returned. This happens when the sterile storage inventory is managed by another department, or team of professionals. When complete ownership of “supplies” falls to SP and not the Operating Room (OR) or Central Supply (CS), there is a much more efficient method for traceability and inventory control. In where central supply staff are responsible for only the ordering and stocking of sterile storage, this can cause issues and requires strong collaboration between the two teams. If the CS or materials management are responsible for all activity such as ordering, picking, placing and delivery of supplies for surgical procedures, then SPD doesn’t have to worry as much about what ends up on their case carts as they are only responsible for what they process, such as instruments. Whatever structure your facility uses, you can apply the same practices for the storage of surgical instruments, unprocessed or processed sets, decontamination supplies, personal protective equipment (PPE) and even supplies that you use within your department to function.

Par Leveling

The term PAR level stands for ‘periodic automatic replacement’ and refers to the inventory level that a department or unit should keep in stock to meet customer demand. This means that stock levels are maintained so they are neither too high nor too low at any time. PAR levels are particularly important to businesses that deal with perishable goods or items with an expiration date. Managing inventory levels is a delicate balancing act: understocking puts you at risk for customer shortages or delays, while overstocking increases the likelihood of goods expiring before they ever reach the customer. PAR levels can be the ideal measurement for determining a beneficial balance of stock for your department: not too little, not too much. When calculated accurately, they allow your department to endure a small amount of increased demand while avoiding major overstocking numbers. What are some benefits of using a PAR level approach in healthcare?

Reduce costs associated with expired goods

This can be applied to a variety of areas within the SPD. The amount of expensive pre-sterilized items that are flowing through any surgical operation or case cart picking environment can be thousands of dollars. Jeopardizing this cost, through expired items, should never be an issue. One Ethicon Stapler might cost a department $1,500-$3,000 and a pack of biological indicators are $850. These example items should all have PAR levels and be stocked at the appropriate amounts to avoid high costs of potential expired waste.

Reducing Product Waste

If one pack of chemical indicators or chemical indicator tape expires, or even the entire inventory of these items are overstocked they increase the risk of expiration. Chemical indicator tape is also sensitive if not stored properly, which could shorten its shelf life. Consider disposable poly-propylene FDA approved wrap, that has a pre-determined shelf life. Improper stock rotation can increase waste in the department and has the potential for ordering delays.

Eliminating delays

Patient delays in procedures can occur when supplies or sterilized items are not ready when they are needed. This could also increase costs for the operating room, and patients themselves. Creating an inventory management system for both consumables that are needed to run the department, as well as sterilized instruments, can help rotate items in and out and provide clarity of what is being most frequently used. By creating a first in, first out practice with surgical trays, it can help ensure trays are being used more consistently and aid in their life and longevity as well as being sent out, on time, for regular maintenance.

Prevent overstocking.

By setting a par level of the supplies you need to run your department, you utilize a more efficient layout of your spacing, storage availability and minimize the occurrence of overstocking. Start by collecting data, measuring the number of items you use in a given period, and compare that to the number of procedures. This will help you to determine your PAR level numbers.

Promote proper inventory turnover.

Turnover of trays and items needed in SP is inevitable, due to low inventory or purchasing barriers limiting the quantity of infrequently used, unique, items. It’s critical for the department to track the inventory turnover and utilize stock rotation to determine what sets and quantities will be needed and re-used. A scan point at each storage location, or an inventory tracker with button, can help track these items and their flow.

Increasing staff and customer satisfaction

When items are placed in their correct storage space, and available when needed, it causes less confusion, makes the SP job easier, and reduces the potential for frustration. Incorporating good inventory control practices will help ensure items are available when needed, rotated in a proper manner, resulting in increased customer satisfaction of both internal and external customers.

Take Control of your Internal Inventory

Let's talk about the areas in the SPD in which PAR leveling and inventory management can be successfully applied. Below you will see a list of areas in which you can apply these practices within an SPD.

Loose instrument inventory back up that includes storage of needed item replenishment when instruments go missing, are damaged, out for repair or are replacements.
Decontamination tools, cleaning supplies and consumables used in the cleaning process can be organized and stored in their own efficient manner, using storage bins and an inventory control practice that helps the team monitor what they are using most often.
Backlogged instrument trays that are waiting to be prepared and packaged can also be organized in a manner that helps throughput and production by organizing your “holding” areas. Set a maximum or minimum number of trays to each holding area with assigned staffing to monitor those “PAR” levels in the reverse order. This means that SP techs would pull trays when a certain number is hit on a particular shelf, keeping the backlog numbers down creating a consistent inventory flow through sterilization.
Supplies used to run the department can also be organized in their own storage area utilizing a PAR level system, when at all possible, to help the flow of supplies for all necessary processing and to eliminate the potential for over ordering or running out.
Preparation and packaging tables are stocked with necessary tools and supplies to complete the assembly process, these stations could be organized in a standardized method with the same amount of pre-determined supplies at each station. Allowing SP techs to over stock can lead to waste from expiration, and hoarding practices that don’t allow clear visibility of what’s available to the team.