ERCP Inventory Management

Using an Internal “Lotto” to Improve Supply Costs

INVENTORY MANAGEMENT is always a challenge for healthcare workers. How do we, as leaders, help our staff become more aware of supply costs while teaching them to be conservative in the use of them? These were questions I asked myself, when during a single ERCP, my entire inventory was wiped out.

I understand it was a very difficult ERCP; I understand the physician needed to try a variety of items in order to succeed; I understand that when you’ve been at it for almost two hours, desperation sets in. However, I don’t understand why four of the same exact sphincterotomes, and four of the same exact guide-wires were used. It was then I realized I needed to do something, and thus began the project, “ERCP Lotto, the Game of Skill and Chance.”

Inventory management has always been an issue, especially in today’s culture of “do more with less.” As assistant director of a two-room endoscopy unit, trying to do more with less is one of my biggest challenges. Endoscopy supplies are not cheap, especially those used for endoscopic retrograde cholangiopancreatography (ERCP). Educating staff on conserving and managing ERCP supplies was my goal when I started “ERCP Lotto, The Game of Skill and Chance.”

How can inventory management be fun and educational? After giving this some thought, I decided that first, staff needed to be aware of supply costs. An informed staff may, in itself, help accomplish my goal, but I wanted to take it a step further, so I created a sign advertising our ERCP supplies as if in a store. Our store is called “ercp R us.” I decided each team member would be responsible for paying for supplies used during an ERCP. When the procedure is scheduled and assignments made, a bill of sale is provided to the team. The bill of sale contains a place for each team member’s name, as well as the cost of supplies used in a typical ERCP. For every item opened after the first one, each team member involved in the procedure must pay the listed price. I chose the team approach to encourage cooperation in conserving supplies and also to provide a stronger voice from employees when physicians ask for multiple supplies to be opened.

I investigated different types of currency, including Monopoly® money, and then decided to create our own currency, called “biliary bucks,” featuring our gastroenterologists, physicians Najeeb Rehman, MD, and Michael Rourk, MD. Each team member receives $500 in “biliary bucks” prior to the procedure. If the team only uses one of each supply, they keep their $500. If they open a second device, then each team member must pay the listed price from their $500. This is placed on the bill of sale; then the money and bill of sale is turned in to me at the end of the procedure.

Now that I had the process in place, my next obstacle was to get staff to buy into this “game.” I did some soul searching and asked myself, “What motivates me?” I realized that my motivations were recognition for a job well done, pride in my work, competition, and monetary rewards. With this in mind, I chose competition and rewards to be the incentives used to motivate the staff. I created a very colorful display in our break room that explained the rules of the “game,” displayed examples of our currency, and examples of the bill of sale. I then listed each staff member’s name, and to fuel the competition, I kept a running total of biliary bucks, which I updated weekly.

The reward system was a little tricky. I wanted it to be fair, so I devised a reward system in which each staff member gets a lottery ticket for every $200 they have earned. As the game began, I soon realized I could use biliary bucks for rewards outside of inventory management. So when I had a nurse receive a thank-you note from a patient, this earned her $200 in biliary bucks. When staff volunteered to work past their normal shift, they earned $200. If I witnessed great teamwork, those staff members received $200. It soon became an incentive for good behavior as well as inventory management. I also observed that when I rewarded good behavior, other staff became more aware of their own. I actually had staff come to me and apologize for having a bad attitude, or not demonstrating good teamwork.

At the end of a three-month period, the lottery tickets were placed in a basket and a neutral party drew for two winners. Each winner received a $25 gift certificate. After working with these people for so long, I knew that eating and being pampered is a treat that most of them enjoy; therefore, I purchased a salon and restaurant gift certificate. We held our first drawing on Sept. 7, 2005. Our first winner was Jeannine Barford, RN, who had a total of 10 tickets entered. Our second winner was Jennifer Mounce, RN, who had a total of six tickets.

At the end of the first quarter, I performed data analysis to see if my inventory management program had worked. I looked at supply usage for three months prior to the start of the program, then supply usage during the three-month program. I was pleased to see we saved a total of $237.07 per procedure (we did 16 procedures), which is $3,792 for three months, or a total of $15,168 for 12 months, after implementing the ERCP Lotto game.

We are now entering our second quarter of ERCP Lotto, and the staff is still excited. The competition, as well as behavior rewards, continue to add fun and excitement to our daily routines. This system can be adapted for almost any situation. For example, our operating room has modified this system to reward staff for turnover times of 20 minutes or less. The name of their game is “Beat the Clock,” and instead of play money, they made clock faces, and a staff member who “Beats the Clock” gets a clock and a chance to win.

The program requires a commitment of time and a small amount of money, but in the end, your staff will feel empowered, important, and recognized for their efforts. It also helps inspire teamwork and create a more positive working environment. The rewards are numerous, so what do you have to lose? Put this system to work for you.

Debbie Woodring, RN, BSN, is the assistant director of operative services for the Moses Cone Health System, Annie Penn Hospital in Reidsville, N.C. Left to right: Debbie Woodring, RN, BSN, Kim Faint, endo scheduler, and Pam Shreve, RN, drawing a winner from the basket.

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