title: Reducing waste in the critical care setting.
abstract: BACKGROUND
  The ICU at London Health Sciences Centre-University Hospital (LHSC-UH) is a 40-bed critical care unit that contains two separate supply rooms that carry all the essential materials necessary for patient care. However, considering the patient acuity in critical care, it is vital that this equipment is made more accessible for practitioners at the bedside. Therefore, nurse servers or bedside supply cabinets are present in each of the patient rooms. While these servers provide timely access to the supplies essential for nursing care, they are also a huge source of waste. When patients who are identified as having antibiotic-resistant organisms (AROs) are discharged, numerous unused items are discarded for infection control purposes.
  
  
  OBJECTIVE
  Project objectives were to curtail waste by minimizing stocked supplies at the bedside, exploring alternative stocking options and increasing awareness of this issue with practitioners.
  
  
  METHODS
  An interprofessional team was formed consisting of registered nurses, support service workers, environmental service workers, infection control practitioners and critical care leadership. A cost analysis of discarded supplies was undertaken, and results were communicated to all staff. Infection control practitioners developed guidelines specific to use of the nurse servers and linen supply areas. The stocking process and contents of the servers were reviewed; surplus was removed and relocated to a close central area outside patient rooms. Following agreement on new server contents, lists and photos were created and posted in each supply room. New stocking guidelines were phased in gradually and were adapted according to user feedback.
  
  
  RESULTS
  Over a two-week period, a pilot cost analysis identified that supplies valued at $2,327.25 had been discarded from five bedsides. Future long-term cost savings will enable management to redirect such resources and therefore improve other essential care services in the ICU.
  
  
  CONCLUSIONS
  Increasing awareness of wasteful stocking practices facilitated the engagement of this CQI project. New stocking practices have greatly reduced waste and increased service efficiencies while maintaining the integrity of optimal patient care.
authors.affiliation: Jean Morrow, RN, BScN, Clinical Educator, Critical and Neurosurgical Care.
authors.forename: Jean
authors.initials: J
authors.lastname: Morrow
authors.affiliation: Shelia Hunt, RN, Medical-Surgical Intensive Care Unit.
authors.forename: Shelia
authors.initials: S
authors.lastname: Hunt
authors.affiliation: Virginia Rogan, RN, Medical-Surgical Intensive Care Unit.
authors.forename: Virginia
authors.initials: V
authors.lastname: Rogan
authors.affiliation: Kathryn Cowie, RN, Medical-Surgical Intensive Care Unit.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Cowie
authors.affiliation: Jan Kopacz, RN, Medical-Surgical Intensive Care Unit.
authors.forename: Jan
authors.initials: J
authors.lastname: Kopacz
authors.affiliation: Colleen Keeler, Manager, Quality and Patient Safety.
authors.forename: Colleen
authors.initials: C
authors.lastname: Keeler
authors.affiliation: Mary Beth Billick, RN, BScN, Coordinator, Medical-Surgical Intensive Care Unit.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Billick
authors.affiliation: Mary Kroh, RN, BScN, Coordinator, Cardiac Surgery Recovery Unit, London Health Sciences Centre - University Hospital.
authors.forename: Mary
authors.initials: M
authors.lastname: Kroh
mesh_terms: D000046:Academic Medical Centers / Q000191:economics* / Q000458:organization & administration*; D003299:Cooperative Behavior; D017046:Cost Savings / Q000191:economics*; D003365:Costs and Cost Analysis; D004209:Disposable Equipment / Q000191:economics* / Q000600:supply & distribution*; D004865:Equipment and Supplies, Hospital; D019983:Guideline Adherence; D017721:Hospital Costs / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics* / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics* / Q000458:organization & administration*; D033183:Interdisciplinary Communication; D007857:Leadership; D009741:Nursing Staff, Hospital / Q000191:economics / Q000458:organization & administration; D009864:Ontario; D019095:Point-of-Care Systems / Q000191:economics* / Q000458:organization & administration*