PAD.DR.

D Y PATIL

COLLEGE OF NURSING

PANEL DISCUSSION
ON
MATERIAL MANAGEMENT

SUBMITTED TO:

SUBMITTED BY:

Mrs.Rupali Salvi

II Year MSc. Nursing Students

Asso.Professor

Dr.D Y Patil College of Nsg

Dr.D Y Patil College of Nsg

Pimpri

OBJECTIVES FOR MATERIAL MANAGEMENT

At the end of the panel discussion the group will be able to :

Define the terms in material management

Enumerate the elements of material management
Discuss the principles of material management
Explain the process of material management
Elaborate the concepts of Inventory control
Discuss the ABC and VED analysis
Planning for equipments for nursing care unit and hospital
Discuss Condemnation in material management
Discuss the application of material management to nursing service and
education

OUTLINE
a)
b)
c)
d)
e)

f)
g)
h)
i)
j)
k)
l)

Introduction
Definitions
Elements of material management
Principles of material management
Procedure of material management
Purchase transaction
Receipt and analysis
Selection of supply source
Placing order
Record maintenance
Payment
Inventory control
ABC and VED analysis
Planning for equipments for nursing care unit and hospital
Condemnation of material management
Application of material management to nursing service and education
Conclusion
References

MATERIAL MANAGEMENT

INTRODUCTION: Materials are an essential resource to achieve the objectives

of a health care organisation.While about 60% of the funds of the health are
consumed to provide manpower,health care being a labour intense activity
,almost 40 % of the funds are used up for providing materials.In the absence of
the materials required for health care activities ,the man power deployed is
rendered non-functional.Therefore it is of great importance that materials of
right quality are supplied to the consumers in right quantity at right time and at
right place of use.All activities involved in the achievement of above stated
objectives ,ie:planning for materials,their
demand,estimation,procurement,stocking and use come under the purview of
term , materials,planning and management. Since the beginning of 20th
century, materials have been occupying a place of importance among the Ms of
Materials, Money, Man, Machine and this will continue to be so in the years to
come.
Material management is one of the areas covered by the whole process of
management. The effective use of all manpower is looked after by the personnel
management. But for a balanced growth and efficient running of the enterprise,
it is necessary that material cost, material supply and material utilization are so
controlled that they lead to
The maximization of production,
The reduction in the cost of production and distribution,
The maximization of the margin of profit.

DEFINITIONS / KEY TERMS:

1) MATERIAL MANAGEMENT:
MATERIAL MANAGEMENT is concerned with providing
the drugs, supplies and equipment needed by health personnel to deliver health
services.

 Material management is a scientific technique, concerned with

planning, organizing and controlling the flow of materials from
their initial purchase through internal operations to the service
point through distribution.

Material management ensures the availability of the right material

at the right time ,at the right place and at the least cost.

It involves control over purchase, storage, distribution, use and

disposal of the supplies and equipments.
Lack of control cause many problems such as over stocking, under
stocking, damage of storage , obsolence (disuse) of materials,
pilferage, theft.

2) SUPPLIES:
Supplies are those item that are used up or consumed e.g. in hospital
supplies are drugs, surgical goods (disposables, glasswares), chemicals,
antiseptic food materials, stationaries (papers, pencil, ink, soap),linen etc.

3) EQUIPMENTS:
This term is used for more permanent type of articles and may be
classified as fixed & movables.

a) FIXED EQUIPMENT: is not a structure of the building but it

is attached to the walls of floors (e.g. sterilizers, washing
machine etc)

b) MOVABLE EQUIPMENT: It includes furniture ,instruments,

chairs etc.
4) OBSOLENCE : It means disuse.

5) INVENTORYIt is the list of items which are present in the particular ward at the
time.
6) INDENT
It is the list of requirement which is essential in particular ward.

ELEMENTS OF MATERIAL MANAGEMENT SYSTEM:

Material planning and management (MP & M) is a system having
numerous elements. Proper functioning of each of the elements (sub-system)
coupled with interdependence of all the subsystems to are the achieve the
primary objectives are the classical characteristics of the MP and M system. The
major sub-system are:
a. Demand estimation
b. Procurement
c. Receipt and inspection
d. Storage
e. Issue and use
f. Maintenance and repair
g. Disposal
h. Accounting and information system.

1) Demand estimation:

A large variety and number of materials are used in hospitals and other
health care institutions. The Advisory Committee for development of surgical
instruments, equipment & appliances (1963) identified 3200 items of
instruments & equipment being used in hospitals. This is just to illustrate the
variety & diversity of stores used for patient care in a hospital situations. There

is, therefore need for variety reduction of the materials as less the number of
materials, less will be the problems of planning & management of the same.
Along with variety reduction of the materials there is need for laying down
proper specification of the materials. In this area, the Indian Standards Institute
has been & is playing a very important role by standardizing a large number &
variety of instruments & equipments. The ISI has set up a number of technical
committees to work out the details of standards of surgical instruments,
glassware, anesthesia, equipments, dental machine, artificial limbs, surgical
dressing, utensils, electro medical instruments, rubber woods, etc. Along with
standardization, variety reduction, & proper classification of materials a major
area of activity of MP & MS is demand estimation of each category of material.
This should always be done keeping in view the trends in consumption pattern
over the last 2-3 years, objectives of the organization, changing clientele &
changing emphasis on various programs & activities in the health field. In this
field a sound data base & use of advance projection techniques are of great
use. These techniques are relatively simple & medical administrator should use
them frequently to streamline the MP& MS system.

2) Procurement :

Having drawn up the list of requirements, the next step in MP & MS is the
process of procurement of these materials. Most of the states & other
organizations have laid down detailed set of rules & regulations regarding the
procedure of ordering for materials. The financial authority is also vested in
various levels of the administrative hierarchy. The basic spirit behind all these
rules , regulations, procedures etc. is to maximize the value of money invested
in the purchase of stores. Organizations like Directorate General of Supplies &
Disposals (DGSD) play a crucial role in purchase which involve heavy costs.
Many states have medical stores depots which are centralized agencies of
procurement & stocking of medical stores. There is also a system of fixed
contract or running rate contract which is followed in large organizations &
some State Governments Limited tenders , rate enquiries local spot & emergent
purchase form a part of the complex sub- system of procurement. However , the
role of DGSD needs special mentioning in the sub- system of procurement of
bulk materials.

Normally three types of contractual services are offered by

DGSD. These are:

a) Fixed quantity contract: This type of contract is generally entered into

where firms are called upon to offer to supply a definite number quantity of
stores by a specified date. Such contracts, are binding on both the purchasing as
well as supplying agency.

b) Running contract: These contracts for the supply of an approximate

quantity of stores at a specified price during a certain period of time.

c) Rate contract: These are the most important contracts as far as health
institutions are concerned. Under these contracts the firms are asked to supply
stores at specific rates during the period covered by the contract. No fixed
quantities are mentioned. The purchaser is bound to order from the contractor
all stores under the contract, which are required to be purchased.

Value Analysis:
The obvious & elementary principle of material use is the right quality
of material. This includes questioning & analysis of each specification to see if
it could be amended or substituted to maximize the end use of material. This
process of analysis of the intrinsic value of the material for achieving the
objectives of the organization is termed as value analysis. This is a vital
function of a materials manager. The following considerations help to carry out
the value analysis.
a) Can the material be dispensed with ?
b) Can it be simplified?
c) Will a standard material do?
d) Is its value proportionate to its cost?
e) Is anything cheaper but equally good available in the market?

f) Would not it be better to manufacture it?

3) Receipt & Inspection:

The stores ordered are received in the store. A reasonable sound policy &
methodology of inspection of incoming stores is an essential elements of MP &
MS. The inspection policy should enunciate the sampling procedure for
inspection & this procedure must be followed. The lot thus picked up by a
random sampling method be subjected to physical & chemical inspection. Basic
facilities for such examination be created in the organization itself depending
upon the size of stores turnover , governmental & commercial chemical
laboratories should also be made use of for analysis of chemical composition of
drugs etc. Investments made in sound sampling policy & procedure will go long
way in assuring the right quality of materials supplied to the organization.

4) Storage:
The medical stores should be situated near the other stores of the
hospital. It should be easily accessible to suppliers as well as indentors.
Location of the store will, therefore, be guided by the flow activity of the stores.
The store should be of adequate size to accommodate all the drugs, instruments,
appliances etc. required for use in form of steel racks with shelves.
Refrigeration should be provided for storage of thermo labile items. A graded
temperature zone concept is essential in medical stores. Separation of stores of
various types, i.e. injections, tablets, local use agents from others, poisons from
non-poisonous, inflammable from non-inflammable etc. dictates the layout of
the stores. Drugs & medicines should be grouped according to the
pharmacological actions & in accordance with the classification adopted in the
formulary. Alphabetical arrangement group-wise enables easy identification &
retrieval. Items received later from the supplies should be stored behind similar
items & the principle of First out (FIFO) should be adopted.

5) Inventory control:

Inventory control mean stocking adequate number & kind of storage so

that the materials are available whenever required & wherever required. This
has to be done at an optimum outlay of financial & human resources. High
inventory level leads to high cost of inventories by:
a) Locking the finance
b) Large storage space
c) Large handling & administration charges
d) Obsolescence
e) Spoilage etc.
On the contrary, low inventories may lead to frequent stock outs & high
shortage cost. Balancing the cost of carrying high inventories & the cost of
shortages is done through a system of scientific inventory control.

6) Use, Maintenance and Disposal of articles:

- Articles have to be used to its optimum period. Careful handling ,

periodical cleaning, servicing, disinfection and repairs will help to
prolong the life of equipments and other articles.
- The operation and service manuals supplied along with the equipment
should be kept safe in the purchasing department. Duplicated copies
may be supplied to the department.
- Each hospital should set up a condemnation committees to review the
articles that are to be disposed off. When the articles cannot be used
for the purpose for which they were bought, it may be possible to
recycle or reuse materials for another purpose. Some parts may be
used with another unit. It may still have value as a scrap.

BASIC PRINCIPLES OF MATERIAL MANAGEMENT PLANNING

1. Planning

2. Organizing
3. Staffing
4. Directing
5. Controlling
6. Reporting
7. Budgeting
8. Sound purchasing methods
9. Skilful and hard poised negotiations
10.Effective purchase system
11.Should be simple
12.Must not increase other costs
13.Simple inventory control programme

There are seven principles of material management which must be kept in mind
to ensure good results. Health managers should follow the principles or rights.

1. Right Item
2. Right Quality
3. Right Price
4. Right Source
5. Right Delivery
6. Right Method
7. Right People

Principles of Administration applicable in Material Management

(Equipment & Supplies)

I.

Discipline involves observance of norms, rules regulations and established

procedures

II.
III.

Unity of command Refers to having one superior to give commands

Unity of Direction- Refers to having a single superior in control and for
giving directions

IV.

Orders concerned with systematic and orderly arrangement of materials,

supplies and equipment according to requirements of specific departments

PROCESS OF PURCHASE

Identification of items for Purchase by department

(Selection of Item)

Written Purchase request from various departments will be received in

The purchase department (demand estimation)

Receipt and analysis of requisition

Call for quotation and select the best item

Place the order

Receive the order material and check the invoice

Storage

Payment and maintain all the records and files for reference

Issue for use or consumption

Maintenance and repair

Disposal and condemnation (if needed)

INVENTORY CONTROL:-

An inventory is a detailed list of all articles on the ward, their specifications and
standard number or quantity. The pacification makes it possible to identify the
article by size, number or description. The standard indicates the quantity that
should be kept on the floor.
Frequent counts are an aid in maintaining and tracing equipment. Such articles
as flashlight scissors, needles, hypodermic syringes, stethoscope, and
sphygnornaometers may require a daily count. These items disappear or are
articles easier. Some articles may be counted weekly or monthly. For others
such as furniture, probably an annual or semiannual inventory is sufficient.
The actual count of articles which is made on the wards is known as a physical
inventory.
Inventory in general means a stock of goods. The specifications make it possible
to identity the article by size, number or description. The standard indicates the
quantity that should be kept. Sometimes the condition and cost of items are
included.

II

MEANING OF INVENTORY:

An inventory is a detailed list of all articles on the ward, their specifications,

and standard number of quantity.

DEFINITION It is an ideal resource of any kind having an economic value.

Definition of control Control may be defined as the process through which
managers ensure that actual activities to confirm to planned activities.
Inventory control means stocking adequate number and kind of stores so
the materials are available whenever required and wherever requirement. High
inventory level leads to high cost of inventory.
e.g. a] Locking the finance
b] Large storage space.
c] Large handling and administration charges .
d] Obsolescence
e] Spoilage etc.
Objectives of Inventory Control
1. To keep the investment on inventories to the minimum.
2. To minimize idle time by avoiding stock outs and shortages.
3. To avoid carrying cost.
4. To improve quality of care with lesser inventory.
5. To avoid obsolescence of inventor

III.

PURPOSES OF INVENTORY:

1.
Inventory helps to check the standard count and corrections made as
necessary.

2.
Taking of inventory not only gives an opportunity to determine whether
the standard has been maintained but it provides a good chance to dispose of
excess and obsolete materials.
3.

To recommend changes in standards.

4.

To determine the condition of articles and equipments.

5.

To order, repair or replacement if necessary.

6.
The purpose of inventory is to determine appropriate levels of holding
inventories the ordering sequence and the quantities, so that the total cost
incurred are minimized.
7.

It is an ideal time to return equipment to its proper place.

8
Articles borrowed from central supply room or another ward may be
located and returned.
9.

Frequent counts help in maintaining and tracing equipments.

IV. Types of Inventory:a) Physical inventorywards.

The actual count of articles which is made of the

b) Daily count

Some articles require daily count.

e.g. Articles like flashlights, scissors, stethoscopes, sphygmomanometer, etc.

c) Weekly count-

Some articles require weekly count.

d) Monthly Inventory- Some articles require monthly inventory.

e) Annual Inventory Some articles or items require inventory annual or
semi-annual inventory. e.g. Furniture, Linen, Medical equipment, dead stock
etc.
Inventory of some items may be take at night if day period seems impractical.
The items can be divide and proper inventory can be taken. e.g. Furniture on
one day, linen on another day, medical equipments on another day etc.

V.INVENTORY CONTROL METHODS

i] Intuitive method This is the want book method. This is the most effective
method. Here items are recorded in the want book when the number of units in
stock reaches closed to zero.

II] Perpetual inventory method This is the best accurate and effective
method of inventory.
III]ABC method- This method is based on the fact that some stock items have
a much higher annual usage value than others.
IV] VED ( Vital essential desirable )In this method each stock items is
classified on either vital essential desirable based on how critical the item is for
providing health Services.
V].Two bin methods.- This method separates the stock of each item into bins.
( Boxes ) one bin contains the main stock, the second small bin contains
enough stock to satisfy demands
during the period necessary for
replenishment.

Organization of Inventory:I.

Preferably the day or days selected for inventory are those on which
the nursing load is the lightest.

II.

Time and assignments are planned so that all personnel may assist in
the count.

III.

Each individual is assigned a certain group of items to count usually

those by which related by location.

IV.

Checklist for room articles and individual bedside equipments are set
up.

V.

All medical equipments are gathered together in one central place,

office equipment in another and so on.

VI.

Everyone must be cautioned to count all items and to return articles

which are found in wrong place to the proper room so that all may be
included in the inventory.

VII. Borrowed equipment is taken to a central place from which it is

returned to the proper department.
VIII. If the equipment is not in perfect condition, it is set aside for head
nurse to inspect it.

IX.

Totals of all articles are assembled the figures are compared with the
standard.

X.

There should be a place in the inventory book to keep record of

monthly or annual counts.

XI.

Head nurse or supervisor assists, keeps herself free to direct and to

answer questions.

ABC, VED, HML ANALYSIS IN MATERIAL MANAGEMENT

Inventory control it is an important aspect of material management.

Inventory control is a scientific system which indicates as to what to

order, when to order, and how much to order, and how much to stock so
that purchasing costs and storing costs are kept as low as possible.

Techniques in Inventory Control

ABC Analysis (Always Better Control)
VED Analysis (Vital, Essential, Desirable)
HML Analysis (High, Medium, Low)
FSN Analysis (Fast, Slow moving and Non-moving)
SDE Analysis (Scarce, Difficult, Easy)
ABC Analysis
ABC analysis is the analysis of the store items cost criteria.

It is a simple approach, which avoids being money wise.

The cost of each item is multiplied by the number used in a given period
and then these items are tabulated in descending numerical value order.

 It will be seen that first 10% of items approximately account for 70%, the
next 20% for 20% of value and the last 70% account for 10% of value.
It has been seen that a large number of items consume only a small
percentage of resources and vice- versa.
A Items represent the high cost centre, B items represent the immediate
cost centres, and C- items represent low cost centres.
A very close control is exercised over A items while less stringent control
is adequate for those in the category B, and less attention for category C.
A-

Items
1. Tight controls
2. Rigid estimates of requirements
3. Strict and close watch
4. Safety stocks should be low
5. Management of items should be done at top management level.

B-

Items
1. Moderate control
2. Purchase based on rigid requirements
3. Reasonably strict watch and control
4. Safety stocks moderate
5. Management be done at middle level

C-

Items
1. Ordinary control measure
2. Purchase based on usage estimates
3. Controls exercises by store keeper.
4. Safety stocks high
5. Management be done at lower levels..

Class

Number of items

Rupee value in items

10% of total items

70%

20% of total items

20%

70% of total items

10%

FSN Analysis
It is based on rate of consumption.
The items can be classified into:
1. Fast moving
2. Slow moving
3. Non- moving
4. Obsolete
An understanding of the movement of items helps to keep proper levels of
inventories by deciding a rational policy or reordering. This method is based on
the fact that some stock items have a much higher annual usage value than
others. This after doing a cost analysis, stock items are separated into three
classes with the following characteristics
VED ANALYSIS
The stores when subjected to analysis based on their criticality can be classified
into vital, essential and desirable stores. This analysis is termed as VED
analysis.
1. Vital: items without which treatment comes to standstill: i.e. nonavailability can not be tolerated.
2. Essential: items whose non availability can be tolerated for 2-3 days,
because similar or alternative items are available.
3. Desirable: items whose non availability can be tolerated for a long
period. Although the proportion of vital, essential and desirable items
varies from hospital to hospital depending on the type and quantity of

workload, on an average vital items are 10%, essential items are 40% and
desirable items make 50% of total items available.
Although not included in scientific VED analysis, in some public organizations
which are static or inefficiently managed, there is a peculiar category of U
items which can be grouped as unnecessary. These unnecessary items get
purchased due to the following reasons.
a)

Thoughtless continuation of previous purchase.

b)

Indifferent attitude towards hospital formulary

c)

Fear of change

d)

Poor supervision and control

e)

Unfair practice due to vested interest.

The vital items are stocked in abundance; essential items are stocked in
medium amounts, and desirable items we stocked in small amounts.
By stocking the items in order of priority, vital and essential items are
always in stock which means a minimum disruption in the services
offered to the people.

SDE Analysis
Unit value is the basis of this analysis and not the annual consumption
value.
H - Unit value > 1000 (Sanctioned by higher officials)
M - Unit value 100 to 1000
L - Unit value < 100
ABC & VED Analysis (Matrix module: criticality Vs cost)
It is possible to conduct a two dimensional analysis taking into consideration
cost on one hand , i.e. A,B,C categories, and critically VED on the other.
Findings of ABC and VED analysis can be coupled and further grouping can be
done to evolve a priority system of management of stores:
Coupling matrix model

Cat I

Cat II

Cat III

Av

Ae

Bv

Be

Bd

Cv

Ce

Cd

Ad

An example for the coupling matrix model for equipment between criticality
and cost

Defibrillator

X-ray machine

Air- curtains

Ventilator

Electric cautery

Ultrasonic wash
machine
6

Oxygen regulator

Patient trolley

Electronic BP machine

Cell 1 contains vital and high cost items like defibrillator. It must be
noted that a material manager has to comprehensively supervise category
1 items since an item may be a low cost one but critical for patient care.
( oxygen regulator)

Category I items: these items are the most important ones and require
control by the administrator himself.
Category II items: these items are of intermediate importance and should
be under control of the officer in charge of the stores.
Category III items: these items are of least importance which can be left
under the control of the store keeper.

 The grouping will essentially depend upon the strategy of management

and the environment of functioning. However these simple techniques
can be effective in material management system.

Items with high criticality (V), but required in small quantity (A) should
receive highest priority. Items with low criticality (D) and which are
required in big quantity should receive least priority

A thorough understanding and use of the techniques of materials management

would help in ordering the supplies when needed, controlling their use, keeping
them safely and in working order.This also prevents chances of non availability
of equipments and drugs as being out of stock of these reduces the usefulness of
the hospital system.

PLANNING FOR EQUIPMENT & SUPPLY FOR NURSING

CARE; UNIT AND HOSPITAL

Good Ward Management

Good administration aims at seeing that a ward is so arranged and equipped, that
good Nursing is possible. Economy of effort and maintenance facilitated and the
time and energy of personnel is conserved.
-Goddard-

Equipment- It includes many items

Instruments
Suction machine
B.P. apparatus

 E.C.G.
Ventilators
Etc.

Supply- It includes many items

Medication
Gauze
Glove
Grown
I.V. set
Syringe
Catheter
Etc.

Hospital material management side

Perfusion materials
Surgical disposables
Instruments
Drugs, medicine, oxygen, linen
Biomedical equipment
Disinfecting items
Computers, telephone and fax

 Food and beverage materials

Anaesthetic equipment
Electro medical equipment
Glass ware, dental machines
Surgical dressing utensils
Artificial limbs ,bandages, cots for patient, furniture
Engineering items and many others
Computer, fax, telephone, stationary items
Public address items overhead projector
Audiovisual systems

GENERAL UTILITY SERVICES IN THE HOSPITAL

1. Electric supply and installations
A hospital must have a steady electrical supply at a stable voltage. Voltage
fluctuations play havoc with sophisticated electronic equipment, endoscope,
sterilisers, X-ray equipments etc. While planning hospital departments,
provision should be made for voltage stabilisation in areas with heavy
concentration of electrical and electronic equipment. This is preferred over
using voltage stabilisers with individual equipment. There should be an
emergency generator capable of supplying power to all emergency areas of the
hospital. This generator should be of right capacity and kept in working order
by periodic test runs.
2. Water supply

Since safe water supply is not always assured, hospitals must have their own
purification system. Also there should be plumbing system.
3. Disposal of waste liquids and solids.
Disposal of waste both solid and liquid is a totally neglected area. A hospital
incinarator good for the waste management.
4. Refrigeration, air conditioning, ventilation and environment control.
Air conditioning is required for protection of sophisticated electronic
equipment, X ray, machines etc.
5. Transport
Lifts are needed for vertical transport. There should be separate lifts for patients,
visitors, staff and supply. Patients lift should accommodate a standard hospital
bed. Sides of the lift must be protected to prevent damage by trolleys. Lift
surfaces and flooring should be capable of easy cleaning and disinfection.
Ventilation, communication and emergency escape system should be provided
on all lifts. As for horizontal transport also trolleys and ramps with gentle
gradient are useful.
6. Supply of medical gases , compressed air, hot water, vacuum suction
and gas plants
Piped supply of medical gases , compressed air, vacuum suction , hot water,
steam, necessitates thoughtful planning at all stages to consider problems of
Easy uninterrupted safe supply
Fire and explosion hazards
Easy of servicing and maintenance without disrupting hospital
services.
7. Laundry- A hospital laundry has 2 separate areas, with provision for
decontamination and sterilising of soiled linen.
8. Fire hazard- there should be consideration of ventilation, exhaust
systems and adequate earthing of all electrical installation.

9. Communication- public telephone and internal telephones are required

in each hospital.
10.Repairs workshop -There should be provision for repair and
maintenance of necessary equipments used in the hospital .

IMPORTANCE OF EQUIPMENT AND SUPPLIES

1. Smooth running of the ward.

2. To provide quality care.
3. Provide specified materials, drugs and supplies in the required quantity and
quality as and when required.
4. Cut down materials costs through standardization.
5. Develop knowledge and skills of health care.
6. Increase efficiency of health care systems.
7. Teaching.
8. Location of equipments.
9. Emergency care.
10.Identify in service blend.
11.Purchase of new articles.
12.Orientation of staff nurse.

CRITERIA FOR MAINTAINCE OF EQUIPMENT & SUPPLY

1) Maintain should be adequate in amount

It is the responsibility of hospital it providing adequate amount equipment &
supply of proper maintaince of adequate care. If it is not in sufficient amount of
patient make many problem & discomfort.

2) It should be repairedIt is the basic responsibility of CSSSD (Central sterile supply services
department) department that repairing of particular equipment according to the
condition means proper repairing should be essential for proper working condition
& using west time.

3) Supply equipment it should be assess condition

It is basic criteria of maintain equipment & supply in which head nurse
maintain proper record inventory & proper containing of equipment & supply so
she can prevent misuse & prifrage stroke should be keep in the locked.

4) Materials are sometimes inconveniently located

In which responsibility of hospital is this that easily transferable the
equipment & supply 1 unit to another unit for providing basic care to the particular
patient.

CENTRAL STERILE SUPPLY SERVICES DEPARTMENT

(CSSSD)/ (CSSD)

It is the important department the hospital which provides sterile & non
sterile equipment & supply according to the need & requirement of hospital.

Ward sister

Indent

(Inventory)

Verify

CSSSD

Supply

AIMS OF CSSSD

1) Providing sufficient supply & equipment to the particular ward.

2) Purchas efficient number of essential number of essential &
maintain proper quality of equipment & supply.
3) Supplies should be become according to the condition & need of
ward.
4) Proper maintaince & repairing essential proper working of
equipment.
5) New research should be performing for the improvement of
services.
6) Educate nurse & others members about use & misuse.
PRINCIPAL OF CSSSD

1) All material should be asses for sterilization means it require

steribility or not.
2) The workers should know the procedure of sterilization.
3) The system of packing should be very easy & cheeped.

4) It is the responsibility of workers to sterile and non sterile material

should not be keep together.
5) Services should be available round the clock.
AIDS IN KEEPING AN ADEQUATE SUPPLY ON HAND

1. Standard
There are established quantities which are required to meet the
needs of a particular ward or division. For example, a ward may have a
standard of six 2 cc luer syringes which is the number the head nurse should
keep on hand at all times. When one is broken the pieces are exchanged for a
new one if this is the system which exists in the institution. If one is lost, it
should the system which exists in the institution. If one is lost, it should be
replaced, but the total number should not exceed six which is the standard
for her ward.
Standards are determined by-

1. Bed complement for equipment, census for supplies.

2. Type of service- A surgical ward will need more instruments and dressings,
a medical ward more syringes and physical examination equipment.

3. Age of patient- Children need require different types and amounts of

equipment and supplies than adults require.

4. Sex- Men and sometimes require different kinds of equipment.

5. Degree and types of illness- Neurologic patients may require more bedsides,
rubber mattresses, and linen than patients with an other type of illness.

6. Cost of items- A head nurse might have as large a standard of inkwells as

she wishes whereas she probably will be limited to one costly
ophthalmoscope.

7. Durability- Whereas the standard for face basins will be one for every
patients unit, the thermometer standard will be higher since breakage is
inevitable.

8. The period of time between ordering. - Standards for supplies are partially
determined by the necessity to order for a day, a week, or a month.

2.Exchange system

Many hospitals maintain an exchange system for equipment replacement in order to

prevent overstocking or the lowering of equipment standards.
1. The broken equipment is returned before a new article will be issued.
2. The exchange systems help to study the amount and type of breakage or
deterioration.

3. Inventory

An inventory is a detailed list of all articles on the ward, their specifications

and standard number or quantity. The pacification makes it possible to identify the
article by size, number or description. The standard indicates the quantity that
should be kept on the floor.
Frequent counts are an aid in maintaining and tracing equipment. Such
articles as flashlight scissors, needles, hypodermic syringes, stethoscope, and
sphygnornaometers may require a daily count. These items disappear or are articles
easier. Some articles may be counted weekly or monthly. For others such as
furniture, probably an annual or semiannual inventory is sufficient.
The actual count of articles which is made on the wards is known as a
physical inventory.

4. Requisitions:A requisition is a written order for supplies & equipments or for the repair. This
may be the head nurse or some one else specifically delegated the responsibility.

1. Frequency of ordering Hospitals usually designate specific times for

ordering certain types of materials upon the following factors;
1. Their perishbility; Food such as milk, egg, and fruit must be ordered daily.
Sterile supplies which may become outdated are also ordered each day or
every other day.
2. Storage space on the ward
3. Cost & convenience of handling & filling requisitions & of transportation

REQUISITION FORM

Department-

S.NO

Date-

Item

No.

In Words

Signature of the indenter

Signature of the perusalRecommending authoritySignature of the sanctioning authority-

Principles involved in writing requisition

1. To make for accuracy & ease of handling
a. Articles are specified by catalogue no.
b. Amounts are indicated in proper form
c. A separate requisition is made for each department.
2. To ensure proper authorization & reception of articles.

Remark

3. To prevent over ordering & errors in ordering the head nurse is provided
with list of equipments with specifications.

2. Requisitions for exchange items:- articles for exchange may be listed

on the regular requisition from or a special one. Complete specifications are
necessary as with other requisition. Duplicate copies of the order may be
required, one to accompany the articles for exchange, the order to be sent
with the set of requisitions for approval.

3. Requisition for replacement: - To bring up the supply to stand ard or

to increase the standard, requisitions accompanied by a statement explaining
their need may be required.

4. Requisition for repair or constructions:- These are usually written

on a special from and give an exact description of the job to b done.

5. Method of ordering supplies- Before writing the order a systematic

check needs to be made to determine the amounts which are on hand. The
check may be made by an aide or the ward clerk.

DELEGATION OF RESPONSIBILITY FOR THE HANDLING

SUPPLIES & EQUIPMENT

In a busy ward, the head nurse cannot carry responsibility for all details of
ward management. A student nurse may have a short experience in assuming
responsibility for supplies & equipment, usually in connection with her treatment
room assignment.

A non-nurse assistant could relieve the head nurse of the entire responsibility
in this area.
1. Keeping shelves stocked- Any one of these individuals could easily keep a
check on the amounts in cupboards or on shelves ready for use making sure
that there is always enough available.

2. Keeping the treatment room in order- If equipment is sterilized on the ward,

this responsibility as well as task of keeping the treatment room in order and
the cupboards and drawers clean can be specifically delegated to a nurse
with a maid or aide to assist her.

3. Taking inventory- The individual assigned to the task of handling supplies &
equipment may also take the periodic (daily & weekly) counts of equipment
as necessary to keep track of it.

4. Need for a routine Procedure- The only way to ensure the efficient
management of the activities associated with supplies & equipment is to
establish a definite routine & set up specific directions for its
accomplishment.

5. Reporting deficiencies- It should be the function of every individual to

report breakage, equipment which is in need of repair & low stocks of
material.

WASTE & MISUSE

In the hospital so many items become waste & misuse.

WASTE
Material which is not used in proper way or semi use & through.

MIS USE
It is related the using more number of items comparison requirement.
uirment.

Following Items Are Mostly Becomes Waste & Mis Use in the Hospitals

1. FOODS- It is mainly mis use by the patient by taking more than

requirement.
2. MEDICATIONS- Many type of medications are become waste after expiry
date.
3. RUBBER WOODS- Many types of rubber wood are catheter, gloves,
syringe, and N.G. tube are waste & misuse in the hospital.
4. GLASS- The mostly misuse & waste become o syringe & specimen bottle.

CRITERIA FOR PREVENTION TO MISUSE & PILFERAGE

These are following criteria use by hospital to prevent on misuse & pilferage.

1. Keep stock in locked- It is the responsibility to head nurse that all equipment
on supply are keep in locked for prevention for misuse & pilferage.

2. Maintain inventory- It is the list of present items in the particular ward it is

completed by the head nurse. It helps to prevent from misuse & pilferage.

3. Keep authority on his own hand- It is the responsibility of head nurse that
keep what authority on his own hand means subordinates are not having any
type of authority.

4. Maintain of record of used- it is related the maintaince of record about use

equipment & supply in the particular ward which is done by head nurse.

5. Delegation of responsibility about use- It is the responsibility of sister in

charge she should give working responsibility to particular person who is
having special knowledge about so the misuse & pilferage can be prevented.

6. Keep stock according to the requirement- It is the responsibility of head

nurse she should keep stock according to the requirement of particular ward.
If it is more than requirement so more changes of misuse & pilferage.

7. Punishment for misuse & pilferage-In the hospital it is basic requirement

that punishment is given to the person who do misuse & pilferage of
equipment & supply. This punishment should be given by the head nurse.

EQUIPMENT CONDEMNATION AND DISPOSAL

The life cycle of equipment is fairly simple, but one process that seems to
cause problems is deciding when to condemn and how to dispose of equipment.
When looking at condemnation and disposal, the engineer in charge of the
department should have the experience, knowledge, and authority to decide
when a piece of equipment should be scrapped and removed from use.
The reasons for condemning equipment will usually be:
Beyond economical repair - Where equipment comes in and the cost of
repairing it is considered too high after looking at the current value
(taking depreciation into account), and the age of the equipment.
Technically obsolete - Parts and service support are no longer available.
Clinically obsolete - The clinician using the device (or manufacturer)
recommend replacement for clinical reasons. (Diagnostic ultrasound
imaging usually becomes clinically obsolete after 5 years due to the rapid
improvements in imaging technology, but can still be used and supported
by the supplier.)
Equipment that has been damaged by contamination.
The information supplied to the user must include the date of condemnation,
whom the equipment belongs to and who authorized the condemnation. This
would usually be the EBME Manager on a condemnation form.

When sending out the notification of condemnation copies should be sent to

senior managers responsible for procurement, and users of the equipment. An
equipment condemning note/memo should be individually numbered and
logged onto the equipment database with an individual job number, equipment
description, including the make, model, serial number, control (asset) number,
purchase date (age), reason for condemning and any additional information.
You should also state the equipment location (Dept / Ward) and at which
Hospital.
If the manager/user requires further information, contact details must be added,
such as your telephone, e-mail, fax, etc.
Finally, the EBME manager should sign off the condemnation letter.
If a replacement is required the cost for new equipment needs to be included in
the capital bids processes (where the equipment is over 5000) giving financial
priority to the most urgent purchase based on need and risk.
A record of all condemnations should be kept on the database.

DISPOSAL
Once the equipment has been condemned it should be quarantined or thrown
away.
To quarantine the equipment means removing it from clinical use and putting it
somewhere it cannot be used which is allocated as an area for scrapped
equipment.
There may be an alternative use for this equipment:
Third world charity
Research project
Training
Sold on to vetinary practice, etc.

If there is an alternative use, the equipment may be held in the quarantine area
until it can be handed over. Whoever takes the equipment must sign a form
agreeing that the equipment is 'taken as seen'. All service and inventory labels
must be removed, and all patient information deleted (where the device has IT
storage capability)
The equipment that cannot be found an alternative use must be disposed of
safely. This will usually include:
Removal of lead acid, Nickel Cadmium or other alkaline batteries for
separate disposal in line with trust policies.
Evacuation of Cathode ray tubes to prevent the risk of implosion (Usually
by breaking off the nipple at the back of the tube).
Removal of in line fuses.
Cleaning and decontamination.
Removal of all means to power up the device. (i.e. On hard wired devices
the mains cable should be cut off.)
Removal of all hoses able to pressurize a device (if driven by gases)
Once these precautions have been taken, the equipment may be thrown in the
skip to be taken to the local landfill site, or incinerated where appropriate.

Date:
From: EBME DEPT
To:

WARD MANAGER

Copies to:
_______________________________________________________________________
EQUIPMENT CONDEMNING NOTE No:........... /.....................
Job no:

.....................................................................................

Equipment Description:

.......................................................................................

Make:

.......................................................................................

Model:

.......................................................................................

Serial No:

.......................................................................................

EBME control no:

.......................................................................................

Purchase Date:

.......................................................................................

Reason for condemning

.......................................................................................

...........................................................................................................................................
Additional Information:

....................................................................................................

...........................................................................................................................................
The equipment located in the ................................Dept / Ward
at.................................... Hospital should be replaced.
If you require further information please contact: Ext.
Signed ..........................................EBME MANAGER
_____________________________________________________________________________
Replacement Cost..............................

Priority.....................................

Replacement Order No: .....................

Supplier..................................

Model No: ...........................................

Serial No: ................................

Date commissioned.........................................

NURSING IMPLICATIONS:
a) Obtaining the best value for hospitals expenses
The money spend by the hospital on tax payers,patients and stake
holders money is used to obtain the greatest value in return.The
length of the life and usefulness of material determine what are the
best investment.
Eg. Hospital linen should endure many washing and tensile
strength is an important consideration while purchasing
sheet,pillow covers and towels
b) Maintaining adequate supply
Hospital should keep adequate supply of material in hand at all
times ordering large quantities and overstocking cheaper goods are
avoided.The 6 months supply should be kept in mind

c) Records of amount on hand:

Hospital should maintain inventory to check record of material in
hand and actual counting is taken periodically to correct error

Relationship of supplies and equipment to good ward management:

Supplies that are expendable attains those articles which are used
for day to day purpose.Eg: Stationery,food items,Sterile
goods,equipments,soap,linen,furniture,instruments,syringes etc
Supplies and equipments are important contributing factors for smooth
running of ward.Careless work frequently results in lack of material due
to costs or inavailability
If supply of material is inadequate care is neglected.
Eg. Insufficient use of thermometer leads to improper sterilisation,delay
in treatment.Patients comfort and welfare are greatly influenced by
adequacy of supplies.If equipments are not ready for use ,it puts the
personnel not only into an embarrassing situation but wastage of time and

careless attitude. If the supplies and equipments are difficult to procure

then its essential to lock the excess supplies to prevent loss with it
accessible only to the nurse In charge.Keep a small supply freely
accessible to prevent wastage of time
Location of material:
It is necessary to keep the supplies available at one place and the
equipments should be available at one place in all the units.So preferably
while designing the hospitals all the wards should be architecturely
similar.It will allow the nurse to easily
locate the equipments and supplies in any ward
HEAD NURSE: ROLE IN MATERIAL MANAGEMENT RELATED TO
SUPPLIES AND EQUIPMENTS

Following responsibility are having to maintenance equipment & supply

1) Ensuring regular and adequate flow of supply of necessary equipment, supplies,

drugs and solutions.
2) Monitoring and sustaining the quality and safety of the materials used including
drugs and solutions. Issuing of items on the basis of First in First out and
regular checking of expiry dates of drugs contribute, towards safety.
3) Indenting, receiving, storing, checking and timely replenishing of all necessary
equipment, supplies, drugs and solutions.
4) Maintaining of emergency and buffer stocks
5) Arranging for preventive maintenance wherever necessary
6) Maintaining inventory and stock of all items and supplies
7) Arranging for condemnation of articles in accordance with the laid down policies
of the organization and maintaining of a dead stock register
8) Arranging and assisting in audit of materials.
9) Participation in policy making for material management

10)

Participation in tender / procurement sub-committees

11)

Orienting Nursing personnel on material management policies from time to

time.
12)

Evaluating the efficacy of the material management system followed in

particular Nursing unit.

13)

Maintain of proper record about sister.

14)

Delegate the responsibility about proper use equipment & supply to well

known person.
15)

Observe the misuse & prifrage.

16)

Educate the nurses, doctors & others persons about use of equipment &

supply.

CONCLUSION:
Materials management today is a distinct area of industrial management and
plays a vital role in production and productivity. This concept aims at cost
reduction, as a result of integrated approach towards the management of
materials at all stages viz., planning, purchasing, receiving, stocking and
disposal.
Materials management is concerned with the planning and programming of
materials and equipments, market research for purchase, pre-design value
analysis, procurement of all materials including capital goods, raw materials,
components and assembles, finished material, packaging and packing of
material, inventory control etc.
Materials management is a body of knowledge which helps the manager to
improve the productivity of capital by reducing materials costs, preventing large
amounts of capital being locked up for long periods

Economic Analysis of Linking Operating Room Scheduling and Hospital

Material Management Information Systems for Just-in-Time Inventory
Control
1. Richard H. Epstein, MD* and
2. Franklin Dexter, MD, PhD
+ Author Affiliations
1.
2. *Department of Anesthesiology, Jefferson Medical College, Philadelphia,
Pennsylvania; and
3. Department of Anesthesia, University of Iowa, Iowa City, Iowa

Abstract
Operating room (OR) scheduling information systems can decrease
perioperative labor costs. Material management information systems can
decrease perioperative inventory costs. We used computer simulation to
investigate whether using the OR schedule to trigger purchasing of
perioperative supplies is likely to further decrease perioperative inventory costs,
as compared with using sophisticated, stand-alone material management
inventory control. Although we designed the simulations to favor financially
linking the information systems, we found that this strategy would be expected
to decrease inventory costs substantively only for items of high price ($1000
each) and volume (>1000 used each year). Because expensive items typically
have different models and sizes, each of which is used by a hospital less often
than this, for almost all items there will be no benefit to making daily
adjustments to the order volume based on booked cases. We conclude that, in a
hospital with a sophisticated material management information system, OR
managers will probably achieve greater cost reductions from focusing on
negotiating less expensive purchase prices for items than on trying to link the
OR information system with the hospitals material management information
system to achieve just-in-time inventory control.
Abstract

Implications: In a hospital with a sophisticated material management

information system, operating room managers will probably achieve greater
cost reductions from focusing on negotiating less expensive purchase prices for
items than on trying to link the operating room information system with the
hospitals material management information system to achieve just-in-time
inventory control.
Footnotes
FD is employed by the University of Iowa, in part as a consultant to
anesthesia groups, companies, and hospitals.

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